Headache Pain Relief

Also known as Cephalgia, Encephalgia, Stress Headaches, Migraines, Menstrual Headaches, Splitting Headaches, Myogenic Headaches, Myofascial Headaches, Cervicogenic Headaches, Vascular Headaches, Occipital Neuralgia, Occipital Neuritis, Eye Strain, Temporal Mandibular Joint Syndrome, Temporal Mandibular Joint Arthritis

Headache Pain Information

Overview:
Acute and chronic headaches are one of the most common causes of pain and disability in American. Headaches may be divided into two important categories: Benign or life-threatening. Unfortunately, it is frequently very challenging to tell the two types of headaches apart. Benign headaches, while often very painful and debilitating, are usually not a cause of eminent danger to life of the sufferer, whereas life-threatening headaches may be a result of an injury or disease, even malignancy that is likely to result in an immediate or delayed catastrophic outcome to the victim’s life or health. Because of the potentially devastating consequences of headaches caused by life-threatening medical conditions, it is critical for the headache sufferer to seek consultation by a qualified medical physician, and, if necessary, undergo appropriate diagnostic evaluations to differentiate between benign and life-threatening headaches. Headaches may be further divided into primary headaches, which are causes by abnormalities in the head or brain, and secondary headaches, which are a result of another medical condition or disease which may include some life-threatening medical conditions. Many headaches are not the result of one type of headache but are a combination of medical conditions.

Benign Headaches

Tension Headaches: Tension headaches are the most common type of headache and affect almost everyone at one time or another and are usually described as a pressure or ache. Tension headaches involve muscle strain or muscle spasms of the head and neck area and can develop in one localized area of the head, such as the temples, or may encircle the entire head like a band. Muscular or myogenic headaches or myofascial headaches are more scientific names for tension headaches. The forehead is probably the most common location of tension headaches. Usually, tension headaches develop during the day and worsen in the evening. Tension headaches are aggravated by stressful situations, thereby inheriting the name of stress headaches, and improved with rest. Tension headaches may be a rare occurrence in some people or may be a common recurrent problem in others, recurring even on a daily basis. Tension headaches may be caused by eye strain, especially if there is an underlying problem with the eyesight, such as near-sightedness (known as myopia), far-sidedness (known as presbyopia), or astigmatism. Eyestrain is very common in today’s world of computer screens, and small hand-held electrical communication devices. The intensity of tension headaches may vary from a mild annoyance to severe disabling pain. Generally, there are no other accompanying symptoms in tension headaches such as visual or hearing changes, numbness or weakness, difficulty speaking, nauseas, vomiting, or loss or consciousness. Tension headaches are usually self-limited with or without treatment and may last from a few minutes to hours.

Migraine Headaches: Migraine headaches are the second most common type of headache in America and may afflict up to 12% of the population or 28 million people. The pain due to migraines is most often a sudden onset and is described as excruciating, intense, throbbing, or pounding. Migraines are often associated with nausea, vomiting, and sensitivity to light or sound. The migraine sufferer is mostly totally disabled for at least a full day during the acute phase of the migraine headache. Pain due to migraine headaches may be isolated to one area of the head, isolated to one side of the head, or may spread over the entire head and include pain behind the eyes. Migraine headache sufferers usually suffer with recurrent episodes of headache. The frequency of the headaches may vary from daily and in rare cases, to several months. These headaches usually begin during the day or evening, are self-limited, and resolve with or without treatment within 6 to 72 hours. While migraine headaches are officially classified as vascular headaches, these headaches are now believed to be a result of over-reactive nerves inside the brain which, when triggered, result in a sudden constriction, followed by a sudden relaxation or dilatation, of the blood vessels of the brain. The sudden constriction may result in initial transient neurological changes, called an aura, such as visualizing flashing lights, dark spots in the vision (known as scotoma), hearing sounds, having a recurrent taste in the mouth, or transient numbness with or without weakness of the face or extremities. About 20% of migraine sufferers develop auras. Occasionally, migraine headaches may result in transient loss of consciousness, numbness or weakness, making differentiating from a stroke very difficult. Migraine headaches may occur in children as well as adults. In adults, migraines are more common in women. One of the most common causes of regularly recurrent migraine headaches in females is the female menstrual cycle. Many other triggers may precipitate the migraine headache including foods such as chocolate and red wine, food additives such as monosodium glutamate (MSG), sulfites, nitrates, and artificial sweeteners, fragrances, alcohol, cigarette smoke, or bright lights.

