Dr Patel offers care for patients with various types of headaches listed below:
- Migraine headache
- Chronic daily headache
- Cluster headache
- Analgesic rebound headache
- Cervicogenic headache
- Menstrual-associated headache
- Tension headache
- Post-concussive/Post-traumatic headache
- Sports-related concussion
- Trigeminal neuralgia
- Occipital neuralgia
Migraine headaches are less common than tension-type headaches. Nevertheless, migraines afflict about 28 million people in the United States alone. As many as 6% of all men and up to 18% of all women (about 12% of the population as a whole) experience a migraine headache at some time. Roughly three out of four migraine sufferers are female. It is important to recognize that children also get migraine and it affects between 5-10% of children under the age of 18 years.
Migraine is described as a recurrent headache lasting 4-72 hours and often has unilateral pulsating pain, moderate to severe intensity pain, nausea and/or photophobia. The pain of migraine can be aggravated by routine physical activity.
About one in five migraine sufferers experiences an aura prior to onset of a migraine headache. Auras are neurologic symptoms that may occur before during and after a migraine. There are many different types of either visual or other sensory auras and they may differ between attacks.
Tension-type headache (TTH) has been known as muscle contraction headache, psychomyogenic headache, ordinary headache, idiopathic headache and even psychogenic headache. This makes no sense since so many of us have TTH and we do not differ psychologically from people without TTH. Therefore, we are in agreement that all these types of names should be commonly referred to as TTH.
The International Headache Society described tension-type headache as infrequent episodes of headache that last minutes to days. The pain is usually bilateral in location with a pressing or tightening quality. Tension-type headache does not usually worsen with physical activity and may not cause disability. Nausea is usually not a symptom, but light sensitivity (photophobia)or sound sensitivity (phonophobia)may be present.
Tension type headaches is the most common type of headache and as many as 30% to 78% of the general population experience at some time during their lifetime. Studies further suggest that there is a biological mechanism underlying these types of headaches and they are not psychogenically based. The exact mechanisms are not known, but peripheral pain mechanisms are most likely involved.
Tension-type headaches occurring frequently or even daily are classified as chronic tension-type headaches and are a serious condition that is associated with headache-induced disability and significantly impacts quality of life. Pain mechanisms peripherally and centrally may be involved in chronic tension-type headache, making treatment more challenging.
Cluster headaches occur in about 1% of the population and are distinct from migraine and tension-type headaches on several levels. Most of the cluster headache sufferers are men with onset between ages of 20-40 (where most migraineurs are women with onset following the start of menstruation).
- These attacks are characterized by severe, unilateral pain that is around the eye or along the side of the head.
- Headache attacks last from 15 to 180 minutes and occur once every other day to up to 8 times daily.
- Attacks are associated with tearing on the same side of the head that the pain is located. Patients may also experience nasal congestion, runny nose, forehead and facial sweating, dropping eyelids or eyelid swelling.
- During an attack, patients may be restless or agitated due to excruciating pain
- In about 5% of the cases, cluster headache may be hereditary
- Attacks occur in clusters or periods with weeks or months between new cluster periods; remission periods may be months or even years
- 10-15% of patients do not experience long periods of remission
- During a cluster period, attacks may be provoked or triggered by alcohol or selected drugs like histamine or nitroglycerin
- Pain usually presents on the same side each attack
A headache is secondary when it is caused by some other condition. The term is used to distinguish this type of headache from the primary headache disorders like migraine, tension-type headache or cluster headache. Many medical conditions can cause headache but there are usually clues in the medical history or examination to suggest secondary headache.
Headache can be caused by general medical conditions such as severe hypertension, or by conditions that affect the brain and its coverings. Infections of the head and neck, including pharyngitis, sinusitis and meningitis have headache as a symptom. Head trauma, even if it is mild, can often lead to headache. Anything that takes up space inside the head can cause headache, including tumor, subdural hematoma and hydrocephalus. Other blood vessel problems, like subarachnoid hemorrhage which can result from rupture of an aneurysm can lead to severe headache.
The key to distinguishing secondary headaches from primary headache lies in the features of the headache, other symptoms occurring at the same time, and the physical examination. Your doctor often looks for warning signs that would point to a secondary headache over a primary headache. These include:
- First or worst headache of your life
- Abrupt onset of headache without any warning or build-up
- Fundamental change in the pattern of recurrent headaches
- Headache beginning at unusual ages
- ≤5 years old
- ≥50 years old
- The presence of cancer, HIV, pregnancy,
- Abnormal physical exam
- Headache onset:
- with seizure or syncope
- with exertion, sex or Valsalva (squeezing)
There are also features that your doctor will look for that will be reassuring that a primary headache disorder exists:
- Stable pattern of headache over many months or years
- Long-standing history
- Family history of similar headaches
- Normal physical exam
- Headaches consistently triggered by:
- Hormonal cycle
- Specific foods
- Specific sensory input
- Weather changes