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Headache, a manifestation of underlying disorder

Sharjah - Lifestyle modification is also an important component of migraine management

Headache as a presenting symptom is so common that it is estimated that half of the world adult population would have had an active headache disorder at some phase in their lifetime.
Headache in itself is not a diagnosis and akin to fever is only a symptom or manifestation of an underlying disorder. When headaches are severe, recurrent, intractable and poorly responsive to medication it warrants a detailed medical and neurological examination.
Headache can be a manifestation of a myriad number of medical, neurological, psychiatric or local craniofacial problems. Primary headache disorders are neurological conditions where patients experience recurrent headaches but there is no underlying structural cause - the classical examples being migraine, tension headaches and cluster headaches.
The primary headache disorders although recurrent and often severe are most often benign and potentially treatable. The primary headache disorders include migraine with and without aura, tension type headache, cluster headaches, hemicrania continua, primary thunderclap headache, hypnic headache etc.
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Most of these disorders especially migraine come to medical attention after months to years of recurrent episodic headaches which are often treated with over the counter. Episodes often subside with sleep, analgesics and after vomiting.
Lifestyle modification is also an important component of migraine management with emphasis on adequate sleep, regular meals, minimising exposure to triggers and relaxation techniques.
Cluster headache are more common in males and are characterised by intense unilateral pain around the eye associated with redness, watering from eyes and rhinorrhea (nasal congestion). Each attack can last up to 180 minutes and often cause severe distress to the patient who often paces up and down during the episode. A cluster episode may last days to weeks and then subside only to recur again periodically after a headache free interval.
Acute attacks are managed with 100 per cent oxygen inhalation and triptans. Tension headaches are often bifrontal or occipital/neck dull aching, continuous headaches with a band like steady tightness. The episode may last days to months.
Secondary headache disorders have several subcategories and include headaches due to head or neck trauma, headaches due to stroke, infection, tumours, headaches due to eye, ear, sinus or dental problems and headaches due to psychiatric conditions like depression. Red flags in headache disorders which warrant an early evaluation include recent onset headache, recent change in character of headache, sudden onset worst ever headache, early morning headaches, headaches in young children, elderly, women pregnant or post delivery, headaches associated with fever and other neurological symptoms like seizures and paralysis, post traumatic headaches.
Routine haemogram, ESR and C-reactive protein and other blood investigations may be needed as per the clinical diagnosis. CT or MRI brain is indicated in select cases based on the index of suspicion of a secondary headache disorder.
Dr Aparna Pai, Consultant Neurologist, Zulekha Hospital, Sharjah
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