Cluster Headaches: Although cluster headaches are less common than migraine or tension headaches, these headaches can be equally disabling to the sufferer. Cluster headaches are frequent episodic bursts of headaches lasting a few minutes to many hours following by a pain free or pain reduced period of minutes to hours. These sets of headaches may resolve spontaneously and not recur for weeks or months. Pain due to cluster headaches is usually of sudden onset and excruciating. The headache pain is usually sharp and stabbing often described as a hot poker. These headaches usually occur in one area of the head and most frequently in or around the eye. However, cluster headaches may also spread to wider areas of the head and are usually located on one side of the head. Cluster headaches can be associated with other changes such as a red or watery eyes, nasal congestion or runny nose. Custer headaches may begin in the sleep. Men between 20 and 40 are the common victim of cluster headaches. While the exact cause of cluster headaches is not known, these headaches are classified as vascular headaches and have triggers in common with migraine headaches including some environmental toxins, smoke, foods, food additives, or fragrances.

Cervicogenic Headaches: Cervicogenic headaches arise from injuries or diseases of the neck, usually the cervical spine such as disc bulges or herniations, diseases such as arthritis of the joints of the neck, known as cervical facet disease, or degenerative joint disease, or strained or pulled muscles and ligaments of the cervical spine. Disc herniations can cause pressure on the spinal cord or nerve roots of the cervical spine resulting in radiation of pain into the back and sides of the head. Cervical facet joint arthritis, muscle or ligament strain may also result in pain radiating into the back and sides of the head. Usually, cervicogenic headaches are associated with an aching and sometimes sharp neck pain and localized tenderness over the neck muscles and facet joints. Cervicogenic headaches are usually aggravated by movement of the head and neck and improved by rest or heat applied locally over the head and neck areas. Generally, cervicogenic headaches are more frequent and more constant than headaches due to migraine or cluster headaches. Cervicogenic headaches may also be associated with pain, numbness, or weakness of the upper or lower extremities, especially if the spinal cord or spinal nerve roots are involved. Cervicogenic headaches most commonly occur in adults and are not usually associated with nausea, vomiting, visual or hearing changes, and auras and are usually not precipitated by the triggers that result in migraine headaches.

Occipital Neuralgia or Occipital Neuritis: The greater occipital nerve is the main nerve that serves the back of the head or the scalp. This nerve, located on each side of the base of the skull, arises from the roots of the nerves of the upper-most portion of the spinal cord inside of the spinal column. The occipital nerves provide sensation and muscular strength to the muscles in the scalp at the back of the head behind the ears. If the occipital nerves become inflamed or injured, severe pain may radiate into the back of the head and even be referred to the front of the head and behind the eyes. The occipital nerves may be directly traumatized such as from a football helmet, stretched as in a whiplash type of injury, or become inflamed after a viral infection or other inflammatory condition of the body. Injuries to the cervical spine may also damage the roots of the occipital nerves in the neck, causing radiation of pain along the course of the occipital nerve. Headache pain due to occipital neuralgia is typically constant sharp and shooting pain, aggravated by movements of the head or neck and associated with severe tenderness over the base of the skull. While occipital neuralgia may occur at any age, in males or females, most cases of occipital neuralgia occurs in younger and older adults. Headaches due to occipital neuralgia are not usually associated with nausea, vomiting, visual or hearing changes, and auras and are usually not precipitated by the triggers that result in migraine headaches.

