HEADACHES

Sarita Jangra Bhyan

Asst. Prof.
Department of Pharmacy Practice
 Headache
• Headaches are one of the most common medical complaints; most
people experience them at some point in their life. They can affect
anyone regardless of age, race, and gender
• The World Health Organization (WHO) reports that
• almost half of all adults worldwide.

• A headache can be a sign of

• stress or emotional distress, or it can result from a medical disorder,
such as migraine or high blood pressure, anxiety, or depression. It
can lead to other problems. People with chronic migraine headaches,
for example, may find it hard to attend work or school regularly.
 Contd…
• A headache can occur in any part of the head,
on both sides of the head, or in just one
location.
• There are different ways to define headaches.
• The International Headache Society (IHS)
categorize headaches as primary, when they
are not caused by another condition, or
secondary, when there is a further underlying
cause.
 Primary headaches

• Primary headaches are stand-alone illnesses caused

directly by the overactivity of, or problems with,
structures in the head that are pain-sensitive.
• This includes the blood vessels, muscles, and nerves
of the head and neck. They may also result from
changes in chemical activity in the brain.
• Common primary headaches include migraines,
cluster headaches, and tension headaches.
 Secondary headaches

• Secondary headaches are symptoms that

happen when another condition stimulates the
pain-sensitive nerves of the head. In other
words, the headache symptoms can be
attributed to another cause.
 Contd,,
• A wide range of different factors can cause secondary headaches.
• These include:
• alcohol-induced hangover
• brain tumor
• blood clots
• bleeding in or around the brain
• "brain freeze," or ice-cream headaches
• carbon monoxide poisoning
• dehydration
• glaucoma
• teeth-grinding at night
• influenza
• overuse of pain medication, known as rebound headaches
• panic attacks
• stroke
 Tension headaches

• Eating something very cold can lead to a "brain freeze."

• Tension headaches are the most common form of primary headache.
Such headaches normally begin slowly and gradually in the middle of
the day.
• The person can feel:
• as if they have a tight band around the head
• a constant, dull ache on both sides
• pain spread to or from the neck
• Tension-type headaches can be either episodic or chronic. Episodic
attacks are usually a few hours in duration, but it can last for several
days.
• Chronic headaches occur for 15 or more days a month for a period of
at least 3 months.
 Migraines

• A migraine headache may cause a pulsating, throbbing pain

usually only on one side of the head. The aching may be
accompanied by:
• blurred vision
• light-headedness
• nausea
• sensory disturbances known as auras
• Migraine is the second most common form of primary headache
and can have a significant impact on the life of an individual.
According to the WHO, migraine is the sixth highest cause of
days lost due to disability worldwide. A migraine can last from a
few hours to between 2 and 3 days.
 Rebound headaches

• Rebound or medication-overuse headaches stem from an

excessive use of medication to treat headache symptoms. They
are the most common cause of secondary headaches. They
usually begin early in the day and persist throughout the day.
They may improve with pain medication, but worsen when its
effects wear off.
• Along with the headache itself, rebound headaches can cause:
• neck pain
• restlessness
• a feeling of nasal congestion
• reduced sleep quality
• Rebound headaches can cause a range of symptoms, and the
pain can be different each day.
 Cluster headaches

• Cluster headaches usually last between 15 minutes and 3 hours, and

they occur suddenly once per day up to eight times per day for a
period of weeks to months. In between clusters, there may be no
headache symptoms, and this headache-free period can last months to
years.
• The pain caused by cluster headaches is:
• one-sided
• severe
• often described as sharp or burning
• typically located in or around one eye
• The affected area may become red and swollen, the eyelid may droop,
and the nasal passage on the affected side may become stuffy and
runny.
 Thunderclap headaches

• These are sudden, severe headaches that are often

described as the "worst headache." They reach maximum
intensity in less than one minute and last longer than 5
minutes.
• A thunderclap headache is often secondary to life-
threatening conditions, such as intra cerebral hemorhage,
cerebral venous thrombosis, ruptured or
• unruptured aneurysms, reversible cerebral vasoconstriction
syndrome (RVS), meningitis, and pituitary apoplexy.
• People who experience these sudden, severe headaches
should seek medical evaluation immediately.
 Treatment

• The most common ways of treating headaches are rest and pain
relief medication.
• Generic pain relief medication is available over the counter
(OTC), or doctors can prescribe preventative medication, such as
tricyclic antidepressants, serotonin receptor agonists, anti-
epileptic drugs, and beta-blockers.

It is important to follow the doctor's advice because overusing

pain relief medication can lead to rebound headaches. The
treatment of rebound headaches involves the reducing or stopping
pain relief medication. In extreme cases, a short hospital stay may
be needed to manage withdrawal safely and effectively.
Primary Chronic Daily Headache Disorders of Long-Duration (>4 h)

Disorder Demographic Clinical Features Recommended Treatments

Headache ≥15 days per

month for >3 mo, of which
Female/male, 3 : 1 ≥8 days meet ICHD-II Topiramate, divalproex
Chronic migraine Prevalence
criteria for migraine sodium, amitriptyline
2%
without aura or relief with
triptan or ergot
Mild-moderate severity; no
Chronic tension-type Equal sex ratio Prevalence migrainous symptoms; Amitriptyline
headache 2% bilateral, nonthrobbing

Bilateral, persistent,
moderately severe; may be
New daily persistent Female > male preceded by viral infection; Amitriptyline
headache may resemble migraine or
tension-type headache

Rare; unilateral, constant,

exacerbations of severe
Hemicrania continua Female > male headache, cranial Indomethacin
autonomic symptoms, and
ice-pick pain; responsive
to indomethacin by
definition
6. Headache attributed to cranial or
cervical vascular disorder
1.Headache attributed to ischaemic
stroke or transient ischaemic attack
2.Headache attributed to non-traumatic
intracranial haemorrhage
3.Headache attributed to unruptured
vascular malformation
4. Headache attributed to arteritis
5. Carotid or vertebral artery pain
6. Headache attributed to cerebral
venous thrombosis
7.Headache attributed to other intracranial
vascular disorder
 Headache attributed to bacterial
meningitis
A. Headache with1 of the following characteristics
B. diffuse pain
9.1.1 Headache attributed to
1. intensity increasing to severe
2. associated with nausea, photophobia and/or
bacterial meningitis
phonophobia
C. Evidence of bacterial meningitis from examination
of CSF
D. Headache develops during the meningitis
E. One or other of the following:
1. headache resolves within 3 mo after relief from
meningitis
2. headache persists but 3 mo have not yet passed since
relief from meningitis