A common problem with headache treatment is consultation with a non-specialist/self-medication leading to “medical overuse headache”
Headache disorders are common but often ignored and improperly treated with the patients subjecting themselves to self-medication. Timely management and consultation from a Neurologist can not only reduce the disability associated with headache but also sometimes prevent disastrous consequences
What is Headache & Headache disorder?
Headache in general refers to pain involving the head which is above the level of eyes & ears and may extend to back of the head(occipital) or involve the upper neck. Headache disorder is a condition wherein a person has recurrent headache episodes.
What are the various types of headache disorders?
How can Headache be treated?
Treatment of Headache disorder involves evaluation by a Neurologistto determine the type and cause of headache. Management of Primary headache disorder in general involves a combination of lifestyle modification, judicious use of analgesics and prophylactics medications if the patient is having frequent Migraine headaches. While management of Secondary headache, apart from symptomatic management with analgesics, is directed towards treating the underlying brain disorder.
Most of the time, a headache is self treated and isn’t properly clinically diagnosed. This causes a longer diagnosis period, making treatment difficult. In India, headaches are underestimated, under-recognised and under-treated.
Management of Headache/Migraine – FACT Check
|Common Belief||Fact Check✓|
|High blood pressure is a common cause of headache
|Hypertension is usually clinically silent but if there is sudden surge in blood pressure (accelerated/malignant hypertension), it can result in headache which mostly involves the back side of head(occipital)|
|Eye power change is a common cause headache||Refractive error may cause eye fatigue but is unlikely a common cause of headache in adults|
|Children do not have Migraine
|While Migraine usually starts in adolescents or early adult life, but not rare in children and as per some studies it may be seen in ~ 9% of children|
|Caffeine relieves headache||Caffeine in moderation helps but excess can worsen the pain|
|Migraine can cause visual impairment||Some Migraine attacks may be preceded by an aura, most likely visual but is transient|
26-year-old Shweta Nanda, software engineer by profession consulted with Dr. Prashant Makhija with headaches. She reported that her headaches started at a much younger age and almost 20-30 minutes prior to the headaches she would notice blurring of vision, subsequently she would start having pulsatile headache. She initially consulted an Ophthalmologist who suggested correction of a minor refractive error but as the headaches persisted she consulted a Physician who attributed it to exam related stress. In the last 3-4 yrs, headaches became more frequent and many a times without “visual warning”andlately she started having analgesics on multiple days in a month. Dr. Makhija found out that Shweta’s neurological examination was within normal limits and all her routine blood investigations as well as repeated brain scans were normal. A detail interview with the patient revealed that what started as infrequent “Migraine with aura”was becoming more frequent and many a times without the “visual auras”. This further transformed over time to “Chronic daily headache”. She was asked to maintain a headache dairy and started on Migraine prophylactics and explained that she may have to continue the medications for a reasonable period of time. She showed remarkable response in three weeks and over time her headaches resolved.Shweta not only regained her confidence at work place but her personal life was also back on track.
By: Dr. Prashant Makhija, Renowned Neurologist, Wockhardt Hospital, Mumbai Central