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- Herausgeber: Geddes and Grosset
- Kategorie: Ratgeber
- Sprache: Englisch
A guide to headaches and migraines. It provides descriptions of mild and severe headaches, with symptoms, causes and treatments for the main types of headaches. With advice, treatment and prevention guidelines.
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Veröffentlichungsjahr: 2015
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CONTENTS
CoverTitle pageMedical AdvicePart OneHEADACHES AND MIGRAINES: SYMPTOMS, CAUSES AND TREATMENTChapter 1INTRODUCTIONChapter 2DEFINITIONS AND TERMS: HEADACHE OR MIGRAINE?Part One
HEADACHES AND MIGRAINES: SYMPTOMS, CAUSES AND TREATMENT
Chapter 1
INTRODUCTION
The experience of headache is universal among human beings, affecting people of both sexes from infancy until old age. It is also fascinating to note that scientists increasingly believe that other mammalian species have headaches as well. In people, some types of headache show a gender bias and it is also the case that the type of headache to which a person is subject tends to change with aging. Additionally, an individual may experience more than one type of headache during any particular time period. Hence a person who commonly has migraines may occasionally experience a headache of a different type.Although around 150 different causes for headaches have been identified, doctors recognise relatively few types and these are the ones that most commonly affect the majority of people. Categorising headaches has always proved problematic and this is reflected in the fact that there is a degree of overlap between the medical terms and definitions used to describe them.
The experience of headache varies greatly, not only between individuals but also in the same person. It is possible for an individual to have an intense and painful headache on one occasion and one that is hardly noticeable the next time it occurs. Some people experience headaches at night while others have headaches that are linked to already existing conditions such as thyroid disorders. Sometimes headaches are experienced in conjunction with other disorders such as epilepsy or because of actual injuries to the head.
It is acknowledged that there is a strong psychological component both in the generation and experience of certain types of headache but this is certainly not the same as saying that headaches are ‘all in the mind’. However, the fact that this is the case means that there is a role not only for orthodox medicine but also for complementary therapies in the treatment, management and prevention of headaches and migraines and many of these are explored in part two of this book.
It is hoped that this guide will prove helpful not only to those who are often afflicted by headaches or migraines but also to those who simply wish to learn a little more. While every attempt has been made to provide accurate information, this book should not be used for self-diagnosis or treatment. As with all aspects of health, if you are experiencing headaches on a regular basis or are worried or concerned about your symptoms, it is always best to seek medical advice.
Chapter 2
DEFINITIONS AND TERMS: HEADACHE OR MIGRAINE?
Primary and secondary headaches
The generally accepted guidelines for the classification of headaches have been devised by an organisation called the International Headache Society. However, these criteria may not always be rigidly followed and may be open to differing interpretations and application by individual doctors.The simplest and most basic classification of headaches defines them as either primary or secondary. Primary headaches arise spontaneously and they are by far the most common group, accounting for around 90% of all cases. Secondary headaches occur as a symptom of another underlying disorder or illness and since only about 10% of all cases fall into this category, they are evidently uncommon. However, although it is rare for any particular instance of a headache to be caused by a serious medical condition, with fewer than 5% of people who seek medical advice for headaches having any form of serious disorder as the cause of their symptoms, it is perhaps more helpful to clarify this a little by saying that with feverish, viral infections, such as the common cold or flu, a secondary headache is a frequent accompanying symptom and most people will experience this at some stage or another in their lifetime.
Acute and chronic headaches
Other terms that are commonly used to categorise headaches are acute (also, acute single or episodic) and chronic (also, chronicdaily or recurrent). Difficulties arise with the use of all these terms, which can perhaps be most usefully thought of as a sort of sliding scale of definition.An acute headache is one that arises as a single, one-off event or, at least, occurs rarely and in isolation over a generally lengthy time period. Hence a secondary headache of an unusual cause could be described as acute but equally, so can the very first experience of a primary headache that a person has, commonly during childhood.
Chronic headaches are strictly defined as ones that occur on at least 15 days of each month for a minimum period of 6 months. However, it is apparent that an over-rigid application of this definition might not always prove to be useful. Common sense suggests that anyone afflicted by headaches on a regular basis should be called a chronic sufferer, whether or not they fulfil these strict time criteria. Finally, the category of chronic daily headaches can be applied to any of the three types of headache described below, if these are occurring on at least 15 days of each month for 6 months or longer.
Types of primary headache
All the terms outlined above are fairly general in their application but the three main types of headache recognised by doctors are more tightly and specifically defined. All of them are primary in nature and they may be either acute or chronic, according to the frequency of their occurrence. However, it is probably safe to assert that if a headache of any type has become significant enough to be regarded as a problem then it is likely that it is happening on a regular basis, even though it may not be frequent enough to be classed as chronic according to the strict definition.The three types of commonly occurring, primary headache, each of which is defined by a fairly specific set of symptoms are called tension headaches, cluster headaches and migraineheadaches and these are considered in greater detail below.
