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HEADACHE

It is defined as a pain in the head and upper neck region which can arise from many disorders or may be a disorder in and of it. It is one of the most common locations of pain in the body. Most of the times a headache is more of a nagging nuisance than an indicator of a serious problem. However, in some cases the headache does warrant more serious attention as it can be the indicator of some significant problem.

Types:
1.Primary Headache or idiopathic headache
Those headaches in which no pathology is present. This includes:
a.Tension type headache- the most common type of primary headache; as many as 90% of adults have had or will have tension headaches. Tension headaches are more common among women than men. They are often brought on by stress, overexertion, loud noise, and other external factors. The characteristic feature is that, this is the only type of headache which persists continuously throughout the day and night without any relief in between with sensation of fullness or lightness in the head.
b.Migraine- the second most common type of primary headache. There is intense throbbing pain occurring on one or both sides of the head and is accompanied by other symptoms such as nausea, vomiting, blurred vision, and aversion to light, sound, and movement. People having migraine often get prodromal symptoms ( features which occur before the actual onset of headache ) like seeing flashes of light, nausea, tingling on the face, etc. They should then immediately take the medication prescribed by their doctor because it is easier to control the headache before it comes on full blown rather than after it has occurred. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. An estimated 6% of men and up to 18% of women will experience a migraine headache. For women, a hormonal connection is likely, since headaches occur at specific points in the menstrual cycle, with use of oral contraceptives, or the use of hormone replacement therapy after menopause.
c.Cluster Headache- a rare type of primary headache, affecting 0.1% of the population, most of the sufferers is men. The average age of cluster headache sufferers is 28-30 years of age, although headaches may begin in childhood. It causes excruciating pain. The severe, stabbing pain centers around one eye, become red, inflamed, and watery like a hot poker, and eye tearing and nasal congestion occur on the same side. The headache lasts from 15 minutes to four hours and may recur several times in a day.  Heavy smokers are more likely to suffer cluster headaches, which are also associated with alcohol consumption.
Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and can be driven to desperate measures.

2.Secondary headache
Secondary headaches are those that are due to an underlying structural problem in the head or neck. There are numerous causes of this type of headache.
The International Headache Society lists eight categories of secondary headache. A examples in each category are noted (this is not a complete list):

a. Head and neck trauma

  • Injuries to the head may cause bleeding in the spaces between the layers of tissue that surround the brain (subdural, epidural and subarachnoid bleeding) or within the brain tissue itself.
  • Concussions, where head injury occurs without bleeding
  • A symptom of whiplash and neck injury
b. Blood vessel problems in the head and neck
  • Stroke or transient ischemic attack (TIA)
  • Arteriovenous malformations (AVM) may cause headache before they leak.
  • The carotid artery in the neck can become inflamed and cause pain.
  • Temporal arteritis (inflammation of the temporal artery)
c. Non-blood vessel problems of the brain
  • Brain tumors, either primary, originating in the brain or metastatic from a cancer that began in another organ
  • Seizures
  • Idiopathic intracranial hypertension, once named pseudotumor cerebri, where there is too much cerebrospinal fluid pressure within the spinal canal.
d. Medications and drugs (including withdrawal from those drugs)
e. Infection
  • Meningitis
  • Encephalitis
  • HIV/AIDS
  • Systemic infections (for example, pneumonia or influenza)
f. Changes in the body's environment
  • High blood pressure (hypertension)
  • Dehydration
  • Hypothyroidism
  • Renal dialysis
g. Problems with the eyes, ears, nose throat, teeth and neck
h. Psychiatric disorders

Pathophysiology:
The brain in itself is not sensitive to pain, because it lacks nociceptors. However, several areas of the head and neck do have nociceptors, and can thus sense pain. These include the extracranial arteries, large veins, cranial and spinal nerves, head and neck muscles, the meninges, raised intracranial pressure, disturbance of the intracerebral serotonergic levels.

Diagnosis
While, statistically, headaches are most likely to be primary (harmless and self-limiting), some specific secondary headache syndromes may demand specific treatment or may be warning signals of more serious disorders. Differentiating between primary and secondary headaches can be difficult.
As it is often difficult for patients to recall the precise details regarding each headache, it is often useful for the sufferer to fill-out a "headache diary" detailing the characteristics of the headache.

Imaging
When the headache does not clearly fit into one of the recognized primary headache syndromes or when atypical symptoms or signs are present then further investigations are justified. Neuroimaging (noncontrast head CT) is recommended if there are new neurological problems such as decreased level of consciousness, one sided weakness, pupil size difference, etc or if the pain is of sudden onset and severe, or if the person is known HIV positive. People over the age of 50 years may also warrant a CT scan.
When to see the doctor:
  • If your headache is not relieved by over the counter drugs.
  • If it persists for over 2 weeks.
  • If it is associated with other features like nausea, vomiting, tingling on the face, etc.
  • If the pain is too severe as to be unbearable
  • If it occurs suddenly along with pain and stiffness in the neck and feeling of weakness in a particular part of the body.
Treatment:
1.In cases of secondary headaches, underlying cause has to be finding out and treatment must be according to that only.
2.In conventional medicines- treatment of primary headaches are simple analgesia (painkillers) such as paracetamol/acetaminophen or members of the NSAID class (such as aspirin/acetylsalicylic acid, diclofenac or ibuprofen).
3.Homoeopathy- Homeopathy is meant to enhance the body's natural healing and encourages your body's own ability to heal itself. It aims to cure the disease and not just palliate the symptoms like pain. Homeopathic treatment uses diluted quantities of various plants, mineral or animal substances to focus on the root cause of an illness. It treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualized examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc.

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