Migraine Headaches Introduction

Headaches are very common; in fact, almost everyone will have a headache at some point. Headaches have been written about since the time of the Babylonians. Migraine headaches are even discussed in the Bible. Some very famous historical figures (for example, Napoleon Bonaparte) suffered from severe headaches.
Although headaches might rarely be due to infections or diseases, most are probably the result of an inborn protective mechanism responding to an external environmental stress. Headaches can be divided into 2 broad categories: primary headaches and secondary headaches. Primary headaches are not caused by problems with a person's internal structure or organs or by bacteria, viruses, or other organisms. Migraine, cluster, tension, and rebound headaches are types of primary headache. Secondary headaches are those caused by an underlying structural or organic disease.
Several observations support this idea. When exposed to very high or low temperatures, people sometimes develop a migraine like headache. (Migraine headaches are sometimes called vascular headaches. Vascular means having to do with the blood vessels.) These headaches can also suddenly arise in some people when they do not get enough sleep or food.
Common triggers of migraine headaches include heat, stress, and lack of sleep or food. Not every headache sufferer is sensitive to these triggers, but virtually all persons with migraine headaches (called migraineurs) have some environmental trigger. About 70% of migraineurs have a first-degree relative (parent, brother, sister, or child) with a history of migraine. People with an inherited tendency for headaches may respond more easily than others to these external stress factors. Some experts have therefore thought that headache is an adaptive and developed response. Most primary headaches slowly develop over minutes to hours. The pain experienced in headache is transmitted by the slowest of all unmyelinated nerves. Unmyelinated nerves lack a myelin sheath, or covering, and send impulses slowly.

Chronic tension-type headache

Chronic tension-type headaches are not associated with a history of migraine or cluster headaches. Patients report almost constant daily headaches of mild-to-moderate intensity. The headache is described as a feeling of tightness or pressure that is not worsened, and may actually be improved, by activity. Patients with chronic tension-type headaches can carry on their daily activities. Nausea and photophobia (sensitivity to light) may occur, but vomiting usually does not. A small group of patients may have head and neck tenderness.
Chronic tension-type headache, Treatment
Patients who are less responsive to previous treatment and those with conditions like depression and stress may be good candidates for psychological treatments. Biofeedback has been successful in patients with tension headache. They are taught how to relax their tense muscles. Thermal biofeedback, in which patients are taught to increase their body temperatures to improve their headaches, has also worked. Other less conventional treatments, such as relaxation training and stress-coping training, may be helpful in the long term.

Transformed migraine
Migraine transformation has been a term used by some experts to describe when intermittent migraines become daily migraines. This type of headache is believed to be associated with analgesic or ergotamine overuse. Patients report intermittent typical migraine attacks along with the daily chronic headaches.
Transformed migraine, Treatment
  • Detoxification 
    • Stopping all analgesics and headache-related medications is best done in aninpatient setting. 
    • Doctors may prescribe a clonidine(Catapres) patch to lessen withdrawal symptoms if narcotic analgesics are involved.

  • Preventive: Preventive treatments for transformed migraine headaches are identical to those used for the other types of migraine headache. 
Other uncommon chronic headaches
Hemicrania continua and chronic paroxysmal hemicrania are uncommon forms of chronic headache. Chronic paroxysmal hemicrania is a severe chronic headache similar to cluster headache. It has a male predominance. The headaches are paroxysmal (pulsing), with pain in the temple/eye region lasting 20-30 minutes. The paroxysms occur several times a day. This type of headache can last several years. Treatment with indomethacin (Indocin) results in a dramatic response.

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