Headache is one of the most common disorders seen to occur in all age groups but much more so in women. Broadly headaches can be classified as Primary and Secondary Headaches disorders. Primary Headache disorders have no apparent causative factor and are thought to be interplay between genetic predisposition and environmental provocative factors. The most common by far is Migraine. Secondary headaches are those that result from a cause e.g. Brain Tumor.

1. THE COMMON BANE of
HEAD PAIN
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2. Headache is one of the most common disorders seen to
occur in all age groups but much more so in women.
Broadly headaches can be classified as Primary and
Secondary Headaches disorders. Primary Headache
disorders have no apparent causative factor and are
thought to be interplay between genetic predisposition and
environmental provocative factors. The most common by
far is Migraine. Secondary headaches are those that result
from a cause e.g. Brain Tumor.

3. The Primary Headaches:
Migraine Tension-type headache Cluster headache and other
trigeminal autonomic cephalalgias Other primary headaches.
The Secondary Headaches:
Headache attributed to head and/or neck trauma Headache
attributed to cranial 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 homoeostasis
Headache or facial pain attributed to disorder of cranium, neck,
eyes, ears, nose, sinuses, teeth, mouth or other facial structures.
Headache attributed to psychiatric disorder

4. Cranial Neuralgias, Central and primary facial pain and other
headaches
Cranial neuralgias and central causes of facial pain Other
headache, cranial neuralgia, central or primary facial painFor all
practical purposes, most people suffering from headaches have
primary headache disorders especially Migraine. Though most
people worry that they may have a “Brain Tumor” or serious
disease causing headache that is a rare and an unusual
situation. Certain Red flags can help and decide if the headache
cause could be of a dangerous origin.

5. Workisome Headache Red Flags “Snoop”
Systematic symptoms (Fever, weight loss) or secondary risk factors
(HIV, Systematic cancer)Neurologic symptoms or abnormal signs
(confusion, impaired alertness or consciousness)Onset: Sudden,
abrupt or spilt second Older : New onset and progressive headache,
especially in middle –age > 50 (Giant cell arteritis) Previous
headache history : First headache or different (change in attack
frequency, severity or clinical features)There is also an incorrect
belief that the word migraine would always implies a very severe
headache. That is incorrect and most headaches suffered by people
in the world are Migraine. Migraine is a spectrum of headaches that
could be mild and infrequent or severe, frequent and daily. Migraine
with aura (usually visual symptoms) is also called Classic migraine
and occurs in 15% patients. Migraine without aura (also called
Common Migraine) occurs in 85% patients.

6. Common Symptoms of Migraine
Head pain (Pounding, pulsating, throbbing) Nausea/Vomiting Loss
of appetite Light or sound sensitivity (Sonophotophobia) Scalp
tenderness Dizziness and lightheadedness IrritabilityCommon
Aggravating Causes of Migraine are:
Sleep deprivation – Excess or lack Irregularity of meal times
Stress Hormonal changes Food triggersThe management of
headaches begins by establishing the correct diagnosis clinically
or with the help of tests ruling out the rare but dangerous
secondary headache disorders.
Once it is established that underlying condition is migraine than
the treatment has the following steps:

7. Lifestyle management - to recognize and eliminate aggravating
factors. Preventive therapy: Daily medications of various types
which are used to prevent/reduce the number of “attacks” of
headache. These are not Rescue (immediate/SOS) pain
relieving medicines and must be taken regularly for 3- 6 months
or more. Rescue therapy: To abort the “attack” of severe
headache.It is important to recognize and appropriately deal with
these disabling headaches to prevent Medicine Overuse
Headache (MOH) which occurs in many people who chose only
to take “Acute/Abortive/Rescue” medications. Painkiller over use
can also result in Ulcer disease and kidney dysfunction. For
patients in whom headaches have worsened to a point where
they have incapacitating near daily headaches. Newer modalities
of therapy like Botox are available.

8. Key points:
Recognize that most headache are Migraine and not “Gas”, “Weak
eyes” or “Sinus”. Migraine does not imply only severe debilitating
headaches. Practically most headaches is the world are Migraine.
Prevent MOH and side effects of rescue medications. Recognize
CDH (Chronic daily headache) and consider newer modalities of
treatment such as Botox.

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