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ANOTHER HEADACHE? by IHOR MAGUN, M.D., F.A.C.P. Headaches are a very common daily occurrence. They may be quite uncomfortable, disabling and fre quently cause anxiety in all of us. This common fre quency is partially due to the rich nerve supply to the head. Any mechanism of stretching, inflammation or changes in the nerve endings, both outside and inside the cranium, can produce pain. Probably the most frequently encountered headache is the tension headache. This can occur daily and usu ally begins in the early afternoon or evening and in creases in intensity as the day progresses. The pain is steady, can begin in any area of the head and can grip the entire head “in a vise”. There are usually no asso ciated symptoms such as nausea, vomiting or sensitivity to light. The tension headache tends to occur more fre quently in women than men and can begin after signifi cant tension and anxiety-producing situations or as a result of improper posture leading to sustained muscle contraction. The most common treatment for this type of head ache is aspirin. Chronic tension headaches are occa sionally treated with biofeedback or with antidepres sants or antianxiety agents. Classic migraine headaches usually have associated antecedent neurological symptoms such as visual chan ges, flashing lights or strange numbness sensations. These symptoms usually disappear before the headache actually begins. The headache is unilateral, usually on the side opposite of where the neurological symptoms occur. Migraine headaches are accompanied by nausea, vomiting, light sensitivity, sensitivity to noise and a general feeling of illness. Four to six hours is the typical duration of a migraine headache, but it can last up to one or more days. Afterwards, there is a characteristic feeling of exhaustion, with tenderness of the scalp at the headache site. Fortunately, in most people these headaches rarely occur more than once a month and no more than four or five times a year. Common migraine headaches do not have any neu rological symptoms. These headaches usually begin unilaterally and can be associated with nausea and vom iting. Migraine headaches usually run in families, affect women more often than men and are characteristically precipitated by specific factors such as menstrual peri ods, stress or certain foods such as red wine, cheeses, chocolates or nuts. The best treatment for the migraine is primary prev ention. This may be in the form of avoiding foods or situations that can bring on a migraine headache or by the use of prescription pharmacologic prophylaxes like beta blockers, calcium channel blockers or new medica tions like Imitrex, by injection or tablet form. Acute attacks respond to potent analgestic agents. Cluster headaches produce a rapid onset of severe pain lasting from thirty minutes to two hours. They can occur several times daily and characteristically begin behind the eye and then spread to the forehead. Cluster headaches occur more often in men than women, typi cally in the spring and fall. There are no systemic symp toms such as nausea or vomiting. The headache disap pear just as abruptly as it arises. Treatment is usually not necessary since the attack is over by the time an analgestic agent becomes effective. A sudden bleed in the brain may also produce a severe sudden headache followed by a chronic persist ent headache and neck stiffness. This is due to the inflammation of the membrances of the brain by blood. This hemorrhage is usually referred to as a subarach noid hemorrhage and is treated surgically. Hypertensive headaches occur only in patients with very severe hypertension — usually when there is very poor medical control. They occur in the early morning and characterisitcally produce a throbbing sensation in the back of the head. These headaches respond to treatment for hypertension. Sinus headaches are, in fact, mostly vascular or tension headaches. True sinus headaches are usuaily dull and achy and are worsened by head movement. The condition usually improves with decongestants. There are numerous causes for headaches and, at times, they can occur in combination. It is important to discuss persistent, frequent or severe headaches with your physician. Advances in treatment have been ex ceptional and may significantly improve your daily life. 18 НАШЕ Ж ИТТЯ”, ТРАВЕНЬ 1996 Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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