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Headaches are of 3 kinds:

  • Primary Headache
  • Secondary Headache
  • Neuropathy, Facial pain, and other types of headaches

Primary Headache

*Migraine

*Tension-Type Headache

*Trigeminal autonomic cephalalgias

* Other primary Headache disorders:  According to The International Classification of Headache Disorders, 3rd edition, primary headache disorders are as follows:

  • Primary cough headache
  • Probable primary cough headache
  • Primary exercise headache
  • Probable primary exercise headache
  • Primary headache associated with sexual activity
  • Probable primary headache associated with sexual activity
  • Primary thunderclap headache
  • Cold-stimulus headache
  • Headache attributed to external application of a cold stimulus
  • Headache attributed to ingestion or inhalation of a cold stimulus
  • Probable cold-stimulus headache
  • Headache probably attributed to external application of a cold stimulus
  • Headache probably attributed to ingestion or inhalation of a cold stimulus
  • External-pressure headache
  • External-compression headache
  • External-traction headache
  • Probable external-pressure headache
  • Probable external-compression headache
  • Probable external-traction headache
  • Primary stabbing headache
  • Probable primary stabbing headache
  • Nummular headache
  • Probable nummular headache
  • Hypnic headache
  • Probable hypnic headache
  • New daily persistent headache (NDPH)
  • Probable new daily persistent headache

Secondary Headaches

  • Headache attributed to trauma or injury to the head and/or neck
  • Headache attributed to cranial and/or cervical vascular disorder
  • Headache attributed to non-vascular intracranial disorder
  • Headache attributed to a substance or its withdrawal
  • Headache attributed to infection
  • Headache attributed to disorder of homeostasis
  • Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structure
  • Headache attributed to psychiatric disorder

What causes Primary Headache?

Primary headaches are not related to any anatomical or physiological abnormalities. Inflammation or infection are not connected to primary headaches as well.

Migraine

In the 2016 Global Burden of Disease Study, migraine was listed as the sixth most prevalent out of 328 diseases and injuries assessed. It is a recurrent headache disorder.

Migraine
  • Usually affects the population aged 22-55 years.
  • Affects women more than men.
  • Tends to run in families thus considered a genetic disorder.

The exact cause of migraines is unknown, but they’re thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain. Migraine attacks can be triggered by a variety of factors. Common triggers include:

  • Emotional stress.
  • Missing a meal.
  • Sensitivity to specific chemicals and preservatives in foods
  • Caffeine
  • Daily use of pain-relieving medications
  • Hormonal changes in women.
  • Light.
  • Changing weather conditions
  • Being overly tired. Overexertion.
  • Dieting, or not drinking enough water.
  • Changes in your normal sleep pattern.
  • Loud noises.
  • Exposure to smoke, perfumes or other odors etc.

Tension-type Headache

These headaches often cause mild-to-moderate pain around the head, face, or neck. Also known in short as TTH, it is of 4 types:

  1. Frequent
  2. Infrequent
  3. Chronic
  4. Probable

Usually, the female population suffers the most from TTH. There is no exact reason found behind this type of headache occurring. But it is estimated that tightening the muscles of the back of the head and/or neck might be one of the causative factors. Eye strain, such as from staring at a computer screen for a long time, Pain in other parts of your head and neck caused by problems such as temporomandibular disorders, Insomnia, Stress related to family and/or work, etc might trigger Tension-type headache.

Trigeminal Autonomic Cephalalgias(TAC)

  • There are five different types of TACs:
  • Cluster headaches
  • Paroxysmal hemicranias
  • Short-lasting Unilateral Neuralgiform Headache Attacks (either with conjunctival injection and tearing (SUNCT) or cranial autonomic symptoms (SUNA))
  • Hemicrania continua
  • Probable TAC

Cluster headache is more common than the other types of trigeminal autonomic cephalgia. The exact cause of cluster headaches is not clear, but they have been linked to activity in the part of the brain called the hypothalamus.

  • People who smoke seem to have a higher risk of getting cluster headaches.
  • Some people who get cluster headaches have other family members who also get them, which suggests there may be a genetic link.
  • Cluster headache attacks can sometimes be triggered by drinking alcohol or by strong smells, such as perfume, paint, or petrol.

Primary Headache Disorders

  • Running, jogging, weight lifting might trigger Primary exercise headaches.
  • Drinking cold water in summer, ice cream might trigger a Cold-stimulus headache.
  • Pressure on the head from the helmet or goggles might trigger an External-pressure headache, External-compression headache.
  • Irritation at the nerve ending of the trigeminal nerve might initiate Primary Stabbing Headache.
  • Torn or ruptured blood vessels in the brain, Stroke (blocked or bleeding blood vessel), Brain aneurysm (bulging or bleeding blood vessel), Head injury that causes a brain bleed, Vasculitis (swollen blood vessel), Infection in the brain such as encephalitis or meningitis, Sudden severe rise in blood pressure, Late-term pregnancy complications including a rise in blood pressure and bleeding in the brain’s pituitary gland during pregnancy or soon after delivery, Spasms in the blood vessels around the brain (vasoconstriction syndrome) might be the causes behind the occurrence of thunderclap headaches
  • Hypnic headache is a rare type of headache. It only occurs when you are sleeping and will cause you to wake up. It is often referred to as an ‘alarm clock’ headache because it happens at the same time several nights of the week. Some people experience it every night. According to the sleep foundation, melatonin production is related to hypnic headaches. Because hypnic headaches occur at the same time each night, some researchers believe there may be a disturbance to the underlying rhythms that regulate melatonin production, which causes lower melatonin levels and, subsequently, hypnic headaches.

Reasons for Secondary Headache

A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions — varying greatly in severity — may cause secondary headaches.

Possible causes of secondary headaches include:

  • Acute sinusitis (nasal and sinus infection)
  • Arterial tears (carotid or vertebral dissections)
  • Blood clot (venous thrombosis) within the brain
  • A brain aneurysm (bulge or ballooning in a blood vessel in the brain)
  • Brain arteriovenous malformation (a tangle of abnormal blood vessels connecting arteries and veins in the brain)
  • Brain tumor (Acoustic neuroma, Astrocytoma, Brain metastases, Choroid plexus carcinoma, Craniopharyngioma, Embryonal tumors, Ependymoma, Glioblastoma, Glioma, Medulloblastoma, Meningioma, Oligodendroglioma, Pediatric brain tumors, Pineoblastoma, Pituitary tumors, rtc.)
  • Carbon monoxide poisoning
  • Chiari malformation (structural problem at the base of your skull)
  • COVID-19 positive
  • Dehydration
  • Dental problems
  • Ear infection (middle ear)
  • Encephalitis (brain inflammation)
  • Giant cell arteritis (inflammation of the lining of the arteries)
  • Glaucoma
  • High blood pressure (hypertension)
  • Influenza (flu) and other febrile (fever) illnesses
  • Intracranial hematoma
  • Medications to treat other disorders
  • Meningitis
  • Monosodium glutamate (MSG)
  • Overuse of pain medication
  • Panic attacks and panic disorder
  • Pseudotumor cerebri
  • Stroke
  • Toxoplasmosis
  • Trigeminal neuralgia (as well as other neuralgias, all involving irritation of certain nerves connecting the face and brain)

Physiotherapy is the most commonly used non-pharmacologic evidence-based treatment of TTH, alongside other types of headaches.

What causes Headache?-1
What causes Headache?-2

Cervical exercises, relaxation, massage, postural exercises, craniocervical techniques, thermotherapy, vertebral mobilization, and stretching are effective in reducing symptoms such as pain frequency and intensity. 

Dr. M Shahadat Hossain
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