Headaches & Its Treatment

treatment of headache

Migraine Headache Headaches & Management


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.

Migraine HeadacheHow 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.

Migraine HeadacheTypes 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) 

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

Migraine HeadacheMigraine is a 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 and can be diagnosed by their characteristics. Family history of migraines, age when the first attack occurred, and frequency and duration of headaches will also help to determine whether an individual is suffering from migraines or not.

Migraine HeadacheDiagnosis of Migraine

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

1. MigraineMigraine without aura (common migraine)

2. MigraineMigraine with aura (classic migraine)

Migraine HeadacheMigraine without aura/ Common Migraine

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

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

III. MigraineAt least one of the following associated symptoms:

1. MigraineNausea and/or vomiting
2. MigraineLight/sound sensitivity (Intolerance to light and/or sound)

IV. MigraineNo evidence of any other diseases that may cause these symptoms

Migraine HeadacheMigraine with aura (classic migraine)

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

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

a. MigraineAlterations in vision
b. MigraineNumbness or tingling in the face, arm, or hand on one side of the body
c. MigraineMuscular weakness or mild paralysis on one side of the body
d. MigraineDifficulty speaking or loss of speech.
2. MigraineGradual development of at least one aura symptom over more than four minutes or two or more symptoms that occur at the same time
3. MigraineAura symptoms that last no more than 60 minutes
4. MigraineHeadache that occurs simultaneously with aura symptoms or follows aura within 60 minutes

III. MigraineNo evidence of any other diseases that may cause these symptoms

Migraine HeadacheMigraine Phases
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. MigraineStiff neck
2. MigraineCold feeling
3. MigraineSluggishness / Mental slowing / Fatigue
4. MigraineHyperactivity / Restlessness
5. MigraineDizziness / Drowsiness /Irritability
6. MigraineIncreased thirst
7. MigraineIncreased urination
8. MigraineLoss of appetite
9. MigraineDiarrhea / Constipation
10. MigraineFluid retention
11. MigraineFood cravings
12. MigraineSensitivity to light and/or sound
13. MigraineDepression
14. MigraineEuphoria

II. 2nd phase or aura

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

1. MigraineScintillation scotomas, which are characterized by a bright rim of light around an area of visual loss and flashing lights or jagged lines that block the visual field.
2. MigraineVisual resizing or reshaping of objects.
3. MigraineNumbness or tingling of the face, arm, or hand on one side of the body.
4. MigraineMuscular weakness.
5. MigraineMild paralysis on one side of the body.
6. MigraineDifficulty 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. MigraineHeadache on one/both side of the head, behind /around the eyes, posterior or occipital area, or it may be generalized.
2. MigraineIntensity of pain is moderate to severe and worsened by physical activity
3. MigraineLoss of appetite /Nausea /Vomiting
4. MigraineIntolerant to light, sound, or odors
5. MigraineBlurry vision /Blocked nose /Pale face
6. MigraineSensations of heat or coldness /Sweating
7. MigraineTenderness of the scalp
8. MigraineProminence of veins or arteries in the temple
9. MigraineImpaired 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.

Migraine HeadacheManagement of Migraine:

I. Preventive Treatment

a. MigrainePreventive medicines:

It is indicated in the following situations

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

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

b. MigraineInterventional 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 could reduce the frequency of migraine attacks by half. They are as follows:

MigraineFoods Aged cheese, Alcohol, MSG, Chocolate, Caffeine, Hot dogs, Bacon, Luncheon meats, Avocado, Fermented or pickled foods, Yeast or protein extracts, Onions Nuts, Aspartame.
MigraineMedications Antibiotics, Antihypertensives, H2 blockers, Vasodilators.
MigraineHormonal Factors Menstruation, Oral contraceptives, Hormone replacement therapy
MigraineLifestyle Factors Delaying or skipping meals, Changes in sleep patterns, Stress
MigraineEnvironmental 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.

MigraineInterventional 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.