Headache Classification & Migraine

Introduction:

There is no one on this earth who did not suffer from any type of headache in his lifetime. Fortunately, most kinds of headaches are benign or harmless in nature. There are only a few kinds of headaches, which are serious. Thank god, they are really very rare. Probably you are not suffering from such.

How to know which headaches are dangerous headaches?

If you notice any of the following symptoms, it may be serious. Consult your doctor.
1. Sudden onset of severe headache.
2. It is a new type of headache that you have never felt before.
3. Your headache is taking bad shape quickly.
4. Headache is associated with other symptoms like projectile vomiting, visual problems, weakness of one or both sides of the face/body, fever, etc.
5. Your headache is increasing with bending forword.
6. New kind of headache starting at an older age.
With these symptoms CT-scan or MRI- scan is required.

Types of headache:

There are two broad types of headache:

1) Primary- where exact reasons are not known. There are many hypotheses, postulations, but the exact cause of these types of headaches is still not understood. The common headaches of these categories are following:

1. Tension-type headache (Know more about tension-type headache)
2. Migraine (Know more about common migraine and classical migraine)
3. Cluster headache (Know more about Cluster headache)

2) Secondary- where the headache is a symptom of some other diseases. Like a common cold, fever, eye strain, cervical spondylosis, or, rarely cancer. Below are few common types of secondary headaches:

1. Cervicogenic headaches (Know more) due to pathologies in the neck or,
2. Occipital Neuralgia (Third occipital neuralgia is one of them)

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Best headache treatment in Kolkata by best headache doctors in Kolkata

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Migraine is the commonest type of severe headache and we shall discuss details of it…

Migraine is the commonest type of headache that needs a visit to a doctor. It is also the commonest cause of severe headaches. Migraine headaches are different from other types of headaches. It can be diagnosed by their characteristics. Some history will help to determine whether an individual is suffering from migraines or not. These are : family history of migraines, age when the first attack occurred, and frequency and duration of headaches

Diagnosis of Migraine

The International Headache Society has laid down the guidelines to diagnose the two forms of migraine headaches:

1. Migraine without aura (common migraine)

2. Migraine with aura (classic migraine)

Migraine without aura/ Common Migraine

I. At least five attacks per year that last 4 to 72 hours
II. At least two of the following headache symptoms:

1. Pain on one side of the head
2. Pulsing/throbbing pain
3. Moderate-to-severe intensity that inhibits or prohibits one’s ability to work
4. Aggravation of pain by physical activity, such as climbing stairs etc.

III. At least one of the following associated symptoms:

1. Nausea and/or vomiting
2. Light/sound sensitivity (Intolerance to light and/or sound)

IV. No evidence of any other diseases that may cause these symptoms

Migraine with aura (classic migraine)

I. At least two attacks per year
II. At least three of the following symptoms:

1. One or more of the following aura symptoms that later subside.
Aura symptoms are:

a. Alterations in vision
b. Numbness or tingling in the face, arm, or hand on one side of the body
c. Muscular weakness or mild paralysis on one side of the body
d. Difficulty speaking or loss of speech.
2. Gradual development of at least one aura symptom over more than four minutes or two or more symptoms that occur at the same time
3. Aura symptoms that last no more than 60 minutes
4. Headache that occurs simultaneously with aura symptoms or follows aura within 60 minutes

III. No evidence of any other diseases that may cause these symptoms

Whare the pahases of Migraine?

Researchers believe that migraine attacks have four distinct phases. These phases are:

I. 1st phase or prodrome

It is experienced by 60% of patients with migraine headache. It starts hours or days before an attack of migraine. Many physical and psychological symptoms are seen in this phase. These symptoms vary between the individuals but remain consistent for a particular individual.

The symptoms include:

1. Stiff neck
2. Cold feeling
3. Sluggishness / Mental slowing / Fatigue
4. Hyperactivity / Restlessness
5. Dizziness / Drowsiness /Irritability
6. Increased thirst
7. Increased urination
8. Loss of appetite
9. Diarrhea / Constipation
10. Fluid retention
11. Food cravings
12. Sensitivity to light and/or sound
13. Depression
14. Euphoria

II. 2nd phase or aura

Aura is experienced by 20% of migraineurs. They are suffering from classic migraine. Just before the migraine attack they experience aura. It develops 5 to 20 minutes before a migraine attack and lasts less than an hour.
Aura symptoms include:

1. Scintillation scotomas- These are a bright rim of light around an area of visual loss. There will be flashing lights or jagged lines that block the visual field.
2. Visual resizing or reshaping of objects.
3. Numbness or tingling of the face, arm, or hand on one side of the body.
4. Muscular weakness.
5. Mild paralysis on one side of the body.
6. Difficulty speaking or loss of speech.

III. 3rd phase or phase of migraine headache

Symptoms of migraine headaches are different from other headaches.
Symptoms that distinguish migraines from other headaches:

1. Headache on one/both side of the head, behind /around the eyes, posterior or occipital area. Or, it may be generalized.
2. Intensity of pain is moderate to severe and worsened by physical activity
3. Loss of appetite /Nausea /Vomiting
4. Intolerant to light, sound, or odors
5. Blurry vision /Blocked nose /Pale face
6. Sensations of heat or coldness /Sweating
7. Tenderness of the scalp
8. Prominence of veins or arteries in the temple
9. Impaired concentration /Depression /Fatigue /Nervousness /Irritability

IV. 4th phase or postdrome

Some individuals may experience the following symptoms after a migraine attack:
Fatigue /Irritability /Impaired concentration /Scalp tenderness /Mood changes.

Management of Migraine:

I. Preventive Treatment

a. Preventive medicines:

It is indicated in the following situations

1. Migraines occur twice a month, producing disability that lasts three days or longer
2. Medication that treats symptoms or tries to stop an attack are not best for patients or are not working
3. Pattern of migraine attacks are predictable, such as menstrual migraines

Medicines commonly used are Flunarizine, Propranolol, Methysergide, Amitriptyline, Carbamazepine, Divalproex sodium etc.

b. Interventional Pain Management:

Injections of Botulinum Toxin in the scalp prevent migraine attacks for a prolonged period.

Sphenopalatine ganglion block also keeps the patient symptom free for long time.

II. Avoidance of triggers

Researchers have found that trigger factors often provoke migraine attacks. Studies have shown that avoiding these trigger factors are helpfull. This can reduce the frequency of migraine attacks by half. They are as follows:

Foods Aged cheese, Alcohol, MSG, Chocolate, Caffeine, Hot dogs, Bacon, Luncheon meats, Avocado, Fermented or pickled foods, Yeast or protein extracts, Onions Nuts, Aspartame.
Medications Antibiotics, Antihypertensives, H2 blockers, Vasodilators.
Hormonal Factors Menstruation, Oral contraceptives, Hormone replacement therapy
Lifestyle Factors Delaying or skipping meals, Changes in sleep patterns, Stress
Environmental Changes Weather changes, High altitude, Time zone changes like jet lag.

III. Abortive Treatment

There are certain medicines used to abort the attacks of migraine headaches:
Cerebral vasoconstrictors: ergotamine tartrate, dihydroergotamine, sumatriptan, zolmitriptan etc.
Non-vasoconstrictors: Butorphanol and other narcotic analgesics.

Interventional Pain Management: Spheno-palatine Ganglion block abort acute attack of migraine.

IV. General pain management

Simple analgesics like Paracetamol, Aspirin to other NSAIDs and opioids like codeine, tramadol etc.