Rebound or Withdrawal Headaches: Headaches may occur after a sudden withdrawal from medications or substances such as chocolate or caffeine. While rebound headaches are mostly thought of as occurring after the withdrawal from narcotic analgesic medications such as hydrocodone (Vicodin or Norco), these headaches may occur after the abrupt withdrawal of many types of medications, including medications used to treat high blood pressure. These headaches are usually described as an aching, throbbing, or pounding headache, and may be associated with upset stomach, nausea, lightheadedness, sweating, palpitations, blurred vision, mood changes such as irritability or depression, and fatigue. Sudden withdrawal of many medications may result in severe complications such as severely elevated blood pressure, which could result in heart attack or stroke, or even seizures. Suffice it to say, that any medication taken routinely should never be abruptly discontinued. Most medications require tapering or a gradual reduction prior to discontinuing the medication.

Sinus Disease or Sinusitis: Inflammation or infections of the sinuses, a frequent cause of headaches, usually results in a constant throbbing or pounding pressure around the forehead and eyes, and are usually aggravated by lowering the head. Acute sinus headaches are common after an upper respiratory infection (URI) and can be associated with fevers and mucous production. Sinusitis may or may not be associated with fevers and chills. Chronic sinus headaches may occur as a result of an obstruction of the normal drainage of fluids from the sinuses or even tumors growing in the sinuses. While headaches due to sinusitis are usually benign, severe life-threatening brain infections may occur if the untreated infection erodes into the brain. Sinusitis should always be evaluated and treated as necessary by a medical physician.

Temporal Mandibular Joint Pain (TMJ): The temporal mandibular joints are small but very complex joints on each side of the face, in front of the ear and are the reason that we can chew food and communicate through speech. The temporal mandibular joints are subjected to incredible forces when food is chewed. As with any other joint, the temporal mandibular joints can be injured by direct trauma to the face or jaw or may deteriorate gradually with a condition known as degenerative joint disease or degenerative arthritis. Pain from temporal mandibular joints may be on both sides or limited to one side. Temporal mandibular joint pain is usually a constant ache aggravated by movement of the jaw with chewing or talking and frequently associated with clicking and popping of the joint. Temporal mandibular joint pain frequently travels or radiates into the face, temple area, and even the forehead and is often difficult to differentiate from other headaches such as tension headaches, headaches due to dental abnormalities such as abscess, or diseases of the ears such as middle or inner ear infections or sinusitis.

Life-threatening Headaches

Strokes: Also known as a cerebral vascular hemorrhage, cerebral vascular accident (or CVA), stroke is one of the most devastating of the life-threatening headaches because of rapid onset of symptoms, limited window of opportunity for treatment, and the potentially severe outcome including death, coma, loss of memory and speech, and paralysis. Recognizing the signs of stroke in oneself or another person is critical to the treatment of the stroke sufferer. With stroke, minutes count! Stroke victims may or may not have severe headaches. Important signs of stroke include sudden weakness or numbness of the arm, leg, or face, difficulty speaking such as garbled speech, unable to smile on one side, also known as a crooked smile, a drooping eye on one side, sudden onset of confusion or nonsensical speech, sudden change in mental status, and sudden loss of consciousness or seizure. Whenever a stroke is suspected, emergency services (911) must be contacted immediately and the victim watched closely.

Subarachnoid hemorrhage or subdural hematoma and aneurysm: Headaches due to subarachnoid hemorrhage or subdural hematoma is hemorrhage or bleeding inside the brain usually, although not always, follows an injury to the head or even a severe whiplash injury. An aneurysm is a large dilated and often weakened artery in the brain that may cause pressure on the surrounding brain tissues. An aneurysm may suddenly rupture resulting in catastrophic bleeding into the brain. The headaches due to aneurysm or bleeding may be of sudden and severe onset, immediately following an injury, as in the case of subarachnoid hemorrhage, or may develop slowly over time and be less painful, as in the case of many subdural hematomas. While these headaches are frequently associated with neurological changes, such as loss of consciousness, seizure, loss of memory, weakness or numbness in the face, arms or legs, fatigue, or mood change, often, in the case of a slowly expanding hematoma, these changes may not develop or may develop slowly and imperceptibly. If headache due to subarachnoid hemorrhage or subdural hematoma is suspected, the best course is to call emergency services (911). Failure to treat these victims could result in death, coma, and permanent neurological deficits such as paralysis, permanent memory loss, or loss of speech.

