The Pathophysiology Of Severe Intermittent Headaches

Bob, a 38 year old male, has been experiencing severe intermittent headaches for about 10 years. When they occur, he experiences intense burning pain on one side of his head, tearing in his eye, congestion and a runny nose. These headaches generally occur several times a day and last approximately one hour. The headaches are episodic; Bob can be headache free for several months but then experience an attack. 1. Based on the case scenario, provide a diagnosis for Bob. Provide the pathophysiology for this type of headache and discuss current treatment options The Pathophysiology Of Severe Intermittent Headaches.


Headaches are a very common condition that most people will experience many times during their lives. The main symptom of a headache is a pain in your head or face. This can be throbbing, constant, sharp or dull. Headaches can be treated with medication, stress management and biofeedback The Pathophysiology Of Severe Intermittent Headaches.
Multidisciplinary team takes new approach to headaches.

How common are headaches in adults?

If your head is throbbing, you’re not alone. Headache is one of the most common pain conditions in the world. Up to 75% of adults worldwide have had a headache in the past year.

Headaches are a major cause of absenteeism from work and school. They also take a toll on social and family life. For some people, continually battling headaches can lead to feeling anxious and depressed The Pathophysiology Of Severe Intermittent Headaches.

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What are the types of headaches?
There are more than 150 types of headache. They fall into two main categories: primary and secondary headaches.

Primary headaches

Primary headaches are those that aren’t due to another medical condition. The category includes:

Cluster headaches.
New daily persistent headaches (NDPH).
Tension headaches.
Secondary headaches

Secondary headaches are related to another medical condition, such as:

Disease of blood vessels in the brain.
Head injury.
High blood pressure (hypertension).
Medication overuse.
Sinus congestion.

Are headaches hereditary?

Headaches have a tendency to run in families, especially migraines. Children who have migraines usually have at least one parent who also suffers from them. In fact, kids whose parents have migraines are up to four times more likely to develop them too.

Headaches can also be triggered by environmental factors shared in a family’s household, such as: The Pathophysiology Of Severe Intermittent Headaches

Eating certain foods or ingredients, like caffeine, alcohol, fermented foods, chocolate and cheese.
Exposure to allergens.
Secondhand smoke.
Strong odors from household chemicals or perfumes.
What causes headaches?

Headache pain results from signals interacting among the brain, blood vessels and surrounding nerves. During a headache, an unknown mechanism activates specific nerves that affect muscles and blood vessels. These nerves send pain signals to the brain.

What causes migraines?
Migraines aren’t fully understood. But researchers think migraines result when unstable nerve cells overreact to various factors (triggers). The nerve cells send out impulses to blood vessels and cause chemical changes in the brain. The result is disabling pain.

What triggers headaches and migraines?
Common triggers of tension headaches or migraines include: The Pathophysiology Of Severe Intermittent Headaches

Alcohol use.
Changes in eating or sleeping patterns.
Emotional stress related to family and friends, work or school.
Excessive medication use.
Eye, neck or back strain caused by poor posture.
Weather changes.
What do headaches feel like?

Headache symptoms vary, depending on the type of headache you have.

Tension headaches

Tension headaches are the most common type of headache. Tension headache pain tends to be:

Consistent without throbbing.
Mild to moderate.
On both sides of the head (bilateral).
Responsive to over-the-counter treatment.
Worse during routine activities (such as bending over or walking upstairs).
Migraines are the second most common type of primary headaches. Symptoms of migraines include:

Moderate to severe pain.
Nausea or vomiting.
Pounding or throbbing pain.
Pain that lasts four hours to three days.
Sensitivity to light, noise or odors.
Stomach upset or abdominal pain.
Cluster headaches

Cluster headaches are the most severe type of primary headache. Cluster headaches come in a group or cluster, usually in the spring or fall. They occur one to eight times per day during a cluster period, which may last two weeks to three months. The headaches may disappear completely (go into remission) for months or years, only to recur later. The pain of a cluster headache is:

Intense with a burning or stabbing sensation.
Located behind one of your eyes or in the eye region, without changing sides.
Throbbing or constant.
New daily persistent headaches

New daily persistent headaches (NDPH) come on suddenly and last for more than three months. They typically occur in people who weren’t having frequent headaches before. The pain of NDPH is:

Constant and persistent without easing up.
Located on both sides of the head.
Not responsive to medications.
Sinus headaches

Sinus headaches are the result of a sinus infection, which causes congestion and inflammation in the sinuses (open passageways behind the cheeks and forehead). People, and even healthcare providers, often mistake migraines for sinus headaches. Symptoms of sinus headaches include: The Pathophysiology Of Severe Intermittent Headaches

Bad taste in mouth.
Deep, constant pain in your cheekbones and forehead.
Facial swelling.
Feeling of fullness in ears.
Pain that gets worse with sudden head movement or straining.
Mucus discharge (snot).
Medication overuse headaches

