Headaches Types, Diagnosis and Management

Headache Types

Headaches affect people of all ages, races and socioeconomic backgrounds. However, the prevalence of headaches is more common in the female population. Tension headaches, cluster headaches and migraines are all classified as primary headache disorders that account for 98% of all headaches. Depending on the type of headache, different risk factors and courses of treatment are involved.

Migraine headaches are one-sided, throbbing in character, and often associated with nausea, vomiting, sensitivity to light or an aura. Migraine headaches have been associate with various causes including vascular, neurovascular and neurotransmitters. There is often an increase of oxidative stress and inflammatory markers seen in individuals suffering from migraines. Risk factors include increased body weight, increased blood pressure, increased cholesterol levels, impaired insulin sensitivity, history of stroke, overuse of certain medications and sleep apnea.

Cluster headaches are episodic, one-sided with severe pain in the temples and eye area. They can last several minutes to several hours with one or more episodes throughout the day. Tearing and redness of the eyes and nasal congestion can be associated symptoms seen with cluster headaches. These headaches can be triggered by alcohol consumption as well. Risk factors include previous head-trauma.

Tension headaches are commonly due to muscular and psychogenic causes. Things like poor posture, stress and depression can trigger tension-type headaches. They are characterized as a “band-like” pain that is tight and pressing in character. 

Diagnosis

Unfortunately, no specific biological markers are used to diagnose the type of headache and neuroimaging is often reserved for very severe cases. Therefore, a thorough intake is key with the evaluation of the history of presenting illness, past medical history, family history, social history and relevant physical examinations. 

Red-flags

From the British Association for the Study of Headache:

1. Thunderclap headache (intense, exploding and sudden onset)
2. New-onset headache in patients >50 or <10
3. Persistent morning headache with nausea
4. New onset of headache in a patient with history of cancer
5. New onset of headache in a patient with history of HIV infection
6. Progressive headache, worsening over weeks
7. Headaches associated with postural changes
8. Aura symptoms that
1. Last longer than an hour
2. Include motor weakness
3. Are different from previous aura
4. Occur for the first time on using oral contraceptive pill

 

Management

Given that naturopathic doctors treat the root cause of illness, the underlying cause of a headache is key in determining the course of treatment. Lifestyle and dietary modifications are typically implemented in conjunction to the primary therapeutic method. Addressing the weakened system or organ involved, correcting structural causes and addressing underlying pathology are some of the methods of approach. Addressing the root cause may include treating a traumatic brain injury that has resulted in a cluster headache or regulating hormones in a cyclical patterned headache. Headaches can be debilitating and affect a person’s quality of life so they should be taken seriously and addressed with care. 

The following are a list of lifestyle management strategies that have been shown to decrease the frequency, severity and duration of certain headaches:

• Stress management and regular exercise
• Physical therapies including – massage, electro-stimulation, trigger point release and acupuncture
• Sleep hygiene – appropriate pillow height i.e. water pillow
• Hydration – using an app that reminds you to drink water
• Nutrition – eating well-balanced and nutritious meals
• Tart Cherry juice – a potent antioxidant and the anthocyanin constituents reduce inflammation
• Hydrotherapy – warm foot bath with a cold towel behind the neck for vasoconstriction and vasodilation effects
• Determining and eliminating food sensitivities, effective for persistent chronic headaches
• Avoiding foods high is aspartame
• Awareness and potential reduction in coffee intake

 

References:

A. Fayyaz. Headache disorders: differentiating and managing the common subtypes. Br J Pain. 2012 Aug; 6(3): 124–132.

British Association for the Study of Headache. Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type headache, cluster headache, medication-overuse headache. 3rd edn (1st revision). www.bash.org.uk (accessed April 2018).

Gaby. A.R. Nutritional Medicine. Fritz Perlberb Publishing, Concord, NH. 2011.