Breaking your head?

Of late, we hear people complaining of headaches rather too often. It is one of the most common health problems affecting almost 90 percent of the general population at one time or another. When headaches are severe, frequent or disabling, they interfere with our ability to function and enjoy life. It may create trouble in our day-to-day work, affecting our quality of life. It can plague everyone - from a school-going kid to an aged person.

Generally, most people with headache, do not consult their doctors, and instead self-manage it, using over-the-counter therapies. Headaches are broadly classified as primary and secondary headaches.

Secondary headaches are those that are caused by serious conditions such as trauma, infections or even tumour. Primary headaches usually do not have any obvious underlying causes. 

The most common type of headache is "Tension Type Headache". It is a myth that this kind of headache is caused by stress or tension. It is caused by the chemical changes in the brain and muscle spasm giving it the name muscle tension headache.

However, stress can be an aggravating factor. When headache is very severe, throbbing or pressure-like, and maybe accompanied by other symptoms such as nausea, vomiting, light sensitivity, affecting the ability to function, they are suggestive of migraines.

World Health Organisation has recognised migraine as among the top 20 causes of disability (hampering daily activities) around the world. Lack of adequate understanding about migraine and chronic headache among the public has resulted in it being under diagnosed and under treated.

Often, recurrent headaches are falsely attributed to vision-related problems, allergy, sinus, stress and psychological problems. Misconceptions have created a tendency to attribute headache to problems other than migraine.

Other headaches include cluster headache, causing extremely severe pain that is more common in men. It is usually one-sided, behind the eye, accompanied by watering and redness of the eye on the affected side. Headache may be caused due to overuse of medications as well. Apart from these usual types of headache, some people are genetically prone to getting headache.

There may not even be any obvious reasons. It is similar to having any other chronic illness such as diabetes or high blood pressure.

When a patient presents himself / herself to the headache clinic, the doctor will first evaluate the person’s overall health in detail. Appropriate diagnosis is made about the type of headache based on history, physical examination, and prior investigations. Further tests such as CT scan, MRI, Electroencephalogram or other tests may be ordered if necessary.

Once the appropriate diagnosis about the type of headache is established, the clinic will employ a variety of treatment modalities, such as pharmacological treatments. These could be in the form of preventive and rescue medications, detoxification from harmful medications and nutrition counselling.  Suggestions on avoiding triggers for headache may also be given, along with psychological and behavioural therapy, if necessary.

One of the effective relaxation techniques to control headache is biofeedback. This involves measurement of physiological processes such as heart rate and temperature during relaxation and providing proper feedback for improving relaxation skills. These processes usually occur involuntarily.

However, patients who receive help from a biofeedback therapist can learn how to completely manipulate them at will. Biofeedback is particularly effective at treating conditions brought on by severe stress. When a person is stressed, the internal processes such as pulse and blood pressure can become irregular. During biofeedback, the patient learns certain relaxation and mental exercises which can alleviate these symptoms.

Therapists can measure a patient's performance by attaching electrodes to their skin and displaying the physical changes such as temperature and blood pressure on a monitor. The biofeedback therapist reads the measurements and through trial and error singles out mental activities that help regulate the patient's bodily processes.

Eventually patients learn how to control these physical changes without the need to be monitored. Yoga, deep breathing and meditation are some of the other relaxation techniques that can control headaches.

Headache is extremely common but very often untreated. Patients may think that it is a trivial symptom and may take medications on their own.

But preliminary treatment and early intervention will not only aid in headache management, but also improve the quality of life of the patient. A holistic and comprehensive approach will not only help in determining the exact cause of headache but also help in getting an effective treatment.

(The writer is an internal medicine consultant, migraine and headache clinic, Fortis Hospitals, Bangalore)