Infections: While headaches are a very common symptom of fevers due to flu, rarer infections of the central nervous system, the brain or spinal cord, called meningitis or encephalitis may result in rapid and catastrophic outcomes such as death, coma or paralysis and may occur in any person at any age. Abscesses or parasites, such as amoeba, may also invade into the brain. Headaches of sudden onset, especially associated with fever, neck stiffness, fatigue, or neurological changes such as change in mental status, change in speech, numbness or weakness, or seizures should be evaluated immediately by a physician. Preferably, emergency services (911) should be contacted. Infection of the middle or inner ear may also result in headaches. These infections are potentially very treatable but may result in severe damage to the hearing apparatus if not treated. Dental infections such as abscess may also result in severe facial and headache pain and also respond to treatment if found early enough.

Cancer or Tumors: Headaches caused by growths inside the brain may result in pain that can be constant or recurring, mild to severe and may occur in anybody at any age. While these headaches are usually of gradual onset, sometimes they may occur more suddenly. Many times these headaches are ignored or minimized by the victim, the family, or even the physician and the disease is allowed to progress. Eventually, all tumors of the brain increase in size and begin to cause neurological deficits. These deficits may be subtle at first, such as a mild memory loss, fatigue, lack of interest, or mood changes, but later increase to numbness or weakness in the face or extremities, even seizure or loss of consciousness.

Headaches due to systemic disease: Many diseases cause headaches as a consequence of the physiological changes in the body. For example, high blood pressure or hypertension may cause headaches. Diabetes mellitus is commonly associated with headaches. Hypoglycemia or low blood sugar may result in fatigue and headache. Headaches due to systemic diseases are generally great warning signs that something is wrong and that the underlying medical condition needs urgent if not immediate treatment. The victim of these headaches should seek treatment by a qualified medical physician to control these underlying diseases. Sufferers of fibromyalgia or chronic fatigue syndrome frequently suffer with headaches due to one or more causes, including migraines headaches and tension headaches.

Headache Pain Treatments

Of course, for headaches that are suspected to be a result of any of the life-threatening causes noted above, emergency services (911) should be contacted immediately. However, treatment of headaches due to benign causes vary and depend on the type of headache. Many causes of benign headache pain may be treated, such as visual correction, or improved medical treatment of high blood pressure. Tension headache pain may be improved with a change in lifestyle, a reduction of work hours, limitation of computer screen exposure, relaxation techniques, or improved rest and regular moderate exercise. Migraine headache pain may respond to regular rest, moderate exercise, and an avoidance of triggers. Physical therapy and nerve injections are sometimes used to control headache pain. Medical treatments for migraine headaches have improved over the past decade with the introduction of the class of medications known as the “triptans” such as sumatriptan. However, these medications do not always help, especially if not used as soon as the symptoms start, and can be associated with severe side effects such as vomiting. Headaches involving infections such as dental abscess, middle ear infections, or sinus infections require treatment of the underlying infection and possibly surgery. Cervicogenic headaches often require treatment of the underlying abnormalities of the cervical spine which may include surgery. Temporal mandibular joint pain often requires a specialist such as an oral surgeon who may use splinting or even surgery.

The standard treatments for moderate to severe or acute or chronic headache pain are over-the-counter (OTC) and prescription narcotic and non-narcotic medication. As most patients who suffer with this type of headache pain soon realize, these treatments are usually not sufficient and many, especially the oral medications, are associated with serious side effects such as sedation, nausea, constipation, and even addiction. Extended use of some over-the counter (OTC) medications such as ibuprofen, naproxen, and acetaminophen may even result in stomach ulcers, kidney failure, heart failure, and liver failure. Many headache sufferers often search for alternative solutions to the usual over-the-counter and prescription medications.

Relieve Aches and Pain Without Harmful Side Effects

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