by admin | May 16, 2014 | Types of Headaches
Exercise-Induced Headache—Benign or Ominous?
Exertional headache can be a relatively minor thing, in which case it is called benign exertional headache, or it can represent something more serious. Since no one can tell the difference by just looking at you or by hearing about your symptoms, it’s best to seek medical evaluation if you have exercise-induced headaches.
Usually this headache is a pulsating or throbbing headache lasting up to two days, brought on by exercise or strenuous physical activity. The headache can occur during or after the activity, and is more likely to occur in hot weather or at high altitude. Occasionally this headache occurs as what is called a thunderclap headache, which means that it strikes suddenly as a severe headache without any warning.
You should see a doctor the first time an exertional headache happens—it can mimic other disorders that are not benign. And you should definitely seek care if you have a thunderclap headache, which may be warning you of something ominous.
Most of the time, exertional headaches are nothing serious, but it is better to be safe than sorry. Hydrating before exercise may help prevent this headache. If it does not, your doctor may be able to recommend treatment.
by Christina Peterson, M.D.
by admin | Nov 13, 2013 | Types of Headaches
Posttraumatic Headaches
Posttraumatic headaches are headaches that occur following a head or neck injury. This type of headache is often associated with dizziness, fatigue, or memory problems, especially in the early phase of symptoms. In the majority of cases, posttraumatic headaches will resolve within a few months. However, sometimes, posttraumatic headaches can be chronic.
There is no specific headache type which characterizes the posttraumatic headache. The headache symptoms may mimic either tension-type headache or migraine headache, and is actually most commonly a hybrid mixture of the two.
Treatment is symptomatic. Surprisingly, as common as this headache type is, there have been no controlled trials of medications for the treatment of posttraumatic headache.
by admin | Jul 1, 2012 | Types of Headaches
What is Thunderclap Headache?
Thunderclap headache is a sudden severe headache which reaches its peak intensity within one minute or less. It is sometimes described as “the worst headache of my life.” Once present, the headache can last from an hour to days.
Causes of Thunderclap Headache
Causes of thunderclap headache are subarachnoid hemorrhage, a syndrome called reversible cerebral vasoconstriction syndrome (RCVS), cerebral aneurysms (even unruptured), cerebral venous sinus thrombosis, cervical artery dissection, spontaneous intracranial hypotension, third ventricle colloid cyst, pituitary apoplexy, epidural cervical hematoma, and hypertensive crisis. Not all cases of thunderclap headache have one of these potentially serious underlying causes, and can be idiopathic, meaning there is no identifiable cause. Idiopathic thunderclap headache is what is known as a diagnosis of exclusion, which means that underlying problems with the blood vessels in the brain or neck should be ruled out first.
Unruptured aneurysms are present in 3.6-6% of the general population. It is thus unclear whether thunderclap headache is always due to an unruptured aneurysm in an individual who has both.
Primary cough headache, exertional headache, and headache associated with sexual activity can also present as thunderclap headache. As mentioned, idiopathic thunderclap headache, in which no underlying problem is identified, can occur. In the past, this has been referred to as “crash migraine.”
80% of those with primary thunderclap headache (with no underlying cause) have a triggering event, such as exertion, defecation, coughing, sexual activity, bathing, or emotional disturbance. Although it is not entirely clear why thunderclap headaches occur, it is thought that a sudden change in sympathetic tone of the blood vessels may cause sudden vasodilation resulting in the headache pain.
What Should You Do If You Have a Thunderclap Headache?
If you have a thunderclap headache, you should seek evaluation. You may simply have idiopathic thunderclap headache, or thunderclap headache associated with exertional headache, cough headache, or headache associated with sexual activity. However, no one will know whether there is a more serious and treatable underlying condition unless it is looked for.
Resources:
1. Schwedt TJ. Clinical spectrum of thunderclap headache. Expert Rev Neurother. 2007;7(9):1135–1144.
2. Linn FHH. Primary thunderclap headache. Handb Clin Neurol. 2010;97:473–481.
3. Dodick DW. Thunderclap headache. J Neurol Neurosurg Psychiatry. 2002;72(1):6–11.
4. Mistry N, Mathew L, Parry A. Thunderclap headache. Pract Neurol. 2009;9(5):294–297.
5. Schwedt TJ, Matharu MS, Dodick DW. Thunderclap headache. Lancet Neurol. 2006;5(7):621–631.
6. Chen SP, Fuh JL, Lirng JF, Chang FC, Wang SJ. Recurrent primary thunderclap headache and benign CNS angiopathy: spectra of the same disorder? Neurology. 2006; 67(12), 2164—2169.
