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Headaches
Headaches come many varieties, of all severities and have multiple causes. Commonly people call any severe headache a "migraine headache." That can be confusing and the following short description will attempt to differentiate for you. As in all of medicine, making the proper diagnosis is essential - because treatment usually directly follows the diagnosis.
- Tension or Muscle Contraction Headaches: Many people have these - and they are often trivialized inappropriately. They result from muscles in the upper back and neck contracting and pulling on the back of the head. There is a skullcap of connective tissue that is pulled, and at first the headache is located on the back of the head, but the connective tissue transfers the forces to the temples, behind the eyes, and even the top of the head. They can be either mild - or extremely severe and incapacitating. Obviously people under stress can develop them, or people who hit their head on a cupboard door. The most troublesome usually originate as an irritation of the suprascapular nerve - a major nerve passing over the top of the scapula (the "wing" in back) and providing motor control to the muscles of the upper back/neck. Treatment involves teaching you exercises to treat yourself, performing nerve blocks on the suprascapular nerve is often dramatic, simple or more powerful medications, massage, and acupuncture.
- Migraine Headaches: Migraine headache is not a diagnosis - rather a common symptom caused by a number of other conditions (a syndrome.) This should be evident when you realize that for genuine migraine headaches, in some people caffeine is a trigger and causes the headache and in others the caffeine clears the headache. That demonstrates 2 different disease processes.
The common pathway is that arteries in the brain contract and then expand. When they expand, they stretch the lining of those arteries - which contain the only sensory nerves within the brain. Stretched nerves are sensitive - and usually give pain with every heartbeat. Symptoms vary depending on what part of the brain is deprived of normal blood supply. "Optic migraine" is a special case where persons afflicted may have vision disturbance - such as going blind in portion of the visual field temporarily without necessarily even having a headache.
Following the concept that there are a number of different causes for migraines, it follows that there are a number of medications specific for each cause. For women having migraines associated with their menstrual period (or ovulation) obviously hormonal manipulation either with medications or acupuncture is very effective. However, there are also acupuncture techniques which can be very helpful in other cases of migraine. It is easiest to treat very frequent or daily headaches. Then you can find out quickly which treatment works and go on to increase the period of relief with that treatment. (Acupuncture tends to have geometrically longer periods of relief with the same treatment.)
- Compound Headaches: have combinations of muscle contraction and migraine headache
- Sinus headache: Another often trivialized category. These result from fluid build up - usually caused by infection. The frontal (forehead), maxillary (level with nose, under eye) and ethmoid sinuses (Behind bridge of nose) and all be involved.
A special case is the sphenoid sinus which shows up as a top of the head headache. Supportive care can help symptoms, but usually antibiotics are needed.
- Trigeminal neuralgia or "Tic Doloreaux" involves irritation of the 5th cranial nerve. Typically it is a VERY severe headache in part of the distribution of the 5th cranial nerve that comes on suddenly and leaves suddenly. Amongst afflicted persons, the incidence of suicide is increased because the pain is so severe and comes frequently and unexpectedly. Recently, neurosurgeons have had success in some persons by enlarging the opening through the skull in which the trigeminal nerve passes. I have had success by blocking the trigeminal nerve.
- "Atypical" headaches. There are a sizeable number of these which have specific treatments which follow the specific diagnosis.
- A discussion of headache would be incomplete without mentioning meningitis, ruptured aneurism, and brain tumor. In general, a brain tumor can manifest as a headache. The headache contiuously gets worse. Today it is worse than yesterday and tomorrow it is still worse
- Ruptured aneurism and meningitis typically have rapid onset and represent the most severe HA you have ever had. With meningitis, expect a fever. In both cases, moving the head forward and backward (touching chin to chest and then the ceiling) makes the headache worse. If you have this situation, you need to be seen by a physician NOW and the appropriate treatment started. (antibiotics or neurosurgery.)
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