Medication overuse headaches (MOH) or rebound headaches affect up to 5% of people. They happen when you frequently take pain relievers for headaches. Eventually, this practice can actually increase your number of headaches. Signs of MOH include:

Headaches becoming more frequent.
More days with headaches than without.
Pain that’s worse in the morning.
Headaches in children

Most kids have had a headache by the time they get to high school. For about 20% of them, tension headaches and migraines are a reoccurring problem. Similar to adults, triggers for headaches in children include:

Certain foods that trigger headaches for the individual.
Changes in sleep.
Environmental factors.
What headache symptoms require immediate medical care?
If you or your child has any of these headache symptoms, get medical care right away:

A sudden, new, severe headache
A headache that is associated with neurological symptoms such as:
Sudden loss of balance or falling
Numbness or tingling
Speech difficulties
Mental confusion
Personality changes/inappropriate behavior, or
Vision changes (blurry vision, double vision, or blind spots)
Headache with a fever, shortness of breath, stiff neck, or rash
Headache pain that awakens you up at night
Headaches with severe nausea and vomiting
Headaches that occur after a head injury or accident
Getting a new type of headache after age 55
Contact your health care provider if you or your child has any of the following symptoms:

Three or more headaches per week.
Headaches that keep getting worse and won’t go away.
Need to take a pain reliever every day or almost every day for your headaches.
Need more than 2 to 3 doses of over-the-counter medications per week to relieve headache symptoms.
Headaches that are triggered by exertion, coughing, bending, or strenuous activity.
A history of headaches, but have noticed a recent change in your headache symptoms.
How are headaches evaluated and diagnosed?
If you have headaches often or if they are very severe, reach out to your healthcare provider. You can usually start with your family physician, where the diagnosis process will begin. It’s important to diagnose headaches correctly so that specific therapy can be started to help you feel better. Your healthcare provider will complete a physical examination, discuss your medical history and talk to you about your headache symptoms. This conversation is part of a headache evaluation. During the headache evaluation, your provider will ask you about your headache history, including: The Pathophysiology Of Severe Intermittent Headaches

A description of your headaches.
What the headaches feel like.
How often the headaches happen.
How long the headaches last each time.
How much pain the headaches cause you.
What foods, drinks or events trigger your headaches.
How much caffeine you drink each day.
What your stress level are.
What your sleep habits are like.
If you have any work issues.
Your headache can be more accurately diagnosed by knowing:

When the headache started.
How long you have had the headache.
Whether there is a single type of headache or multiple types of headaches.
How often the headache occurs.
What causes the headache, if known (for example, do certain situations, foods, or medications usually trigger the headache?).
If physical activity aggravates the headache pain.
What events are associated with the headache.
Who else in your family has headaches.
What symptoms, if any, occur between headaches.
Your doctor will also ask additional questions about performance at work, family background, and if there is any history of drug abuse.

Clinical description of headaches

Describe how you feel when you have the headache and what happens when you get the headache, such as:

Where the pain is located.
What it feels like.
How severe the headache pain is, using a scale from 1 (mild) to 10 (severe).
If the headache appears suddenly without warning or with accompanying symptoms.
What time of day the headache usually occurs.
If there is an aura (changes in vision, blind spots, or bright lights) before the headache.
What other symptoms or warning signs occur with the headache (weakness, nausea, sensitivity to light or noise, decreased appetite, changes in attitude or behavior)The Pathophysiology Of Severe Intermittent Headaches.
How long the headache lasts.
History of headache treatments

You should provide your physician with a history of prior headache treatments. Tell your doctor what medications you have taken in the past and what medications are you currently taking. Don’t hesitate to list them, bring in the medication bottles or ask your pharmacist for a printout.If any studies or tests were previously performed, bring them with you. This may save time and repetition of tests.

Physical and neurological examinations for headaches

After completing the medical history part of the evaluation, your physician will perform physical and neurological examinations. The physician will look for signs and symptoms of an illness that may be causing the headache. These signs and symptoms can include:

High blood pressure
Muscle weakness, numbness, or tingling
Excessive fatigue, wanting to sleep all of the time
Loss of consciousness
Balance problems, falling
Vision problems (blurry vision, double vision, blind spots)
Mental confusion or changes in personality, inappropriate behavior, speech difficulties
Nausea, vomiting
Neurological tests focus on ruling out diseases that might also cause headaches, such as epilepsy, multiple sclerosis, and other cerebrovascular diseases. A disorder of the central nervous system might be suspected in the development of serious headaches. These include:

Hemorrhage (bleeding within the brain)
Bacterial or viral meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
Pseudotumor cerebri (increased intracranial pressure)
Hydrocephalus (abnormal build-up of fluid in the brain)
Infection of the brain
Encephalitis (inflammation of the brain)
Blood clots
Head trauma
Sinus blockage or disease
Malformation (such as Arnold-Chiari)
Infections, such as Lyme disease
After evaluating the results of your headache history, physical examination and neurological examination, your physician should be able to determine what type of headache you have, whether or not a serious problem is present and whether additional tests are needed The Pathophysiology Of Severe Intermittent Headaches.