7. Liao YC, Fuh JL, Lirng JF, Lu SR, Wu ZA, Wang SJ. Bathing headache: a variant of idiopathic thunderclap headache. Cephalalgia. 2003; 23(9), 854—859.
by Christina Peterson, M.D.
edited 7/1/2012
by admin | Jul 1, 2012 | Types of Headaches
Brain tumor or Migraine?
Almost everyone who has ever had a troublesome headache has worried at some point in time that they might have had a brain tumor. So let’s talk about what a brain tumor headache feels like.
Here are some reassuring facts: although up to 70% of people with various brain tumors have a headache at the time of diagnosis, only about 8% of tumor patients have headache as their first and only symptom. Many older sources have described a “classic” brain tumor headache as one that is worse in the morning, and is more likely to be a dull pain, but with nausea and vomiting. (There are other causes of morning headache, though.)
However, neurologist and cancer specialist Dr. Casilda Balmaceda, Assistant Professor of Neurology at Columbia University College of Physicians and Surgeons in New York, states that there is no typical brain tumor headache.
Symptoms for headaches associated with brain tumors
Nausea and vomiting do not usually show up until the tumor has gotten big enough to put pressure on the brain. This increased pressure phenomenon can also be the reason for morning headaches. However, morning headaches are far more likely to be due to sleep disorders like sleep apnea.
A brain tumor headache can link to the spot where the brain tumor is. So if you always get a headache in the same spot, there is a possibility that it could mean a brain tumor—but it’s not a big chance. If most of your headaches are on one side, but a few are on the other, your headaches are still most likely to be migraines.
Migraine patients who have had the misfortune to later develop a brain tumor report that the headaches due to the tumor are different from their migraine headaches. Do you always get a headache with a brain tumor? No—sometimes you get other symptoms instead, like weakness or a personality change.
Children with brain tumor are more likely to experience headaches than are adults.
Most people have no cause for worry, but it’s always best to see a doctor to be sure. A thorough history and a good neurologic examination can help to determine if you need diagnostic imaging studies like an MRI scan.
References: 1. http://www.ncbi.nlm.nih.gov/pubmed/2022972
by Christina Peterson, M.D.
Updated July 1, 2012
by admin | Jan 10, 2012 | Types of Headaches
Rebound Headaches: a common problem
Medication overuse headache, which is the current term in the medical literature, has been called “rebound” headache in the past. The perception, however, was that if you took medication, the next day’s headache was the rebound headache, and that’s all there was to it. More recent research has shown that it is not that simple. A pattern of frequent medication usage leads to an increase in the occurrence of headaches. This is sometimes called pharmacologically maintained headache, or analgesic abuse headache. If you are a migraine sufferer, and you start having more frequent headaches as a consequence of using excessive medication, headaches may become less “migraine-like,” and may lose some of the usual migraine features, such as sensitivity to light and noise, or nausea, and the pain may become dull in character.
Present recommendations of the International Headache Society are not to take over-the-counter medications more than 15 days a month, and not to take prescription analgesics more than 10 days a month. Prescription analgesics that can cause medication overuse headache include triptan medications, ergot medications, opioids, and those containing butalbital. Over-the-counter medications most likely to cause medication overuse headache are those containing caffeine. Recent research suggests that triptans are more likely to cause increased headache frequency in men with frequent headaches than in women with frequent headaches.
A survey of family doctors found that this headache type was the third most common headache seen. Headache clinics in the US report that 30% to 80% of new patients seen have medication overuse headache.
Painkillers—How do you know when you’ve overdone them?
Headaches that keep coming back again and again, until they become almost daily, can be a debilitating problem. Your headache is bad, so you take a pill. It comes back again, so you take another one. But if you keep it up and do it often enough, you may actually be bringing on your next headache. If you are taking painkillers for headache three or more days a week, there is a good likelihood that this may be happening to you.
