USF-COM
Department of Family Medicine
Patient Education Information on...
Headaches
by Rich Castellano, Class of 1999
Do
you suffer from Headaches ?
Tension
Headaches
Migraine
Headaches
Cluster
Headaches
Danger
Signs
Treatment
Websites
for more information
Index of
Patient Education Topics
Do
you suffer from Headaches ?
You’re not alone. Headaches
are among the most frequent reasons for a patient to consult his/her primary
care physician. Though headaches are usually not life-threatening,
they serve to disrupt the productivity of millions, and contribute significantly
to a diminished quality of life. Follow along with this brochure
to understand more about headaches, what are the warning signs, and what
are some of the treatments.
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Tension
Headaches
Tension Headaches tend to be
the most common. Recent studies have shown that up to 65% of men and 86%
of women suffer from tension headaches. Age of onset can range from
childhood to mature adults, and the location of the pain can be variable,
ranging from a specific area to diffuse tenderness, including jaw and neck
muscles. The pain usually is steady, with a gradual onset, is not
pulsatile, and can last from hours to days. The intensity is bothersome,
but usually will not prohibit one’s daily activities. Tension headaches
can be brought on by stress, prolonged inactivity, and emotional duress.1
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Migraine
Headaches
It is estimated that 17.6%
of women and 5.7% of males suffer from migraine headaches. Both children
and adults are at risk, and there is often a strong family history of migraines
in those who are affected. The location of the pain tends to be on
one side of the head (but can be bilateral), or behind the eye. Migraines
tend to be pulsatile, lasting from 4-48 hours, is often associated with
nausea and vomiting, and is occasionally preceded by a prodrome of visual
scotoma, or white spots before the eyes. It has been noted that migraines
can be brought on by stress, various foods (chocolate, red wine, caffeine),
menses, lack of sleep, high altitudes, and low blood sugar 2.
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Cluster
Headaches
Cluster headaches tend to occur
predominantly in men. They usually occur on one side of the head,
or around the eye. They can arise daily, weekly, or monthly, and
usually last from 10-15 minutes to a few hours. Unique to cluster
headaches are the symptoms of tearing of the eye, drooping of the eyelid,
and facial sweating on the affected side, as well as nasal congestion.
Rarely, these headaches are accompanied by nausea and vomiting. Ages
most susceptible range from 20 to 40 years old3.
Danger
Signs
-
Sever headache with a stiff
neck
-
Sudden severe headache
-
Headache with seizure or passing
out
-
New onset weakness or change
in personality with a headache
-
Headache in older person with
no history of headaches
If any one of these signs apply,
immediately contact your physician or dial 911.
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Treatment
The diagnosis and treatment
of headaches is best left to a trained physician.
Tension
headaches are
often treated with relaxation techniques, biofeedback, elimination of stressful
or precipitating factors, and use of tylenol or anti-inflammatory drugs
such as aspirin, motrin or naproxen. Possible side effects of the
anti-inflammatory drugs include peptic ulcers with prolonged usage.
For those who suffer from chronic tension headaches, there are other prescription
drugs available to prevent reoccurrence.
Migraine
headaches can also be treated in the same manner.
One particular study revealed the adequacy of tylenol, aspirin, and caffeine
in the treatment of migraines4.
However, when these modalities do not suffice, prescription medications
like sumitriptan, ergot alkaloids, and narcotics are employed for pain
relief. Both sumitriptan and ergot alkaloids are not advised for
patients with a history of heart disease. Long term prevention of
migraine headaches is also available with proper medication.
Cluster
headaches are often difficult to treat as they only last
a short period of time. However, ergot alkaloids, sumitriptan, and
dihydroergotamine have been used with some succes. Again, these medications
should not be used in someone with heart disease. It has also been
found that inhalation of 100% oxygen has been beneficial in relieving cluster
headaches.
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Please
visit the websites listed below for additional information
References
-
Brian S. Schwartz, MD, et al.
Epidemiology of Tension-Type Headache JAMA 1998; 279:381-383.
-
David J. Capobianco Subspecialty
Clinics: Neurology-An Overview of the Diagnosis and Pharmacologic Treatment
of Migraine. Mayo Clin Proceedings Vol. 71, pp. 1055-1066, Nov. 1996.
-
Jama
Migraine Information Center - Types of Headache (http://www.ama-assn.org/special/migraine/support/educate/types.htm)
-
Richard B. Lipton, MD, etal.
Efficacy and Safety of Acetaminophen, Aspirin, and Caffeine in Alleviating
Migraine Headache Pain Archives of Neurology, Vol. 55, pp. 210-217, Feb.
1998.
-
Judith Teall, RGN, et al. Rizatriptan
(MAXALT) for the Acute Treatment of Migraine and Migraine Recurrence. Headache,
Vol. 38, pp. 281-287, Apr. 1998.