TENSION TYPE HEADACHE

  Tension type headache, also called stress headache, is the most common type of headache. These headaches are characterized by their bilateral location and pressing or tightening quality. Tension type headaches are usually of mild or moderate intensity and can last from minutes to days. This type of headaches are divided by frequency into episodic and chronic types.

 Causes 

 The cause of tension type headache is not fully understood, but it may have a neurobiological basis similar to migraine headaches. For some, episodic headaches evolve to chronic headaches. Increased frequency does not necessarily produce increased headache intensity. However, chronic tension type headache can cause diminished quality of life and severe disability. 

 Symptoms 

 Neck pain, increased tone in the cervical and neck muscles, photophobia. There are no premonitory symptoms, and physical activity does not aggravate symptoms. The headache may occur intermittently for  a week, months, or even years.

  Diagnosis 

 If tension type headache is present  during physical examination, increased resistance to passive movement of the head and tenderness of the head and neck may be noted. Electromyography(EMG) may reveal sustained contraction of neck, scalp, or facial muscles. 

 MIGRAINE HEADACHE 

   Migraine headache is a recurring headache characterized by unilateral throbbing pain. Light, sound, and smell sensitivity and other environmental factors may be either premonitory symptoms or triggers for the migraine headache. The most common age for onset is between 20 and 30 years. Migraines are more common in women than men. Risk factors of migraine headache include family history, low level of education, low socioeconomic status, high workload, and frequent tension type headache. 

Causes 

  Exact cause is not known. The current theory is that a complex series of neurovascular events initiates a migraine headache. People who have migraines have a state of neuronal hyper excitability in the cerebral cortex, especially in the occipital cortex. Migraine is associated with seizure disorders, ischemic stroke, asthma, depression, anxiety, myocardial infarction, and irritable bowel syndrome. Triggering factors include food, 🩸 menstruation, head trauma, physical exertion, fatigue, stress, missed meals, weather, drugs. Food triggers include 🍫 chocolate, 🧀 cheese, 🍊 oranges, 🍅 tomatoes, 🧅 onions and alcohol.

 Symptoms 

 Premonitory symptoms may include neurologic (e.g., photophobia), psychologic (e.g., hyperactivity, Irritability), and other(food craving) manifestations. An aura is a complex of neurologic symptoms that occur before a headache for some patients. It may be characterized by visual symptoms, such as bright lights, visual distortions, or zigzag lines.

  Diagnosis 

  The diagnosis of migraine headache is usually based on the patient history. Neuroimaging techniques (e.g., head CT scan, with or without contrast, and MRI) are not recommended for routine evaluation of headache, unless the neurologic examination reveals abnormal findings. 

 CLUSTER HEADACHE 

  Cluster headaches are the most severe form of primary headache. Repeated headaches occur in clusters, generally at the same time of day or night. Age at onset is typically 2pto 45 years, but they can start at any age. Men are affected three times more often than women.

 Causes

  The unilateral pain may occur with activation of neurons in the ophthalmic branch of the trigeminal nerve. Cluster headache also involves the hypothalamus, with irregularities in melatonin and cortisol.

 Symptoms 

 Intense pain lasting from a few minutes to 3 hours. In contrast to the pulsing pain of migraine headache, the pain of cluster headache is sharp and stabbing. The pain is generally located around the eye, facial flushing or pallor, nasal congestion and constriction of the pupil. During the headache, the patient is often agitated and restless, unable to sit still or relax.

  Diagnosis 

 The diagnosis of cluster headache is based on the patient history according to IHS criteria. Asking patients to keep a headache diary can be useful. CT scan, MRI, or magnetic resonance angiography (MRA) may rule out an aneurysm, a tumor, or an infection.