If possible, try to write down how you feel when you are experiencing a headache. Keeping a journal of your headaches and how they make you feel can be helpful when you are talking to your healthcare provider.

The information you give your healthcare provider about your headaches is the most important part of the diagnosis process. By giving your provider as much information as possible about your headaches, you’re more likely to get an accurate diagnosis and a treatment plan that will help you feel better The Pathophysiology Of Severe Intermittent Headaches.

Although scans and other imagining tests can be important when ruling out other diseases, they do not help in diagnosing migraines, cluster or tension-type headaches. However, if your healthcare provider thinks that your headaches are being caused by another medical condition, there are several imaging tests that may be done. A CT scan or MRI can be used if your provider thinks your headaches are connected to an issue with your central nervous system. Both of these tests produce cross-sectional images of the brain that can show any abnormal areas or problems. X-rays of your skull are generally not done. An EEG (electroencephalogram) may not be needed unless you’ve ever passed out during a headache The Pathophysiology Of Severe Intermittent Headaches.

How are headaches treated?
One of the most crucial aspect of treating headaches is figuring out your triggers. Learning what those are — typically by keeping a headache log — can reduce the number of headaches you have.

Once you know your triggers, your healthcare provider can tailor treatment to you. For example, you may get headaches when you’re tense or worried. Counseling and stress management techniques can help you handle this trigger better. By lowering your stress level, you can avoid stress-induced headaches The Pathophysiology Of Severe Intermittent Headaches.

Not every headache requires medication. A range of treatments is available. Depending on your headache type, frequency and cause, treatment options include:

Stress management

Stress management teaches you ways to cope with stressful situations. Relaxation techniques are helpful in managing stress. You use deep breathing, muscle relaxation, mental images and music to ease your tension.


Biofeedback teaches you to recognize when tension is building in your body. You learn how your body responds to stressful situations and ways to settle it down. During biofeedback, sensors are connected to your body. They monitor your involuntary physical responses to headaches, which include increases in: The Pathophysiology Of Severe Intermittent Headaches

Breathing rate.
Heart rate.
Muscle tension.
Brain activity.

Occasional tension headaches usually respond well to over-the-counter pain relievers. But be aware that using these medications too often can lead to a long-term daily headache.

For frequent or severe headaches, your provider may recommend prescription headache medications. Triptans and other types of drugs can stop a migraine attack. You take them at the first signs of an oncoming headache.

Drugs for high blood pressure, seizures and depression can sometimes prevent migraines. Your healthcare provider may recommend trying one of these medications to reduce headache frequency.

How can I prevent headaches?
The key to preventing headaches is figuring out what triggers them. Triggers are very specific to each person — what gives you a headache may not be a problem for others. Once you determine your triggers, you can avoid or minimize them.

For example, you may find that strong scents set you off. Avoiding perfumes and scented products can make a big difference in how many headaches you have. The same goes for other common triggers like troublesome foods, lack of sleep and poor posture.

Many people, however, are not able to avoid triggers or are unable to identify triggers. In that case, a more personalized multidisciplinary approach with a headache specialist is often necessary The Pathophysiology Of Severe Intermittent Headaches.

Can headaches or migraines be cured?
Treating health problems that cause headaches, such as high blood pressure, can eliminate head pain. Recently, there have been several new advancements in our understanding of what causes headaches. Although we are closer than ever before to a cure, at this time there is no cure for primary headaches. Treatment focuses on relieving symptoms and preventing future episodes.

What if treatment doesn’t work?
There are many different ways to address headaches. When you start a treatment program, keep track of your results. A headache log can help you measure progress.

Ask yourself:

Are my headaches less frequent?
Are they less severe?
Do they go away faster?
If you don’t notice an improvement, talk to your doctor at the next follow-up exam. You may need to try something new.

When should I see my healthcare provider?
Most of the time headaches, although painful, don’t pose a serious threat. However, headaches can sometimes be a symptom of a life-threatening condition. Signs you should seek immediate medical care include:

Confusion or slurred speech.
Headache after head injury.
Severe headache that comes on suddenly or headache that doesn’t go away.
Seizures or loss of consciousness.
Multiple headaches in children.
Stiff neck, or pain in the ear or eye.
Weakness or numbness.
Are there any headache remedies I can try at home?
You can treat the occasional, mild headache at home with over-the-counter pain relievers. Other self-care treatments for headaches include:

Applying heat or cold packs to your head.
Doing stretching exercises.
Massaging your head, neck or back.
Resting in a dark and quiet room.
Taking a walk. The Pathophysiology Of Severe Intermittent Headaches

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