Types of Headaches and Treatment Options

What Type of Headaches Are You Experiencing?

The causes for migraines and headaches is not well known. Research suggests that the pain is due to inflammation, the trigeminal nerve, blood vessels surrounding the brain, and Serotonin levels. This article will give you more information about headaches and treatment options.

Tension Type Headaches

This is the most common type of headache with the clinical features as:

Constant pain spreading all over the skull
Pain radiating forward from the occipital region
Feeling ‘dull’, ‘tight’ or like pressure.
Sometimes, continuous pain for weeks without interruption
The severity of pain varies individually.
There is no photophobia.
No complaint of vomiting
Pain increases as the day goes on.

Diagnosis

Diagnosis of tension headache is mainly clinical. Your doctor can diagnose your headache from a description of your pain. Therefore, never forget to include all the details, such as pain characteristics, pain intensity, pain site, etc. In most cases, your physician will diagnose tension headache based upon the above clinical feature. However, he may run some imaging tests in certain cases to rule out an underlying serious problem.

Following are the most important imaging tests in this regards:

MRI (Magnetic Resonance Imaging) Brain
CT (Computed Tomography) Scan Brain

Management

Management of this type of pain is mainly based on discussion with patients about the causes of this type of disease and the explanation that this is not a serious disease.

Many medications both OTC and prescription, are available to reduce the cluster headache, including:

Pain relievers: Simple over-the-counter (OTC) pain relievers are the first line of treatment for tension headache. These OTC medications include aspirin, naproxen, and ibuprofen.
Prescribed drugs for tension headaches include naproxen, ketorolac and indomethacin.
Combination drugs: Aspirin or acetaminophen or both can be combined with caffeine or a sedative drug to form a single medication. These drugs can be more effective. Some of these combinations are available over the counter.
Triptans can be used in persons suffering from both migraines and episodic tension headaches because they are effective against the pain of both headaches.

Preventive medications:

Your doctor may advise you on some medications to minimize the frequency and intensity of tension headache. This is especially important when you suffer from frequent or chronic headaches that aren’t easy to go away.

Preventive medicines include:

Tricyclic antidepressants such as amitriptyline and protriptyline, are widely used drugs to prevent tension headaches. Beware of the side effects of the drugs.
Anticonvulsants and muscle relaxant such as Topiramate may prevent tension headaches.

Preventive medications can take several weeks or more to build up in your body before they take effect. So, you have to wait before seeing their effects.

Self-care:

Rest
Ice packs
Adopt coping strategies to manage your stress
Maintain a good posture.

Alternative treatments options

Below are alternative treatment options that may help:

Acupuncture
Gentle massage
Deep breathing
Biofeedback
Behavioral therapies

Migraine Type Headaches

Migraine affects 20% of women and 6% of men at some point in their lives. Its causes remain largely unknown.

The following factors are associated with migraines:

Family history, suggesting a genetic predisposition.
Hormonal influences can also exacerbate it.
Medications such as oral contraceptives and vasodilators
Sensory stimulation
Foods such as aged cheeses and salty and processed foods

Clinical features

Prodromal symptoms that appear before the attack are:

Constipation
Mood changes
Swift Food cravings
Neck rigidity
Increased urination
Excessive thirst
Yawning
Frequent yawning

Symptoms of migraine aura include:

Visual hallucinations
Flash Of light in front of eyes
Temporary loss of vision
Pin and limb sensation in their limbs.
Abnormal body moves
Difficulty in speaking

In around 20% of patients, migraine begins with aura (previously called ‘classical’ migraine). Shimmering, silvery zigzag lines (fortification spectra) start appearing across the visual fields for up to 40 mins, sometimes. This can sometimes cause temporary blindness. Another 80% of patients suffer from migraine without aura.

Below are the characteristics of a migraine attack:

Severe and throbbing pain
Photophobia
Irritation to noise or even voice
Vomiting
Pain exacerbated by movement
Limbs weakness

Diagnosis:

Doctors, particularly expert in headaches (neurologists), can diagnose migraines based on your history, clinical features, and general physical and neurological examination.

Your doctor may advise the following tests to rule out any serious underlying disease:

MRI. It can help a doctor diagnose any tumor, stroke, bleeding in the brain, infections, and other problems.
CT scan. A series of X-rays created through a CT scan creates a detailed image of the brain.

