- Diseases, Disorders & Conditions
Various Types Of Headache
Most of us have experienced a severe unbearable head pain at some point during our lifetime. It may be accompanied by photophobia (inability to tolerate bright light) and hyperacusis (Oversensitivity to certain frequencies and volume ranges of sound). In most instances, headache is only a manifestation of stress, poor eating habits or lack of sleep. Only occasionally, it could signify a serious illness such as brain tumor, hemorrhage or meningitis.
Severe Excruciating Headache could be due to meningitis or brain hemorrhage
Characteristics Of Head Pain
- The quality of pain: Most headaches are dull, deeply situated and aching. A throbbing pain and muscle tightness around the head, neck and shoulder girdle are common accompaniments of a headache. Jabbing, brief, sharp pain at different points in the head (ice-pick like pain) points towards a non-serious cause.
- The intensity of pain: Contrary to the popular belief, the headache caused due to a brain tumor is not distinctive or severe in most instances. Very severe pain occurs in migraine headaches, meningitis (an infection of coverings of the brain and cerebrospinal fluid), hemorrhage and cluster headache.
- Location of a headache: Pain referred from paranasal sinuses, teeth, and upper cervical vertebrae are less sharply localized.
- Duration: Head pain due to a ruptured aneurysm (an abnormal widening of a blood vessel) in the brain peaks in an instant, and is like a thunderclap. Cluster headache attacks reach their peak over 3 to 5 minutes, remain at a maximal level for about 45 minutes, and then taper off. Migraine attacks characteristically build up over hours, are maintained for several hours to days, and are relieved by sleep. Disruption of normal sleep pattern occurs in headaches produced by brain tumors.
- Exacerbating factors: Headaches that can be triggered by stimuli such as red wine, sustained exertion, organic odors, hunger, lack of sleep, and weather changes usually do not have a serious cause. Attacks associated with diarrhea and that reduce in frequency and intensity during pregnancy, especially in the latter half, are suggestive of a migraine. Head pain in a person known to have cancer raises a suspicion of its spread to the brain or its coverings. Accentuation of a headache with eye movement points towards the presence of an infection.
Various types of a headache, as per recommendations from the International Headache Society, include the following:
Migraine headaches can be triggered by lack of sleep, glare, worry and strong perfumes
1. Migraine headache
A migraine, with or without aura, comprises of a benign and recurring syndrome of a headache, nausea (giddiness), vomiting and/or symptoms of neurological dysfunction. Attacks can be triggered by red wine (a few varieties of red wine are implicated, more tannins the wine has, more migraine attacks it triggers), hunger, lack of sleep, glare, estrogen therapy, worry, perfumes and during let down phases of life. Attacks subside with sleep, exhilaration, sumatriptan medication. Intensity and frequency of headaches reduce during pregnancy. This variant is more common in young adults, mostly women. The onset of pain is typically after awakening. It may persist from 6 hours to 2 days. Attacks reduce in frequency and severity with increasing age.
Effort Migraine: In some people suffering from a migraine, the headache is precipitated by sustained physical exertion, such as during or after a long distance run. This pain gradually builds up over hours.
2. Cluster headache
It comes in the form of one to three short-lived daily attacks of pain around an eye over a 4-8 week interval, followed by a pain-free period that could be up to 1 year before the next attack recurs. A cluster headache is felt on one side, either the right half or the left half of the head. Attacks are associated with redness and tears in the affected eye, congestion of nose and drooping eyelid on the side of a headache. This pain is more common in middle-aged adults.
Tension headache is felt as a band like discomfort around the head
3. Tension headache
This describes a syndrome of chronic pain that feels as if a band has been fastened tightly around the head. The head feels as if, it is in a vise and muscles at the back of the neck are tight. Pain builds up slowly and fluctuates in severity. At times, it is mild, at others very severe. Pain may persist continuously for many days. Anxiety or depression may coexist with a tension headache. This pain is more common in young adults, especially females. A headache is accompanied by poor concentration. It is exacerbated by emotional stress, fatigue, noise or glare. Techniques to induce relaxation, such as massage, hot baths and biofeedback are beneficial. Exploring the underlying cause of chronic anxiety and finding a solution to it is often rewarding.
4. Depression headache
In this condition, head pain is worse early in the morning, and may be accompanied by other symptoms of depression.
