Headaches & Migraines
Headaches are classified and ultimately treated because they fall under a particular category. In 1988, the International Headache Society (a group of headache specialists world-wide) formed a classification system to help professionals categorize headaches. The greatest benefit to you and your physician is to learn the abundance of features that will make headache classification more likely.
Migraine with Aura
This type of headache, also referred to as "classic migraine", is a type of headache that is accompanied or preceded by an aura (neurological symptoms). Approximately 10% of all migraine sufferers fall under the category "migraine with aura". Bizarre sensory disturbances, 10-30 minutes prior to the headache phase, suggest migraine with aura. The "aura" can be zig-zag lines or spots in the field of vision, tingling of the skin, dizziness, confusion, or blurred vision. The headache usually lasts 4-72 hours, but may be completely absent-suggestive of a condition known as "migraine equivalents" (which many think of as a stroke).
Migraine without Aura
Also known as "common migraine" this headache type (as with other types of migraine) has a 75% rate among women- largely due to the hormonal connection with estrogen. Headaches associated directly with the menstrual period are referred to as menstrual migraine). Migraine without aura typically lasts 4-72 hours, is most-often one-sided, and is frequently associated with nausea and vomiting. The pain sensation is generally throbbing or pounding in nature, with a moderate to severe intensity (limits daily activity). Most migraine sufferers fall under this category. Studies at major headache clinics suggest 60% of migraine sufferers have never been properly diagnosed. Over-the-counter pain medicines (typically designed for tension-type headaches) used to treat migraines, can sometimes lead to rebound headaches or a new headache condition referred to as daily chronic headache.
TENSION HEADACHES
This headache type has been also called "muscle contraction headache" since many researchers have cited neck and muscle pain as the origin of the headache. Many physicians now believe that muscle stiffness is the outcome of a chemical change in the brain. This new theory makes sense since many agents used to treat migraine (vascular headache) also work well to control and eliminate tension headache pain. The typical features of tension headache are that they last 30 minutes to 7 days, generally a 2-sided, band-like headache (may not be any neck pain), pressing, tightening, non pulsating pain that does not seem to get worse with activity (unlike migraine). The pain is usually mild to moderate in nature. The belief that stress is the underlying cause and once eliminated, will discontinue the headache, has been proven false by millions of people. Unquestionably, stress does play a role in your ability to minimize and control headache pain. However, the cause and effect of stress and it's overexaggerance among non-traditional therapists is currently challenged by many headache specialists. 70-90% of the population suffers from the occasional tension-type headache.
CLUSTER HEADACHES
This type of headache has also been called "suicide headache" or "ice-pick headache" due to the extremely excruciating stabbing pain felt in the eyeball area of the sufferer. The name "cluster" was chosen to identify these headaches which come in a series or succession for months at a time. Most cluster sufferers experience a period of remission, where the headaches mysteriously disappear (months or years)and then to only re-appear. Occasionally, the chronic form develops referred to as "chronic cluster headache". Cluster headaches have been connected to REM sleep and are caused because of a lack of oxygen and dilated blood vessels. Cluster headache pain is described as a red hot poker being pushed through the eyeball of the sufferer. A teary eye and a blocked or discharged nostril are also common symptoms. Due to the mysteriousness and ferocity of these headaches, many sufferers suspect, or are advised, of a pinched nerve, or neck injury. Nasal surgery has been incorrectly performed in some cases of mistaken headache diagnosis.
REBOUND HEADACHES/ MEDICATION-INDUCED HEADACHES
Many sufferers develop "rebound headaches" from taking too much pain medicine, too often. The daily or frequent use of over-the-counter (OTC) medicines can often lead to this condition. Researchers suggest medication with caffeine or ergotamine are particularly at fault. The pain associated with rebound headaches is a pressing, dull, diffuse pain that is typically felt all over the head (much like tension-type). Rebound headaches are usually worse in the morning hour and often can be felt on the front or of the head. Typically, a cycle of medication use, followed by partial headache relief, followed by another headache, can be suggestive to "rebound / medication-induced headaches".
SINUS HEADACHES
Many people falsely suspect they suffer from "sinus headaches" since they feel headache pain in the facial area. Similarly, a blocked nostril or stuffy feeling leads many sufferers to self-diagnose the condition, sinus headache. Most often this description does not prove to be sinus headache. Headaches caused from sinus infection are usually associated with a low grade fever and can be detected from an x-ray of the sinus cavity. Antibiotic treatment will clear up the problem if the headaches are caused from sinus infection. Migraine pain typically causes pressure and headache in the facial area and can be confused for sinus pain. Headache associated with allergies are also quite uncommon.
HEADACHES CAUSED BY HEAD INJURY
These headaches are typically felt as a steady ache affecting both sides of the head and occurring daily or almost everyday (similar to chronic tension-type headache). The pain is usually of slight to moderate intensity. Bouts of severe or moderately severe headache may also occur and these are often similar to, if not identical, with "migraine" (one-sided throbbing pain with nausea and sensitivity to light and noise). Dizziness, ringing of the ears, vague blurring of vision, depression, anxiety, and sleep disturbance are only a few of the associated complaints surrounding "head injuries". Headache immediately following a head injury usually clears after minutes or days, but occasionally "post traumatic headaches" develop from months of headache suffering. It is rare for a headache triggered from a bump on the head, to be present 6 months after the closed head injury.
RARE HEADACHES
Rare headaches can be secondary to some underlying disease or medical ailment. Usually, once the condition is sped - the secondary headache goes away. Some examples of rare headaches may include:
Chronic Paroxysmal Hemicrania (cluster-like symptoms found almost always in females and highly treatable with Indomethacin). It is normally short-lasting, multiple attacks that may last 2-10 minutes several times a day.
"Ice-Cream Headache" The official term for this type of headache is "cold stimulus" headache because it occurs between the eyes after eating or drinking something very cold. It does not last any longer than five minutes and may be prevented by eating ice cream slowly, small amounts, and by letting it melt in the mouth before swallowing.
Sex or Exertional Headache (Coital Headache)
Mostly a male problem - this benign headache is usually a sudden, severe, throbbing pain over the back of the head or over the entire head. This condition usually only lasts for a few minutes and can be associated with sexual exertion.
Ice-Pick like Pains or "Jabs and Jolts"
These stabbing brief episodes of pain can be felt at anytime, anywhere in the head area. The cause of these headaches remains to be a mystery.
Migraine Equivalents (Migraine without the headache)
These stroke-like symptoms can occur at any age. These headaches are more common in children than in adults and therefore are difficult to diagnose. People with the classical migraine (migraine with aura), they may find that the aura symptoms continue to recur, as they age, but often without the subsequent headache.
Another common headache is called Cervicogenic Headache. The major criteria of Cervicogenic Headache is symptoms and signs of neck involvement. Certain neck movements or sustained awkward head postures will cause head pain. There may be restricted range of motion in the neck. The headache is usually one sided in the neck, shoulder or arm and does not shift sides. The characteristics are moderate to severe, non-throbbing and non-lancinating pain, usually starting in the neck.
DR. TUCKER'S RECOMMENDED TREATMENT FOR HEADACHES
Dr. Tucker's management and treatment approach to headache starts with a proper and through evaluation and examination. Treatment for headaches by me can include:
- Massage the sore, tight, achy muscles
- Mobilization of cervical joint dysfunction
- Make posture recommendations
- Treat nerve compression (vascular, mechanical) if it is associated with headache
- Use physical therapy modalities i.e. Ultrasound, Electrical stimulation
- Recommend natural pain killers and nutritional advice
- Train you in low load exercises, which address muscle impairment linked with joint pain and dysfunction
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