Types of Headaches

This type of headaches is described as pressing or tightening in quality, of mild or moderate intensity, bilateral in location, without associated nausea, photophobia or phonophobia. It is not made worse by routine physical activity as may be the case with migraine headaches. Tension headaches are the most common type of headache and have many precipitating factors. Removal of identifiable causes and precipitating factors is the ideal way to treat this type of headache. Although the most common precipitating factor – stress – is often difficult to alleviate, reducing the physical effects of stress can be achieved through both non-pharmacological and pharmacological methods

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These headaches usually occur in patients with migraines who take abortive medications too frequently, which leads to worsening of migraines. Abortive medications are the ones that are taken as needed to stop an individual migraine attack. The second type of migraine medications is prophylactic medications, which are taken daily to prevent migraine attacks. Not all abortive medications are equally likely to result in medication overuse (MOH) or rebound headaches. The strongest evidence we have is for caffeine-containing medications such as over-the-counter products, Excedrin, Excedrin-Migraine, Anacin and prescription drugs, Fiorinal (butalbital, aspirin, caffeine), Fioricet (butalbital, acetaminophen, caffeine), Esgic, and other. MOH can be also caused by dietary caffeine. As little as 2 cups of coffee per day can cause rebound headaches in a susceptible individual. Studies suggesting that aspirin, ibuprofen, naproxen and other non-steroidal anti-inflammatory drugs (NSAIDs) and triptans (sumatriptan, or Imitrex, rizatriptan, or Maxalt, and other) are much less convincing. Actually, NSAIDs are used as daily prophylactic drugs. Taking aspirin only intermittently may also help prevent future attacks. Triptans are also not proven to cause rebound or MOH. The blog post that has received the most number of comments is the one I wrote on daily use of triptans, which suggested that daily use of triptans is an acceptable treatment approach for patients who have failed Botox injections, daily preventive drugs, and non-drug therapies.

Elderly patients

Cervicogenic headaches are very common in elderly patients due to arthritic changes in the cervical spine. Pain described as radiating from the neck or occipital in location suggests this diagnosis. Pain originating in this are can sometimes, however, be felt in the front of the head. Loss of sensation over the occipital area, often on one side can accompany occipital neuralgia. Neck muscles are tender, frequently in spasm, and their movement can aggravate the pain.

In many patients post-traumatic headaches will subside in a few weeks or months without any treatment. Chronic post-traumatic headaches, however, may be very resistant to treatment.

Cluster headaches are the most intense headaches of all, leading some patients to thoughts of suicide.

Headaches occur in clusters, frequently during the same season each year, with each episode lasting for several weeks or months.

The pain often wakes the patient from sleep – sometimes at the same time – every night and usually lasts for 30 to 90 minutes. Such regular occurrence, however, is not always present.

The pain is described as retro-orbital, unilateral and is associated with agitation, nasal congestion, conjunctival injection and lacrimation.

HEADACHE TRIGGERS (Hormonal, Dietary and Environmental):
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