5. Lumbar Puncture headache
In this variant, the head pain occurs after a lumbar puncture procedure (in which a needle is injected at or below the interspace of L2-L3 vertebrae to aspirate the spinal fluid for analysis). Pain begins within 48 hours of the procedure, but may be delayed for up to 12 days. It does not occur in all the individuals who have to go through a lumbar puncture but affects only 10-30% of them. This pain has a special positional component, in that, a dull pain develops in the form of a band around the head when the person sits or stands up. It gets relieved on lying down or pressing on the abdomen. The longer the person stands, the longer would be the latency before a headache subsides. It gets worsened by shaking the head. Nausea or giddiness, neck stiffness, blurred vision, photophobia (inability to tolerate bright lights), a ringing of ears and vertigo, may accompany a headache, that may persist for days to weeks to months. Due to lumbar puncture, the cerebrospinal fluid that forms a supporting cushion of the brain is reduced in volume. This causes stretch and tension on pain sensitive areas of the brain when the person stands upright, resulting in pain.
6. Post concussion headache
This headache occurs after seemingly mild head injuries, particularly after rear-end motor vehicle collisions. It is usually a constant dull ache, with superimposed throbbing, that may be localized, or generalized. Head pain occurs along with dizziness, vertigo, impaired memory, anxiety, irritability and difficulty in concentrating on any subject matter. Disequilibrium, sometimes with a rotatory component, may occur. The pain may resolve after weeks or persist for months and years after the injury.
Have you ever had a severe headache ?
7. Temporal Arteritis
This is an inflammatory condition caused due to swelling of arteries (especially extracranial carotid circulation). It commonly affects elderly women. If untreated, the swelling spreads to involve the ophthalmic artery supplying blood to the eyes. A headache occurs along with muscle pains, jaw claudication, fever and weight loss. Head pain presents in the temple region and is associated with muscle pain, morning stiffness, pain in shoulders and hips, and a sense of feeling unwell. It develops gradually and reaches a peak intensity in a few weeks. It is a dull and boring pain, with superimposed episodic ice pick-like lancinating pain. The pain is superficial. The scalp is extremely tender to touch, to the extent that, even combing the hair or resting the head on a pillow becomes impossible due to severe pain.It is worse at night and aggravated by exposure to cold. The overlying skin gets reddened or develops red streaks or painful swellings.
Common Types Of Headache
Migraine with or without aura
On forehead or around temples; uni- or bilateral
Onset after awakening, quelled by sleep, duration : hours to days
Less frequent and less severe with aging
Lateralized; around the eye or in temple region
1-2 attacks per day, Associated with red eye or stuffy nose on the side of pain
Daily attacks for around 6 weeks with annual recurrence of bout.
Nondescript, tight band like discomfort
Cycles of several years
Interrupts sleep, unrelieved by sleep, steadily worsening pain, may be preceded by days to weeks of nausea and vomiting
Continuous pain lasting weeks to months
8. Cough headache
This is a transient severe head pain that occurs on coughing, bending, lifting weights, stooping or sneezing (anything that may increase pressure in the head). A cough headache mostly affects men. It persists for a few seconds to minutes. The initial attack dates back to a lower respiratory infection that was accompanied by a severe cough or strenuous weightlifting programs. A serious structural abnormality of the brain is present in some people suffering from this pain.
9. Brain tumor headache
In around 30% brain tumor sufferers, an intermittent, deep, dull headache of moderate intensity, is present. The pain gets aggravated on exertion or change in position. It is associated with nausea and vomiting. Headaches may even disturb sleep. Vomiting may precede the appearance of headaches by several weeks. Headaches do not have any age or sex predilection. They are unrelieved by sleep.
10. Pseudotumor cerebrii
This is a non-cancerous condition in which pressure inside the head is raised due to impaired absorption of cerebrospinal fluid that surrounds and insulates the brain from external injuries. Pain resembles that of brain tumor and is accompanied by disturbances of vision. It affects mostly young obese females.
11. Headache due to neurological disorders
A severe bout of headache may accompany brain hemorrhage and infection of its covering meninges (meningitis).
12. Headache caused by other illnesses
Certain diseases are characteristically associated with headaches. These include infectious mononucleosis, SLE (systemic lupus erythematosus), chronic respiratory failure with increased carbon dioxide levels (hypercapnia with early morning headaches), Hashimoto's thyroiditis, Inflammatory bowel disease and a sudden increase in blood pressure that occurs in some cancers (such as pheochromocytoma). In people suffering from high blood pressure, headache presents when diastolic or the lower reading reaches 120 mm Hg.