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Tuesday, August 19, 2025

Headaches


Headaches are among the most common medical complaints, affecting people of all ages and backgrounds. They may range from mild and short-lived to severe and debilitating. A headache refers to pain or discomfort in the head or face region and may arise from various causes, including tension, vascular changes, sinus involvement, trauma, or underlying systemic conditions. While most headaches are benign and self-limiting, some can indicate serious underlying disease requiring immediate medical attention.

Causes of Headaches

Headaches are generally classified into two categories: primary headaches and secondary headaches.

Primary headaches (not caused by other diseases):

  • Tension-type headaches: Triggered by stress, fatigue, anxiety, or poor posture.

  • Migraines: Often associated with throbbing unilateral pain, sensitivity to light/sound, nausea, and sometimes aura.

  • Cluster headaches: Severe, sharp pain around one eye, often occurring in cycles.

Secondary headaches (caused by other medical conditions):

  • Sinus infections (sinusitis)

  • Ear infections

  • Dental issues (tooth abscess)

  • Eye strain or vision problems

  • Head trauma or concussion

  • High blood pressure (hypertension headaches)

  • Infections such as meningitis or encephalitis

  • Stroke, brain tumor, or aneurysm (rare but serious causes)

Symptoms

  • Tension headaches: Pressure or tightness around the forehead or back of the head/neck.

  • Migraines: Pulsating or throbbing pain, often unilateral, with nausea, vomiting, photophobia, or phonophobia.

  • Cluster headaches: Excruciating pain around one eye, redness, tearing, and nasal congestion on the same side.

  • Secondary headaches: Associated symptoms may include fever, neck stiffness, neurological deficits, confusion, or worsening pain.

Warning signs requiring urgent care:

  • Sudden, severe ("thunderclap") headache

  • Headache after head injury

  • Headache with fever, rash, or stiff neck

  • Headache with weakness, slurred speech, or confusion

  • Persistent headache unresponsive to pain relief

Diagnosis

  • History and physical exam: Evaluating headache type, triggers, frequency, and associated symptoms.

  • Neurological exam: To check for deficits.

  • Imaging (CT scan or MRI): If secondary causes are suspected.

  • Blood tests: To identify infection, inflammation, or metabolic causes.

  • Lumbar puncture: If meningitis or subarachnoid hemorrhage is suspected.

Treatment

General measures:

  • Rest in a quiet, dark room

  • Adequate hydration

  • Regular meals and sleep

  • Stress management techniques (yoga, meditation, breathing exercises)

Medications:

  • Analgesics: Paracetamol (acetaminophen) 500–1000 mg every 4–6 hours (max 4 g/day).

  • NSAIDs: Ibuprofen 200–400 mg every 6–8 hours, or naproxen 250–500 mg twice daily.

  • Triptans (for migraines): Sumatriptan 50–100 mg at onset, may repeat after 2 hours if needed (max 200 mg/day).

  • Preventive migraine therapy: Propranolol, amitriptyline, topiramate, or valproate may be prescribed in recurrent cases.

  • Cluster headaches: Oxygen therapy, sumatriptan injections, or verapamil for prevention.

Non-pharmacological therapies:

  • Cognitive-behavioral therapy (CBT) for stress-related headaches

  • Physical therapy for posture-related pain

  • Acupuncture or massage in chronic tension headaches

  • Avoidance of known migraine triggers (e.g., chocolate, alcohol, caffeine, strong smells, lack of sleep)

Precautions

  • Avoid overuse of painkillers (can cause medication-overuse headache).

  • Maintain a headache diary to identify triggers.

  • Limit caffeine and alcohol intake.

  • Regular exercise and balanced nutrition may reduce frequency.

  • Avoid abrupt withdrawal from caffeine or certain medications.

Drug Interactions

  • NSAIDs (ibuprofen, naproxen): Increase risk of bleeding when taken with anticoagulants (warfarin, apixaban) or corticosteroids.

  • Triptans: Should not be combined with SSRIs/SNRIs (e.g., sertraline, venlafaxine) due to risk of serotonin syndrome.

  • Propranolol: Can interact with asthma medications (beta-agonists) and worsen respiratory symptoms.

  • Topiramate/valproate: Interact with oral contraceptives, reducing efficacy.




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