Pain Management
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What is a headache?
A Headache is defined as a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.
There are three major categories of headaches:
primary headaches, 
secondary headaches, and 
cranial neuralgias, facial pain, and other headaches
Primary Headaches
Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.
Tension headaches are the most common type of primary headache. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men 
Causes of Tension headaches
While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck inserts, the temple where muscles that move the jaw are located, and the forehead.
. Tension headaches occur because of physical or emotional stress placed on the body. These stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm. Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time concentrating. Emotional stress may also cause tension headaches by causing the muscles surrounding the skull to contract.
Symptoms of tension Headaches
The pain symptoms of a tension headache are:
The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure. 
Often is described as pressure encircling the head with the most intense pressure over the eyebrows. 
The pain usually is mild (not disabling) and bilateral (affecting both sides of the head). 
The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to light and sound. 
The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people. 
The pain allows most people to function normally, despite the headache
Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience a migraine headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime. 
Cluster headaches are a rare type of primary headache affecting 0.1% of the population (1 in a 1,000 people). It more commonly affects men in their late 20s though women and children can also suffer
 Causes of  cluster headaches
The cause of cluster headaches is uncertain. It may be that certain parts of the brain begin to malfunction for an unknown reason. The hypothalamus, an area located at the base of the brain is responsible for the body's biologic clock and may be the part of the brain that is the source for the headaches. When brain scans are performed on patients who are in the midst of a cluster headache, there is abnormal activity in the hypothalamus.
Cluster headaches also:
tend to run in families and this suggests that there may be a genetic role;
may be triggered by changes in sleeppatterns; 
may be triggered by medications (for example, nitroglycerin, used for heart disease).
If an individual is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate) also can be potential causes for headache.
Symptoms of Cluster Headaches
Cluster headaches are headaches that come in groups (clusters) lasting weeks or months, separated by pain-free periods of months or years.
During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some patients may experience pain more than twice daily. 
Each episode of pain lasts from 30 to 90 minutes. 
Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep. 
The pain typically is excruciating and located around or behind one eye. 
Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery. 
The nose on the affected side may become congested and runny.
Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and can be driven to desperate measures. Cluster headaches are much more common in men than women.
Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes or intracerebral bleeding.
Cranial Neuralgias, Facial Pain, and other Headaches
Neuralgia means nerve pain (neur= nerve + algia=pain). Cranial neuralgia describes a group of headaches that occur because the nerves in the head and upper neck become inflamed and become the source of the pain in the head. Facial pain and a variety of other causes for headache are included in this category.
Secondary Headaches
Headache is a symptom associated with many illnesses. While head pain itself is the issue with primary headaches, secondary headaches are due to an underlying disease or injury that needs to be diagnosed and treated. Controlling the headache symptom will need to occur at the same time that diagnostic tests are being considered to diagnose the underlying disease. Some of the causes of secondary headache may be potentially life-threatening and deadly. Early diagnosis and treatment is essential if damage is to be limited.
The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted. (This is not a complete list).
Head and neck trauma 
Injuries to the head may cause bleeding in the spaces between the layers of tissue that surround the brain (subdural, epidural and subarachnoid spaces) or within the brain tissue itself. 
Concussions, where head injury occurs without bleeding 
A symptom of whiplash and neck injury
Blood vessel problems in the head and neck
Stroke or transient ischemic attack (TIA)
Arteriovenous malformations (AVM) may cause headache before they leak 
Carotid artery inflammation
Temporal arteritis (inflammation of the temporal artery)
Non-blood vessel problems of the brain 
  • Brain tumors, either primary, originating in the brain, or metastatic from a cancerthat began in another organ
  • Seizures
  • Idiopathic intracranial hypertension, once named pseudotumor cerebri, where the pressure is too high in the cerebrospinal fluid within the spinal canal.
Medications and drugs (including withdrawal from those drugs) 
  • Meningitis 
  • Encephalitis 
  • Systemic infections (for example, pneumonia or influenza)
Changes in the body's environment 
  • High blood pressure (hypertension)
  • Dehydration 
  • Hypothyroidism 
  • Renal dialysis
Problems with the eyes, ears, nose throat, teeth and neck 
Psychiatric disorders
A patient should seek medical care if their headache is:
The "worst headache of your life." This is the wording often used in textbooks as a cue for medical practitioners to consider the diagnosis of a subarachnoid hemorrhage due to aruptured cerebral aneurysm. The amount of pain will often be taken in context with the appearance of the patient and other associated signs and symptoms.
  • Different than your usual headaches 
  • Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity
  • Associated with persistent nausea and vomiting
  • Associated with fever or stiff neck
  • Associated with seizures
  • Associated with recent head trauma or a fall
  • Associated with changes in vision, speech, or behaviour
  • Associated with weakness or change in sensation
  • Not responding to treatment and is getting worse
  • Requires more than the recommended dose of over-the-counter medications for pain
  • Disabling and interfering with work and quality of life sensation.