Chapter 3
TENSION HEADACHES
What is a tension headache?
Tension headaches are the most frequently occurring type of primary headache, accounting for 70% of all instances and commonly experienced by most people at some stage in life. They may be given the alternative names of stress headaches or muscular headaches, and they can affect people of both sexes at any age, although they are less likely to arise in pre-adolescent children. This type of headache is associated with contraction (tension) of the muscles in the upper back and neck and produces a mild to moderate, generalised pain, rather than one which is localised at a particular point. It is common for the pain to be experienced as pressure around the circumference of the head, as though a band was being gradually tightened and the head squeezed. However, sometimes the pain is felt more at the back of the head and the person can be very much aware of the contraction and tightness of the neck muscles. The pain is constant rather than throbbing, although it may begin as mild discomfort and build gradually over several hours to a greater level of intensity. It is not made significantly worse by ordinary movements or routine physical activity although it may be exacerbated by intense levels of exercise. There is no accompanying nausea or vomiting and neither is there any heightened sensitivity to noise or light.A tension headache usually occurs during the normal round of daily activity but exhaustion and worry can trigger a headache while you sleep or it may be present on first waking up in the morning. The pain is usually short-lived, lasting at most for a day, and is generally effectively relieved by common, over-the-counter analgesic medication.
Causes
Many people experience a tension headache at least once or twice a month while for others its occurrence is a rare event. It is not normally necessary to consult a doctor for an occasional occurrence of tension headache and there is nothing to be gained by doing so. It may or may not be possible to identify the cause or triggering factor for one particular headache and the person affected is best qualified to be the judge of this, rather than a doctor. The only useful purpose served is if it then becomes possible to avoid the trigger in the future and so hopefully avert a recurrence of the pain. For example, holding a phone between your ear and shoulder when busy at work can cause a tension headache and once identified as a trigger, it is easy enough to stop doing this. However, identifying the cause of a tension headache remains highly problematic for most people. This is because the most common cause or trigger of this type of headache is the kind of stress and anxiety that are practically universal in everyday life. These psychological factors, together with the internal biochemical changes that they provoke, are all held to play a part in the generation of a tension headache.Even the most relaxed, unflurried person who believes himself to be impervious to stress will occasionally experience a tension headache. Equally, one individual’s ability to cope with stress varies from one episode to another and hence, perhaps, the likelihood of experiencing a headache on any particular occasion. Although it is practically impossible to entirely avoid the stresses that may lead to a headache, there are ways to lessen or mitigate both the emotional and physical effects, such as the tightening of muscles. Many of the complementary therapies described later in Part Two of this book work precisely in this way. They are helpful in counteracting the effects of stress and as well as being of great use in this regard they also indirectly help to relieve headache pain itself.
Although it is often difficult to pinpoint the exact cause of any particular headache, certain other predisposing factors in addition to stress are recognised. Of these, two have been identified as important in relation to tension headaches: eye-strain and poorposture.
Eye-strain
Eye-strain is one well-known factor and in this context, it is usually refers to a struggle to read but could, of course, equally be connected with any close, concentrated work such as sewing or art and craft. It is surprisingly common for people to strain their eyes in this way, perhaps because they have not needed assistance in the past and simply do not realise that they now require reading glasses. Also, among those who do already wear glasses, it is common to fail to notice that the eyes have changed and that another check-up and new prescription is overdue.It is recommended that all adults should have an eye test every three years and this is provided as a free service on the NHS. An eye test becomes increasingly important with age, since the close examination of the back of the eyes can diagnose other problems, such as glaucoma and hypertension, as well as identifying the gradual changes in focusing ability that naturally take place over time. At all ages in life, it is important to ensure that reading or close work is carried out in good light. Squinting or ‘screwing up’ the eyes causes contraction both of the brow muscles (hence frowning) and those of the scalp, and this tension can easily be relayed to the neck and upper spine. It can readily be appreciated how all this favours the production of a headache.
Eye-strain is not just confined to problems with reading the printed word but has become increasingly recognised as a risk connected with the widespread use of computer monitors and, perhaps, with mobile phones.
Poor posture
A further, well-recognised, predisposing factor is poor posture and this is something that may begin as early as adolescence. It is easy to understand how a rounding of the upper back and shoulders, coupled with incorrect head carriage, can result in tension in the muscles of the neck and upper spine. Postural problems have been particularly recognised as a risk factor for white collar, sedentary office workers – those who sit behind desks all day, increasingly, in recent years, using computers. Evidently in these circumstances, a combination of eye-strain and incorrect posture might be the cause of tension headaches.A great deal of time and effort has been put into the design and production of office chairs that support the back and promote correct posture and these are now widely available. Also, the Health and Safety Executive (HSE) produce mandatory guidelines for employers aimed at safeguarding the health of office workers and these include regulations on the maximum length of time that should be spent in front of computer screens and the provision of eye tests.
