Headache
A headache is also referred to as cephalalgia is the pain symptom of the face head or neck. It may be a migraine, tension-type headache, or cluster headache. Severe headaches are at higher risk for depression.
Headaches may result from numerous conditions. There are several various classification systems for headaches. The best known is that of the International Headache Society, that categorizes it into over 150 forms of primary and secondary headaches. Symptoms of headaches could be due to dehydration fatigue sleep deprivation the influence of medications and recreational drugs, including withdrawal; viral infections, loud noises, head trauma, rapid consumption of a very cold food or liquid and dental and sinus problems.
Treatment of headache varies with the cause but often includes painkillers, particularly in the case of migraine or cluster headaches.A headache is one of the most frequently occurring of all bodily discomforts.
Half of all adults experience a headache in any one year. Tension headaches are the most frequent occurring in around 1.6 billion individuals followed by migraine headaches occurring in around 848 million.
MIGRAINE
Migraine captures an ever-expanding array of headache presentations from the usual, characteristic, periodic attacks to various variant forms, such as a daily persistent form. There is increasing support for an idea proposing that migraine constitutes a wide clinical spectrum or continuum, which on one side is an intermittent occasional migraine with aura and on the other is daily persistent pain akin to the old categorization of chronic tension.
TENSION TYPE HEADACHE
While still a matter of controversy, most headache experts are of the opinion that what has been classically referred to as tension headache, or, more recently, tension-type headache, is a variant of migraine. Symptomatically, there is much overlap between the characteristics of tension-type headache and migraine. A high percentage of patients with tension-type headache actually experience superimposed periodic episodes of classical migraine in addition to their daily or near-daily pain.
Tension-type
MIGRAINE, TENSION TYPE HEADACHE AND COMORBIDITIES
It is now clear that most patients with migraine are afflicted with one or more of a broad range of neuropsychophysiologic disorders in addition to headache. The disorders, now termed comorbid disorders of migraine, seem to occur simultaneously with migraine in a prevalence much higher than would occur by chance alone. These disorders are now thought to have some neurophysiologic features in common with disorders of headache, thought to represent central perhaps brain
CLUSTER HEADACHE
Cluster headache like migraine is a ruinous, agonizing disease that largely involves men more than women in which daily attacks of 0.5 hour to 1.5 hours occur for weeks, months, or years at a stretch. Eight or more attacks may happen per day.
The term cluster headache was first used to explain the clustering or series of series of painful attacks in which the cycle of headache takes place for some duration of time commonly several months then spontaneously remits into a period.
Symptoms of headache
Health-related quality of life assesses the effect of a disease on the physical emotional and social functioning of the patient. The value of assessing HRQoL among patients with chronic conditions has emerged as a field of study in clinical practice since it gives the patient’s own perception of the effect of his or her disorder. Different generic instruments have been designed to assess HRQoL that can be applied to all types of disorders and thus facilitate comparisons with other diseases and also with healthy subjects.
In the headache community most of the activity concerning HRQoL has centered largely on migraine since it is the most common primary headache diagnosis. Although there is no physical abnormality present the character of the attacks with their episodic pain and concomitant symptoms too often affects the patient’s normal functioning.
The World Health Organization in its 2000 Global Burden of Disease study stated that migraine ranked in the top 20 list of causes of disability across the globe. Migraine-specific HRQoL questionnaires have therefore been created to quantify the domains of life that could be impacted in this population of patients. the 24 hours Migraine Quality of Life Questionnaire. In addition to this various headache disability scales that measure disability caused by headaches such as the Migraine Disability Assessment Scale the Headache Impact Test and the Henry Ford Headache Disability Inventory exist.
Despite the fact that disability and HRQoL are distinct concepts they do have close association with each other and measurement of disability is usually incorporated in HRQoL measurement.
Meanwhile HRQoL in other primary headache disorders like tension-type headache and cluster headache have been underinvestigated and disease-specific instruments for them are not yet available. We systematically reviewed the literature with two overall aims to measure HRQoL in primary headache disorders and 2 to determine factors potentially affecting HRQoL in these disorders.
Old headaches
Old headaches are typically primary headaches and are not harmful. They are most commonly due to migraines or tension headaches. Migraines are typically unilateral, throbbing headaches with nausea or vomiting. There can be an aura visual symptoms, paresthesias 30 60 minutes prior to the headache, warning the individual of a headache. Migraines can also not be auras. Tension-type headaches tend to have bilateral bandlike pressure in both sides of the head typically without nausea or vomiting. But some symptoms in both headache groups overlap. It is worth differentiating the two since treatment is different.
The mnemonic POUND differentiates between migraines and tension-type headaches. POUND is an acronym for
One review article discovered that when 4–5 of the POUND features are present, a migraine is 24 times more likely to be a diagnosis than a tension-type headache. If 3 features of POUND exist, migraine is 3 times more probable a diagnosis than tension type headache. If there are only 2 features of POUND, tension-type headaches are 60% more likely. Another study has reported that the following independent factors each add to the likelihood of migraine as opposed to tension-type headache nausea, photophobia, phonophobia, worsening with physical activity, unilateral, throbbing quality, chocolate as a trigger for headache, and cheese as a trigger for headache.
Primary headache disorders, including migraine and cluster headache are ubiquitous and frequently disabling. When preventive treatment is required, multiple oral agents are employed. Patients have low persistence and adherence on their preventive therapy. The availability of treatments that block calcitonin gene-related peptide CGRP is expected to usher in a new era. Besides, non-triptan serotonin receptor agonists, novel delivery systems for established therapies, and new devices are other promising developments in acute and preventive migraine and cluster treatment and will also be covered in this review.
Preventive treatment of migraine
Medications for the prophylactic treatment of migraine belong to numerous classes. Before the creation of the drugs acting on the CGRP ligand/receptor,r only one fairly selective migraine prophylactic drug existed – methysergide, which is no longer prescribed anywhere in the world because of severe side effects: retroperitoneal fibrosis.
In 2012, the American Headache Society and the American Academy of Neurology AAN created a guideline that evaluated the degree of efficacy of preventives available. The following have Level A evidence demonstrated efficacy with two high-quality trials demonstrating efficacy topiramate, metoprolol, propranolol, divalproex sodium, botulinum toxin A.
Amitriptyline was given a level B rating likely effective because of low completion rates in the trials included. All of these oral medications are easily accessible and quite affordable and should thus be the initial choice for patients with low-resource settings. The selection of which one to initiate should be tailored to each patient depending on their comorbid medical conditions, side effect profile, the patients preference, and individual factors in women of childbearing age, divalproex sodium should be avoided since it is extremely teratogenic.
On average, about 50 60% of the patients treated with any of these drugs will have a 50% reduction in headache frequency, and the doses used for such an effect tend to be associated with intolerable side effects