Headache

=Headache=

What it is
A headache is experienced when various structures of the head and neck are irritated. The sensation of pain can be ‘referred’, which means the irritation in one area can transmit the feeling of pain via associated nerves to another area. A good example is neck pain leading to headache.

- Medications: oestrogen (including combined oral contraceptives), calcium channel blockers, nitrates, NSAIDs (particularly indomethacin), and some erectile dysfunction drugs (sildenafil, tadalafil and vardenafil) - Stress: tightens the muscles of the neck, head, upper back and shoulders. Also lowers the tolerance to pain - Hormone changes: migraine usually occurs in the few days prior to or following a woman's menstrual period - Caffeine withdrawal - Food additives: MSG - Drug use and withdrawal (including analgesics, caffeine, alcohol) - Neck problems, jaw and dental problems, - Eyestrain: Long-sightedness people tend to squint and strain the eye muscles in order to better focus their vision - Blood-pressure problems: including dehydration - Sinus problems, from colds or allergy, can cause chronic headache.
 * Causes:**

Health problems triggering headaches need to be properly identified and treated. Other causes, such as foods, may be able to be avoided or minimised.

Symptoms
- Heaviness, a band-like tightness or feeling of pressure around the head - Non-throbbing, but can worsen to throbbing (mixed tension/migraine type headache) - No aura; nausea and vomiting are unusual - Bilateral
 * Tension headache**: //usually mild and short lived, although they can last up to a week//

- Occurs mainly in men. - Sharp, severe pain, centred around the eye and front of head, on one side. - Often occur at night, waking the sufferer from sleep. - Possible rhinorrhoea, congestion or watery eye on the affected side.
 * Cluster headache**: //shorter duration than migraines, 10 minutes - three hours, up to eight times a day over a period of weeks or months.//

Should be suspected when any acute migraine drugs, including combination analgesics (e.g. Mersyndol or Panadeine), are used 10 or more days per month. A diagnosis of probable medication-overuse headache is also specified if simple analgesics are used 15 or more days per month.
 * Medication-overuse headache**: //also known as rebound headache, drug-induced headache, or medication abuse headache//

How to Treat
Initial treatment is with a simple analgesic – ideally soluble for rapid onset of action. Higher doses are usually used – 600-900mg aspirin or 1-1.5g of paracetamol, four-hourly if required (up to max paracetamol 4g/day). Ibuprofen 800-1200mg or other NSAIDs can be used but have not been shown to be more effective than aspirin.

- Massage of tight neck muscles - Application of heat and physiotherapy - Neck stretching exercises - Decreasing caffeine intake - Regular exercise and relaxation exercises, tapes, etc.
 * Tension headache:**

Simple analgesics (paracetamol, aspirin, ibuprofen) are useful for short-term relief. Longterm use of analgesics for frequent headaches may result in medication-overuse headache (rebound headache). For persistent or frequent tension headaches and mixed tension/migraine type headaches amitriptyline and sodium valproate have been used.

//Preventive treatment needs to be started as soon as an attack cycle starts//. Acute treatment, such as analgesics or oral triptans, is of limited use as individual attacks may not last long enough for the dose to be effective. Subcutaneous sumatriptan may be useful. Intranasal preparations have been used on the affected side, but congestion can limit this route. Inhalation of 100% oxygen for 5-15 minutes provides relief in many patients. In some situations this is not practical, however.
 * Cluster headache:**

Treatment for medication-overuse headache should include withdrawal of the overused agent; this often needs specialist management from a pain or headache clinic. Depending on the severity of the syndrome, and the type of drugs overused, resolution may take weeks or even months
 * Medication-overuse headache:**

Other advice
Codeine should be avoided in headache and migraine, even though the addition of codeine ≥ 30 mg/dose may provide marginally better pain relief than aspirin or paracetamol alone. Codeine, as with other opioids, can worsen symptoms of nausea and vomiting and impede the absorption of other medications.

Combination analgesic preparations, but also more generally, codeine and other opioids, are associated with the development of medication-overuse headache, and for this additional reason are not recommended

- Headache that is ‘the worst I’ve ever had’ - Change in the pattern of your headaches, for example, from mild and occasional headaches to severe and frequent headaches; - A new type of headache - Sudden-onset headache - Progressively worsening headache over days or weeks - Accompanied by neck pain and fever (which can indicate meningitis), or by co-ordination problems, fits (convulsions), changes in personality, and weakness on one side of the body (which can indicate a serious brain disorder)
 * Seek medical attention**:

Additional Resources
[|Self-care Card: Headache] [|Facts behind the Fact Card - Headache and Migraine] [|NPS - Medicines for Headache and Migraine]: starting on page 6 [|NPS Newsletter - Headache and Migraine] [|Better Health - Headache: Some causes explained] [|Better Health - Headache: Treatment options] [|mydr.com.au - Headache: different types] [|Headache Australia - Types of Headache]: lists many types, including 'icecream headache' Headache and Migraine]]
 * Lecture Notes:**[[http://www.twango.com/download/pharmacyunisa.10121|