Treatment
Tension headaches can usually be effectively treated by taking common, over-the-counter, pain-relieving remedies such as paracetamol, aspirin or ibuprofen. Codeine should be used with caution as overuse of this medicine can, in itself, be the cause of headaches. It is best to take the recommended dose as soon as the headache starts and possibly repeat the dose four hours later, should this prove to be necessary. Other simple measures may also be helpful, depending upon the severity of the headache. These include rest, relaxation and sleep, the application of a cold flannel to the forehead and gentle massage of the muscles of the neck, shoulders and scalp.Prevention
It is probably impossible to entirely prevent the occurrence of tension headaches but for frequent sufferers, there are various strategies that can be tried. These include keeping a headache diary, which may help to pinpoint any common patterns or triggers in the occurrence of the headaches. If triggers can be identified then it is hopefully possible to either avoid them or at least reduce one’s exposure. Relaxation techniques, such as breathing exercises and other complementary therapies (seePart Two of the book), are helpful both for prevention and treatment. Taking regular, daily exercise and allowing sufficient time for sleep have both been identified as important. Exercise helps to reduce stress and depression, both of which are common causes of headaches. Tiredness is frequently implicated in the generation of headaches and sometimes all that is needed is an adjustment to your daily routine and recognition of the importance of a good night’s sleep.Chapter 4
CLUSTER HEADACHES
(Alternative names: Alarm clock headache, suicide headache, Horton’s headache, histamine headache, ciliary neuralgia, petrosal neuralgia, hemicranial neuralgiformis chronica, erythroprosopalgia of Bing, migrainous neuralgia)What are cluster headaches?
Cluster headaches are a highly distinctive type of headache when compared to either tension headaches or migraines. Although their existence has been recognised medically for over a century, they remain commonly misdiagnosed and consequently sometimes inadequately managed and treated. This is despite the fact that the pain involved is widely acknowledged to be both excruciating and highly disabling for sufferers of the condition. Most of those affected describe the pain as the worst that they have ever experienced or could imagine experiencing while women commonly claim that it is far more severe than the pain of childbirth. Given these facts, it is fortunate that cluster headaches are classed as rare although estimates of how many people are affected vary considerably.While cluster headaches can occur at any age, they usually arise initially in adults between 20 and 40 years old and they are not thought to affect children. The incidence in the UK may be anything between 56 to 279 people in every 100,000 and the condition is 4 to 5 times more likely to affect men. Overall, there may be between 34,000 and 150,000 sufferers of the condition in the whole of the UK.
Cluster headaches are so named because they most usually occur in bouts, arising frequently during a specific time period, termed the cluster period. This is followed by a length of time when the person is headache-free, termed the remission period. This typical pattern is sometimes given the title episodic clusterheadaches and it is by far the most common manifestation of the disorder.
Within this overall pattern, other trends are normally present. Firstly, the headaches typically begin at the same time each day, commonly during the period of night-time sleep (hence, alarm clock headache). Very often, the person is awakened by the headache about an hour and a half after first falling asleep, during the phase of rapid eye movement (REM) sleep that is recognised by specialists. Individuals who experience night-time cluster headaches or who have a cluster headache on awakening may also be suffering from sleep apnea (when a person temporarily stops breathing) which tends to intensify cluster headaches. Many may not be aware that they have this condition and so do not seek any help for the problem. Secondly, the active cluster period is normally seasonal, occurring at the same time of year and often during the spring or autumn. A further characteristic is that the headaches are one-sided and during any particular cluster period, they rarely change sides.
Individual headaches usually occur rapidly, coming on within about 10 minutes, generally without prior warning. They typically last for anything between half an hour to 3 hours but most commonly, for 20 minutes to 90 minutes. Headaches may occur once every 2 days or far more frequently, up to 8 or more times each day.
The precise cause of cluster headaches remains unknown but research has revealed some interesting clues. It has been established that a region of the brain called the hypothalamus is activated ipsilaterally (on one side) during an attack and this area has direct connections with both the trigeminal nerve and cranial parasympathetic nerves. Hence it is believed that a dysfunction within the hypothalamus starts off the chain of events that leads to the generation of cluster headaches. When this occurs, there is a release of neurotransmitters (naturally occurring biochemical substances involved in the transmission of electrical impulses), resulting in stimulation of the trigeminal nerve and parasympathetic nerve network, along with dilation of cranial blood vessels. Treatment for cluster headaches operates on two fronts: firstly, to abort or relieve a headache that has started; and secondly, to prevent the headaches from occurring. In practice, there is a considerable degree of overlap between these two approaches, and the use of some drugs is restricted to one or other of the particular forms of cluster headaches. With regard to treatment, it is the case that the ordinary, pain-relieving medications in common use are entirely ineffective. The prescription-only drugs that are used for the prevention and treatment of cluster headaches are not analgesics but work in an entirely different way. Preventative or prophylactic preparations are also prescribed for use during a cluster period in the episodic form of the condition. Ergotamine is used in this way and it is commonly taken at bedtime before the person goes to sleep, or an hour or two before the expected time of onset of a headache.
