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Headache & its Management

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Headache and its management

Headache is a widespread health condition that attacks adults several times in their lifetime. Pain could be throbbing, sharp, constant, or dull.

The most common types of headaches are:

Sinus headache

Migraine headache

Cluster headache

Tension headache

Sinus headache

Presents with deep and constant pain around the eyes, cheeks, and forehead primarily due to infection in the sinuses and usually lasts for two weeks. It is due to inflammation in the sinus’s air-filled spaces. Sinuses are in the forehead, cheekbone, and behind the bridge of your nose. Due to infection, they make more mucus, and the channels that drain the sinuses get blocked, causing the headache. Nonpharmaceutical interventions such as warm compresses to the face area or a vaporizer or steam inhaling to relieve the sinus congestion. OTC pain killers are prescribed to alleviate the pain and antihistamines, mucolytics (medications that clear the mucus), and decongestants. In case of infection, antibiotics (if the causative agent is bacteria) are indicated.

Migraine

Migraine is another type of headache-causing severe throbbing pain, usually unilateral (on one side of the face) and usually associated with vomiting and light sensitivity.

Symptoms of migraine headache include flashing light, tingling sensation, sensitivity to light, blurred vision, and in some instances, vomiting. Migraines can start at any age, but most commonly, after 30 years. Genetic factors have a role.

Clinically, four stages characterize a migraine attack. 

1. Prodrome

2. Aura

3. Attack

4. Postdrome

Usually, migraine pain is self-limiting, but medical care is indicated if it lasts for more than 24 hours or is associated with nausea and vomiting, leading to dehydration.

Managing migraine headaches includes over the counter (OTC) pain killers like acetaminophen, aspirin, caffeine, and ibuprofen used for instant pain relief. In addition, rest helps in migraine headache relief.

Cluster headache

Cluster headache is one of the most painful types of headaches that occurs in cyclical patterns and develops very severe pain, commonly awakens the patient from sleep. Cluster headache is of neurologic origin and is characterized by quick onset, reaching full potency within 10 to 15 minutes, Sharp and burning in nature, unilateral during one single cycle and stays on one side, and rarely switches to the other side, of short duration lasting from 30 minutes to 3 hours, and recurring several times per day, and cycles can range from 2 weeks to 3 months. Symptoms might start with a tingling pain-like sensation, and at a later stage, severe pain behind or around one eye and might radiate to other regions of the face, head, and neck. Then, uneven torment, restlessness, excessive tearing, redness of the eye, forehead, facial sweat of the affected side, pale skin or flushing all over, swelling around the affected eye with eyelid drooping.

Management of cluster headaches includes using lidocaine in the form of nasal spray. In some instances, oxygen therapy (100% inhalation) for 15 to 20 minutes might reduce the severity of the pain. In addition, triptans and DHE(45)  might be prescribed.

Tension headache

Tension headache is the most prevalent type of headache. More than 90% of the adult population experience this type of headache at least once in a lifetime, characterized by mild to moderate pain around the eyes, head, neck, and tightness in the forehead. There are two types of tension headaches, episodic and chronic, classified based on their frequency of occurrence. Episodic tension headaches are less frequent and occur less than ten times a month, while chronic tension headaches occur more frequently, with 15 to 20 episodes per month. Triggers of tension headaches include poor posture, not enough sleep, mental or emotional stress, overuse of alcohol or caffeine, smoking, or dehydration. Therefore, management of tension headaches should include lifestyle modification. Symptomatic relief includes the use of OTC pain killers like acetaminophen, aspirin, caffeine, and ibuprofen.

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