Some people think that in order for their headaches to be termed a “rebound headache” the pattern must be one of taking a pill one day, and then experiencing a headache the next day. While this can be a common pattern seen in analgesic-induced headaches, it is not the only pattern seen. This is one of the reasons the preferred name has been changed in the medical literature to “medication overuse headache”. Some affected people simply have chronic head pain and do not necessarily take analgesics every single day; it is more about a pattern of use.
If you are particularly susceptible to developing medication overuse headache, as little as two days a week may be all it takes to maintain chronic headache. There is a transition that occurs as you take more and more medication, and sometimes you don’t even notice that your headaches symptoms are changing because it occurs so gradually. The pain may become less throbbing and more dull. The headache may involve more of your head, and become less localized, harder to pinpoint. You may not notice as much nausea or acute sensitivity to light or noise as you did with your migraine attacks. You may have as much inability to think or concentrate as you have during a migraine. You just feel somewhat bad all the time.
Some people in this transition phase still get migraine attacks on top of having daily or near-daily headaches. Eventually, those may go away and only daily head pain is the result, often awakening you in the morning or in the pre-dawn hours. If you find yourself slipping into the pattern of frequent painkiller usage, this may indicate the need for a headache preventative medication.
Only about 10% of those who would benefit from preventative medications are on an effective regimen. If you are already on a medication for prevention, you should work with your doctor to make certain it is as effective as it could be, and to decrease your pain medications to make sure you are not in danger of developing medication overuse headache. Oh, and by the way—over-the-counter painkillers are just as guilty of causing problems as prescription painkillers are.
Chronic Daily Headache may not be due to medication
Between three and four per cent of the population have chronic daily headache. Not everyone with daily headache has medication overuse, however, and in many cases the daily headaches came first, and the medication overuse occurs as a result. It is therefore difficult to interpret studies that say 50% to 86% of chronic daily headaches are due to medication overuse. It may just be that the same person has both.
At US headache clinics, between 30% and 86% of new patients seen have medication overuse headache as a component of their problems. It is the third most common type of headache encountered by primary care physicians. A recent large population-based study (Bigal et al, 2008) found that barbiturate-containing medications, such as butalbital, and opioids (narcotic analgesics) were the most likely to cause a transformation from episodic migraine to chronic migraine. The prevalence of transformed migraine is 2.5%, and that due to medication was found to be 1.5%.
There are long-term risks to taking daily pain medications, even over-the-counter ones. These include stomach irritation, ulcers, gastrointestinal bleeding, and acid reflux disease (heartburn) from aspirin-containing headache remedies and anti-inflammatory medications. Long-term use of NSAIDs and acetaminophen can cause kidney damage, and excessive use of acetaminophen can result in liver damage.
The treatment for medication overuse headache is simple, but that doesn’t mean that it’s easy: stop taking daily pain medication. Depending on how long you have been taking pain medications and on how much you have been taking, the recovery period can vary from three weeks to three months. It tends to be longer if the medication you have been overusing includes narcotic painkillers. No one can wave a magic wand to make you instantly better, but headache specialists can help support you through the process. Preventive medications can help, but take time to work, and may not be fully effective until you have weaned off the analgesic medications. Behavioral treatment strategies such as cognitive behavioral therapy, relaxation training, biofeedback, and hypnotherapy can also be helpful.
The best strategy? Avoid medication overuse in the first place. If you have frequent headaches, and you are using medication more than ten days a month or more than two days each week, you may be suffering from medication overuse headache. Think twice before grabbing that medication bottle. Seek help instead.
1. Bigal, ME, Serrano, S, Buse, D, Scher, A, Stewart, WF, Lipton, RB, Acute Migraine Medications and Evolution From Episodic to Chronic Migraine: A Longitudinal Population-Based Study, Headache, 2008; 48(8):1157-1168
2. Bigal ME. The paradoxical effects of analgesics and the development of chronic migraine. Arquivos de Neuro-Psiquiatria. 2011;69(3):544-551.
3. Diener, HC, Katsarava, Z. Medication Overuse Headache. Curr. Med. Res. Opinion. 2001;17 Suppl 1:s17-21.
by Christina Peterson, MD
Updated January 10, 2012
by admin | Jun 20, 2011 | Types of Headaches
Could Your “Sinus Headache” Be a Migraine?
