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Headache over Headache


Another common problem I see in my daily practice is headache. Young and old alike present with this condition and sometimes, I get 'headache' as well in trying to figure out their headache. Let's learn together the nature of this common problem. This will be a series.

Headache is defined as pain in the head that is located above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. Headache, like chest pain or dizziness, has many causes.

There are two types of headaches: primary headaches and secondary headaches. Primary headaches are not associated with (or caused by) other diseases. Examples of primary headaches are migraine headaches, tension headaches, and cluster headaches. Secondary headaches are caused by associated disease. The associated disease may be minor or serious and life threatening.

Tension headaches are the most common type of primary headache; as many as 90% of adults have had or will have tension headaches. It is more common among women than men. It does not have a clear cause. Many physicians attribute tension headaches to excess stress or a hectic day. There is also evidence that some tension headaches may have a cause that is similar to the cause of migraine headaches.

It often begins in the back of the head and upper neck as a band-like tightness or pressure. It is also described as a band of pressure encircling the head with the most intense pain over the eyebrows. The pain of tension headaches usually is mild (not disabling) and bilateral (affecting both sides of the head). It is not associated with an aura (unlike migraine) and are seldom associated with nausea, vomiting, or sensitivity to light and sound. Tension headaches usually occur sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people. Most people are able to function despite their tension headaches.

Over the counter (OTC) analgesics have been shown to be safe and effective for short-term relief of tension headache (as well as muscle aches, pains, menstrual cramps, and fever) when used according to the instructions on their labels (e.g. every 4 hours or every 6 hours as needed).

Finding an effective analgesic or analgesic combination often is a process of trial and error because individuals respond differently to different analgesics. In general, a person should use the analgesic that has worked in the past. This will increase the likelihood that an analgesic will be effective and decrease the risk of side effects.

There are several precautions that should be observed with OTC analgesics:
  • Children and teenagers should not use aspirin for the treatment of headaches, other pain, or fever, because of the risk of developing Reye's Syndrome, a life-threatening neurological disease that can lead to coma and even death.
  • Patients with balance disorders or hearing difficulties should avoid using aspirin because aspirin may aggravate these conditions.
  • Patients taking blood thinners such as Warfarin should not take aspirin and non-aspirin analgesics without a doctor's supervision because they add further to the risk of bleeding that is caused by the blood thinner.
  • Patients with active ulcers of the stomach and duodenum should not take aspirin and non-aspirin analgesics because they can increase the risk of bleeding from the ulcer and impair healing of the ulcer.
  • Patients with advanced liver disease should not take aspirin and non-aspirin NSAIDs because they may impair kidney function. Deterioration of kidney function in these patients can lead to rapid and life-threatening deterioration of their liver disease.
  • Patients should not overuse OTC or prescription analgesics. Overuse of analgesics can lead to the development of tolerance (increasing ineffectiveness of the analgesic) and rebound headaches (return of the headache as soon as the effect of the analgesic wears off, usually in the early morning hours). Thus, overuse of analgesics can lead to a vicious cycle of more and more analgesics for headaches that respond less and less to treatment and occur more frequently.
Reference: The medical clinics of North America "Headache", Ninan T. Mathew, MD, July 2001.Medically Reviewed by: Joseph Carcione, D.O., M.B.A., Board Certified Neurology.



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