Headache disorders are one of the most common and disabling conditions that cause a considerable burden worldwide. The estimated global prevalence of headaches was 52% in high-income countries. There are 15 people out of 100 complain of active headaches daily.
Before discussing common headaches, seek medical attention if the following "red flags" are present. They may indicate a more severe condition and timely intervention may be life-saving.
RED FLAGS:
Sudden onset and severe: A headache that comes on suddenly and reaches peak intensity within seconds or minutes, often described as a "thunderclap headache," can be a sign of a severe condition, such as a subarachnoid hemorrhage.
New or different headache: If you experience a new headache that differs in character or severity from your usual headaches. Particularly for those aged> 50 and <10.
Neurological symptoms: Headaches accompany neurological symptoms, such as visual disturbances, difficulty speaking, weakness, numbness, or seizures.
Systemic symptoms: A headache with high fever, rash, weight loss, or night sweats may indicate an underlying infection or other serious condition.
Headache triggered by physical activity, such as coughing, sneezing, or sexual activity.
Headache with altered consciousness: confusion, drowsiness, or loss of consciousness.
Headache with head injury: A headache that develops after a head injury, even if the injury seems minor.
Headache with projectile vomiting: may suggest an increase in intracranial pressure.
Persistent or worsening headache: A headache that persists for days or weeks and does not respond to standard treatments or progressively worsens.
Associated with a history of serious illness: Individuals with a history of cancer or immunosuppressed should seek medical attention for new or worsening headaches.
Positional headache: A headache that changes with posture, such as standing up or lying down, may indicate issues such as cerebrospinal fluid pressure.
Severe pain around the sinuses and teeth
The 5 D: Dizziness, Diplopia (double vision), Dysarthria (talking problem), Dysphagia (swallowing difficulties), and Drop attacks (sudden fall without loss of consciousness).
Affecting sensations: loss of hearing, smell, taste, or tingling around the lips.
If the long lists of red flags don't give you a headache. Let's discuss in more detail some of the most prevalent and disabling conditions, such as tension-type headaches, migraine, and cervicogenic headaches.
Characteristics of different types of common headaches
Tension-type headache:
It can range from mild to moderate severity without throbbing or pulsating. It often presents with symptoms of dull aching around the temporal region or a pressing and tightening band around the forehead, behind the eyes, neck, or shoulder area. This kind of headache rarely worsens with movement or is associated with nausea (a chronic tension-type headache may happen with mild nausea).
According to the Global Burden of Disease, tension headache has an estimated worldwide prevalence of 26%. In other studies, the general population reported a lifetime prevalence as high as 30%—78 %. Despite its high burden on society and impact on quality of life, the exact mechanism of tension-type headaches remains unknown.
Migraine:
It is gradually onset and ranges from moderate to severe. It is a disorder of recurrent attacks with pulsating or throbbing pain. It often happens unilaterally but can shift sides and can aggravated by routine physical activity. Each episode may last 4-72 hours. Migraine may also be associated with nausea, vomiting, or sensitivity to light, sound, or smell. Some individuals may present with a migraine *aura lasting 5-60 minutes.
*Aura (a progressive focal neurological symptom), including visual aura (temporary visual disturbances in the form of zigzag lines or diminished sight) or other sensory disturbances (ringing in ears or dizziness).
According to the Global Burden of Diseases in 2019, migraine is the second most common form of headache. The exact cause of migraines is unknown, with some suggesting that genetics may play a role. However, there are a few common triggering factors, such as stress, hormonal changes, medication, sleep deprivation, weather changes, skipping meals, and excessive external stimuli (e.g., flashing lights, loud noises, and strong odors).
Cervicogenic headache:
Cervicogenic headache is a secondary headache that originates in the cervical spine. It begins in the neck or occipital region and may refer to the face and head. More precisely, any structure innervated by C1-C3 nerve roots can be the source of cervicogenic headaches, such as the C2-C3 zygapophysial joint, C2-C3 disc, upper neck muscles (suboccipital muscles, sternocleidomastoid, trapezius), the vertebral and internal carotid arteries, and the dura mater of the upper spinal cord.
If you are still not too headache now, let's look at why C1-C3 nerves may cause pain to the head and face. The trigeminocervical nucleus interneurons exchange sensory information between the trigeminal and upper cervical spinal nerves. Simply put, we can take an example of dysfunction in the C2-3 zygapophysial joint, innervated by the upper cervical nerve roots. When they exchange information (the nociceptive, i.e., pain signals) with the trigeminal nerve, responsible for the sensation in the head and face, the pain generated in the cervical spine may refer to the head and face.
Unlike tension-type headaches and migraines, cervicogenic headaches are less common. A study in 2007 found that they affected less than 5% of the general population and gradually increased to 15% to 20% in studies in 2011 and 2020.
Until now, we may have known only a few facts about the typical headaches that may affect people's quality of life. Let's summarize the three common headaches.
There are some overlapping signs and symptoms between the 3 types of headache, which make it challenging to distinguish and often result in incorrect diagnosis. So again, ask for proper medical practitioners if you have any questions. In fact, tension-type headaches, migraine, and cervicogenic headaches do not mutually exclude each other. The bad news is you may have a recurrent migraine attack together with a dysfunction in the C2-3 zygapophyseal joint, which may make the condition more complicated.
There are various types of meditation available over the counter for headaches. Also, there are plenty of alternative treatment choices, such as manipulation, needling, mindfulness-based stress reduction, etc. The same treatment may not work for everyone, and I am not saying anything should be superior to another.
As a physiotherapist, I will suggest 3 easy exercises for relieving tension around the neck area. The good news is that decreasing the muscle tone in the cervical region may help regardless of the type of headache. Of course, they are not the only choice, but we will start with easy, light exercise.
Reminder: Ensure you are safe for exercises and check for red flags. Please consult medical professionals for proper diagnosis. If you have a neck injury, e.g., a traffic accident, and suspect laxity in your cervical joints, exercise after you clear from those problems. You should not feel any increase in pain during and after the exercises.
The Self- Snags exercises
This exercise helps to mobilize the upper cervical joint in rotation.
Prepare a towel.
Using the left side as the affected side:
Put the towel edge under the affected area, e.g., under the occipital bone; use your right arm to grab the towel and pull it gently across to the opposite eye (right eye) while turning your head to the right side. To leverage the force, the left arm should pull the towel vertically down from the right shoulder.
Turn horizontally in the direction you intend to work on. Do not look up or down during the movement (don't add flexion and extension).
Hold for 3-5 seconds and repeat for 10 times.
Deep neck flexor exercises
Reduce neck and upper back muscle tension, improving the strength and stability of the neck deep flexors for good neck posture.
Lying on your back with your knee bent, without a pillow, place your hands on the large muscles on the front of your neck.
Do a gentle nod, like saying yes. The back of your head should slide slightly up the floor or the bed. (Do not lift your head up from the floor or bed) Make sure the large front neck muscles do not activate.
Hold 3-5 seconds and repeat 10 times.
You can do the exercises sitting and standing if you are familiar with them.
Abdominal /diaphragmatic breathing
Reducing strain on the neck and shoulders accessory muscles and promoting overall relaxation.
Sit or lie down in a comfortable position. Support your back and relax your shoulders. After practice, you can aim to do this in any position.
Place one hand on your chest and the other on your abdomen.
Breathe slowly through your nose, allowing your abdomen to rise as it fills with air. Your chest should remain relatively still.
Breathe out slowly through your mouth, letting your abdomen fall. Again, your chest should remain relatively still.
Continue this process for several minutes, focusing on the rise and fall of your abdomen with each breath.
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