Headaches

The most common pain experienced in the US is headache pain.  Most headaches are benign tension type headaches, but there are many other types described below.

Tension Type Headaches  Each year, 74% of the population develops these headaches.  These headaches are a pressure or tightness in quality, are not worsened with activity, and occur on both sides.  There is usually no nausea or vomiting, or light sensitivity.  Female:male 1.4:1

Migraine Headaches  These are usually one sided headaches that may have an aura (wavy lines in vision, etc).  They are pulsating headaches, moderate to severe, lasting 4-72 hours, aggrevated by walking stairs, accompanied by light sensitivity, nausea, and sometimes vomiting.  Each year, 10% of the population experiences these headaches.  Women:men ratio is 3:1 and there is a great increase in migraines 2 days before and 5 days after the beginning of the menstrual period.

Medication Withdrawal or Rebound Headaches  If headaches are treated frequently with medications, the lack of these same medications will trigger the headache.  Daily acetaminophen (Tylenol) will trigger headaches if drug is stopped.  Similarly, potent narcotics may trigger migraines and other types of headaches if taken more often than three times a week.  Frequent use of Immitrex or other drugs in the same class will trigger migraines if taken too frequently.  Many patients do not realize they are perpetuating their own headaches by taking medications for most headache occurrences.  Occasional medication use works best for headache treatment.

Cluster Headaches  Occurring in a 4:1 male:female ratio, these headaches are present in 0.07% of the population each year.  They are one sided, severe intense one sided headaches, often over or behind one eye, last 15-180 minutes, and are characterized as so intense the patient paces incessantly or bangs his head against the wall. Other characteristics include a red eye (conjunctiva), small pupil, excessive tearing from the affected side, facial sweating, droopy lower eyelid, and nasal stuffiness.  Most of these patients are smokers, many of the attacks occur at night, and there may be several attacks per day.  Alcohol triggers these headaches.

Post Traumatic Headaches  These are common after automobile accidents, may be acute or chronic, are not related to brain injury, and may actually be continuation or worsening of other types of headaches already present. 

Cervicogenic Headaches  One sided head pain, usually beginning in the back of the head and radiating forward, produced by abnormal positions of the neck or by pressure at specific points on the neck are the characteristics of cervicogenic headache pain.

 Brain Tumors  Approximately half the patients with brain tumors will have headaches, but percentage wise, these are a very very tiny fraction of all types of headaches.  Three quarters will have both sided front headaches while one quarter will have one sided headaches.  Almost always, these headaches represent either a new onset of headaches never before seen in the patient or a significant perceptible change in the type or intensity of headaches.  Seven out of eight with brain tumors will have papilledema (swelling of the optic nerve in the eye), one sided paralysis, or seizures.

Sinus Headaches  These are much less common than generally thought.  A true sinus headache is in the front of the face or above the eyes (deep sinuses may refer pain to the head), worsened by bending over forward and by coughing, is associated with a fever, cough, drainage, sore throat.  Many patients assume that because they have had sinus problems in the past, tension type headaches are mistaken for sinus headaches.  Treatment of these headaches with antihistamines and nasal sprays cause rebound pain from swelling of the nasal mucosa.

Sexual Induced Headaches  Masturbation or intercourse may induce a mild headache that disappears usually within one hour afterwards.  However, there is an explosive type of sexually induced headache that is severe, located in the back of the head, and persists from hours to several days.  Exertion or repeated sexual intercourse within a few day period can trigger the headache once again.

Post Dural Puncture Headaches  Following a spinal block or spinal tap or epidural catheter placement with aberrant needle or catheter placement a positional post dural puncture headache results.  This headache almost goes completely away upon lying down flat while standing brings on the headache immediately.  This is due to continued leakage of spinal fluid. 

 

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