Of course it is possible for the migraine sufferer to develop a sinus infection, especially if you also have seasonal allergies. In fact, many suspected sinus headaches are migraines.
Here’s how that works: the sinus cavities are lined by sensitive tissues whose nerves are fed mostly by a branch of the trigeminal nerve. This is the same nerve responsible for migraine headaches. When you have sinus congestion, it can confuse the nerves and cause what is called referred pain, sending pain to distant areas in the face and head, away from the sinuses themselves. So, sinus headaches may cause pain that is not in the sinus region, and migraines can cause pain that is in the sinus region. Just to make things even more confusing, some migraine sufferers experience nasal congestion or watery eyes with their migraine attacks. This is because the trigeminal nerves can release neurotransmitter chemicals that cause blood vessels to dilate, which is why your eyes get red and watery and your nose gets congested.It isn’t clear why this happens more to some people and not to others with migraine.
The Sinus, Allergy and Migraine Study investigated 100 subjects self-diagnosed with sinus headaches. They were then evaluated by headache specialists, and 63% were diagnosed with either migraine with aura or migraine without aura, and 23% with probable migraine. Only 3% actually had sinusitis. Interestingly, 62% reported that exposure to allergens was a significant headache trigger. Although the symptoms can overlap, these general guidelines can help somewhat in telling migraine and acute sinus infection apart. Sorting out chronic sinus headache is more difficult, especially if there is also another type of chronic headache present.
SINUS INFECTION
These are the major features of a sinus infection:
Usually bilateral
Fever*
Discharge thick, yellowish-green*
Diminished or absent sense of smell*
Minor factors:
halitosis (bad breath), cough, headache, dental pain, ear pressure, fatigue
Facial pain or pressure—more likely to be non- throbbing
Sinus CT or direct examination positive
MIGRAINE
Features of a migraine headache:
Often (not always!) one-sided*
No fever
Discharge thin, clear if present
Heightened or altered sense of smell or avoidance of odors
Occasional symptom: watery, red eyes Facial pain or pressure—more likely to be throbbing or pulsating*
Diagnosis based on symptoms.
*Major features of each disorder.
Sinusitis occurs in 15% of the population— and that is even higher than migraine, unless we take into consideration the possibility of overdiagnosis of acute sinusitis in the migraine population.
Contact Point Headache
As if this were not confusing enough, there is another headache type called Contact Point headache. This occurs when you have a deviated septum or bone spurs in the nose, and the bone from the center of your nose comes in contact with the sensitive tissue on the other side of your nose. This can cause headaches that can feel very much like a migraine.
What Should You Do About Sinus Pain and Congestion?
If you think you have allergies causing allergic rhinitis, or allergies triggering your migraines, it might be worthwhile to see an allergist. Specific treatment of allergies may reduce your migraine frequency.
If you think you have a sinus problem, it may be worthwhile to see an ear, nose, and throat physician (the technical name is otorhinolaryngologist). Treatment of a mechanical problem like a deviated septum, bone spurs, or other physical sinus problems can be helpful if you truly do have chronic sinusitis.
Gastric reflux can also be a cause of chronic sinusitis.
Be careful about treating yourself with over-the- counter sinus medications, especially if you do so on a frequent basis. This can result in rebound rhinitis, causing more nasal congestion than you might otherwise have had. They can also cause rebound headaches if used frequently. It is always best to see your doctor for examination, particularly since this can be such a confusing diagnostic challenge. One thing is for sure, though—antibiotics are not the best treatment for migraine! So don’t just pick up the phone and ask for a prescription. If there is any doubt, go in and be seen.
Reference:
1. Rozen TD. Intranasal contact point headache. Neurology. 2009;72(12):1107.
2. Behin F, Lipton RB, Bigal M. Migraine and intranasal contact point headache: Is there any connection? Current Science Inc. 2006;10(4):312-315.
3. Behin F, Behin B, Behin D, Baredes S. Surgical management of contact point headaches. Headache. 2005;45(3):204-210.
4. Eross E, Dodick D, Eross M. The Sinus, Allergy and Migraine Study (SAMS). Headache. 2007;47(2):213-224
by Christina Peterson, M.D.
updated June 20, 2011
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