Management

Acute attack:

Simple analgesia with aspirin or paracetamol
Antiemetic medications to stop the vomiting if there is any
Triptans such as sumatriptan are used to treat the severe attacks of migraine.
Dihydroergotamine
Lasmiditan
Ubrogepant: This oral calcitonin gene-related peptide receptor antagonist has been recently approved for the treatment of acute migraine with or without aura in adults.
Opioid medications can be used in individuals who can’t take other drugs due to any reason.

Prevention:

Avoidance of identified triggers or exacerbating factors.
If frequent, try calcium channel blockers
Beta-blockers such as propranolol
Antidepressants, particularly tricyclic antidepressants (amitriptyline) can prevent migraines.
Anti-seizure drugs such as Valproate and topiramate
Botox injections. Injections about every 3 months offer protection against migraine in some adults.
New drugs such as calcitonin gene-related peptide (CGRP) monoclonal antibodies

Other treatment options:

Acupuncture.
Biofeedback.
Cognitive behavioral therapy.
Herbs, vitamins and minerals.
A high dose of riboflavin (vitamin B-2)

Cluster Type Headaches (migrainous neuralgia)

This is much less common than migraine. Males predominate 5: 1, and onset is usually in the third decade of life. A cluster headache is called so because it generally lasts for several weeks to months. Moreover, it tends to occur seasonally, such as every spring or every fall. A cluster headache happens quickly, usually without any warning signs. Some people might experience migraine-like nausea and aura.

Common signs and symptoms of cluster headache are:

Excruciating pain generally in, behind (retro-orbital) or around one eye
Radiating to other parts of the face
Unilateral pain
Restlessness
Excessive tears
Redness of your eye on the affected side
The runny nose on the affected side
Profuse sweating on the affected side
Drooping eyelid

Causes:

The exact cause and mechanism of cluster headache are unknown. But the cluster pattern of this type of headache suggests that it has something to do with the body’s biological clock (hypothalamus). Unlike other types of jeans, it is not associated with any particular food item. Other medications such as nitroglycerin are thought to trigger cluster headaches.

Diagnosis

Your doctor can diagnose cluster headaches due to the characteristic nature of the headache and the pattern of how it attacks. A detailed description of the attacks, location and severity of your pain and details of any associated symptoms will help your doctor diagnose it. Based on your signs and symptoms, doctors will perform a general physical examination and neurological examination to assess your brain functions. Hev may advise some blood tests Moreover, imaging tests such as MRI and CT scan of the brain can be done as the last test to diagnose this headache or rule our tiger serious conditions.

Treatment Options

There is no permanent treatment for cluster headaches. Medications are used to decrease the intensity of pain, shorten the headache period and prevent further attacks.

Following treatments are given to solve the acute attack of cluster headache:

Oxygen
Triptans
Octreotide
Local anesthetics such as lidocaine ‘
Dihydroergotamine

Moreover, the following medication can be used to prevent cluster headaches.

Calcium channel blockers such as verapamil
Corticosteroids such as prednisone
Lithium carbonate.
Occipital nerve block

Surgical options:

In rare cases, when the cluster headache doesn’t go away, the doctor may have to advise surgical options which include:

Sphenopalatine ganglion stimulation
Noninvasive vagus nerve stimulation (VNS)

Potential future treatments

Following treatment are under research and can be used in future:

Occipital nerve stimulation
Deep brain stimulation

Trigeminal neuralgia

Unilateral lancinating facial pains
Severe, very brief but repetitive pain
It causes the patient to flinch as it happens with motor tic.
It can be triggered by touch.
It can appear and disappear again and again

Treatment Options

Trigeminal neuralgia usually resolves with medicines. However, if it does not, surgery may be performed.

Following medicines are approved time used against trigeminal neuralgia.

Anticonvulsant such as carbamazepine oxcarbazepine lamotrigine, phenytoin, clonazepam, and gabapentin
Antispasmodic agents. such as baclofen
Botox injections

Surgical Treatment Options

Following are the Surgical options for trigeminal neuralgia:

Microvascular decompression
Brain stereotactic radiosurgery (Gamma knife)
Rhizotomy
Glycerol injection
Balloon compression
Radiofrequency thermal lesioning

The Takeaway Message:

If you’re suffering from any type of headache that is not getting relieved by over-the-counter (OTC) medications, it would be the best idea to consult your doctor. He can listen to your signs and symptoms, can examine you, run some test and can formulate an effective personalized treatment plan for your headache.