A significant number of patients present with the associated signs and symptoms of a migraine, including nausea, vomiting, diarrhea and visual disturbances, yet they do not have the hallmark headache. These patients may also have significant vertigo (dizziness).
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* Bright or flashing lights
* Loud noises
* Changes in sleep pattern
* Allergic reactions
* Alcohol or caffeine
* Smoking or exposure to smoke
* Skipping meals
* Emotional stress
* Certain odors or perfumes
* Certain foods containing tyramine (red wine, aged cheese, smoked fish, and some beans)
* Foods containing MSG or nitrates (hot dogs, bacon, salami)
* Other foods, including: chocolate, nuts, peanut butter, citrus, pickled or fermented foods
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More than 23 million people suffer from migraine headache in the United States—more than have diabetes, epilepsy or asthma. Migraines are considered to be a vascular headache, and their signs and symptoms have been found and well-documented on papyrus as far back as ancient Egypt. About one in eight adults suffers from migraine; women are two to three times more likely to experience migraine headache than men. Migraine headache is most commonly found in the 25 to 34 year-old age group.
Migraine pain is usually described as a moderate to severe “throbbing” or “hammering” headache, typically on one side of the head. The pain will prevent activities of daily living and will increase with exertion. While the individual experiencing a tension headache is able to go up and down stairs, or perform household or office activities, the migraine sufferer will find the pain too debilitating to do so.
Patients experiencing a migraine attack, as it is often referred to, may complain of photophobia and sensitivity to sound. This is a typical complaint that may be used to differentiate it from a tension-type headache. Associated nausea and vomiting are also very common for the migraine sufferer.
Migraines may be classified as either “common” or “classic.” Common migraines do not have any warning signs or symptoms, while classic migraines do have a warning in the form of an aura. Patients may have migraines regularly on a weekly or monthly basis. For women, this may occur relative to their monthly menses cycle, triggered by fluctuating hormone levels. Ovulation, birth control pills and the birth control patch may also be contributing factors. Some victims, on the other hand, may go months or even years between attacks.
In general, a migraine headache may last from four to 72 hours. Most individuals with diagnosed migraine headaches understand their condition better than EMS providers do. It is important for us to question why this patient called 9-1-1 when they already know what the problem is. It is key to ask what is different about this headache. If the duration of the headache is longer than 72 hours, consider what is known as a complicated migraine. It would also be appropriate to ask the patient if there is anything else unusual about this particular headache, such as an aura.
The aura, which is caused by cerebral vasospasm and spreading cortical depression, is often described as visual disturbances or changes. It may come on over a period of 10 to 30 minutes. Patients may describe spots before their eyes, loss of peripheral vision or even complete loss of vision, as well as numbness or tingling of the limbs. Slurred speech or changes in speech patterns may also present as an aura. It is also common for patients to experience protracted vomiting, diarrhea and hypovolemia. It is easy to understand why a patient or family member would be alarmed, as these symptoms certainly say stroke until proven otherwise.
Patients who experience some neurological dysfunction with their headache are classified as having a complicated migraine. The area of the body affected by the dysfunction is related to the area of the brain where the headache is occurring. A vertebrobasilar migraine would be associated with symptoms affecting the brain stem. These patients would report vertigo or double vision and may be reported by a bystander or family member to have passed out or fainted. The symptoms from a complicated migraine may last only a few hours or up to several days.
Patients with a history of migraine headache are often prescribed triptans, or serotonin receptor agonists. The most commonly prescribed are sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), and zolmitriptan (Zomig). These are usually found in tablet form or as a nasal spray; however, they may also be prescribed as a self-administered injection.
Ergotamine derivatives and Midrin, which is a combination of the drugs isometheptene, acetaminophen and dichloralphenazone, are other medications used by migraine sufferers. Nonsteroidal anti-inflammatory drugs (NSAIDS), which are over-the-counter medications, may also help arrest a migraine in some individuals.
Patients who experience migraine headaches as frequently as three or more times per month are often prescribed medications to help reduce the number and intensity of the attacks. Most commonly prescribed are beta-blockers, such as propranolol (Inderal); antidepressants, including tricyclics like amitriptyline (Elavil) or fluoxetine (Prozac, Sarafem), paroxetine (Paxil), or sertraline (Zoloft); anticonvulsants like valproic acid (Depacon, Depakene) or divalproex sodium (Depakote), and calcium channel blockers such as verapamil.
The exact cause of migraine headache is not fully known; however, it is believed that blood flow in the brain is the key component. At the start of a migraine, blood vessels in certain parts of the brain constrict and reduce blood flow, at which time the symptoms described as an aura occur, along with visual disturbances, numbness, tingling and slurred speech. Minutes to hours later, the blood vessels dilate, blood flow increases, and the onset of migraine occurs. While the changes in blood vessels and blood flow are not completely understood, it is believed that certain triggers make it more likely for the migraine sufferer to experience an attack.
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This patient typically presents with a chief complaint of head pain described as a tight band around his head that may be heavy or oppressive. In tension headache, the pain is most often described as being on both sides of the head, and there may be some referred pain to the patient’s neck.
Getting a handle on how much head pain a patient is experiencing may be extremely difficult. A good assessment for head pain is to note the patient’s activity level. Patients experiencing a tension headache will be able to perform what are known as activities of daily living (ADL), such as getting out of bed, walking around the house, and descending or ascending stairs, without the pain interfering or limiting these activities. It doesn’t mean they don’t have pain; it is just an indicator of pain severity and that their activity does not increase the pain.
It is not uncommon for a patient with a severe tension headache to also complain of nausea and vomiting, which often leads to a 9-1-1 call. The patient may have a history of tension headache, but has never experienced nausea or vomiting with it. It is not uncommon for this patient to complain of sensitivity to light (photophobia) or sound (hyperacusis), but not both.
As the name implies, tension headache is due to muscle tension. Characteristically, the muscles of the head and neck have contracted very tightly for a prolonged period of time, due to physical exertion, reading intensively, poor posture, work habits, or, of course, retaining stress. Most individuals, EMSers included, will experience episodic tension headaches; however, some may experience tension headache on a more frequent basis. People who have tension headache greater than 15 days a month are considered to have chronic tension headache.1
The majority of folks who experience a tension headache find relief with over-the-counter (OTC) pain medications like ibuprofen, acetaminophen or aspirin. Cold compresses, stopping the activity (e.g., reading, posture change), along with relaxation activities may also provide relief for the individual.
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Following are some symptoms and patient presentations that are common with different headache types.
* Tension Headache
* Migraine Headache
* Hemiplegic Migraine Headache
* Exertional Headache
* Cluster Headache
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At 1428, your unit is sent to a private residence for a reported possible stroke. Upon arrival, an obviously worried family member takes you to a back room, where you encounter a 33-year-old female lying in a recliner. The room is well kept, and you note the lights are off, with just a bit of sunlight coming through the closed curtains.
As you introduce yourself and your partner to the patient, you note she is breathing, and her verbal response is coherent and clear. You also see that she is clearly anxious. When you ask how she is feeling, Mary tells you that she awoke from a nap with severe right-sided head pain and she has lost her peripheral vision. “It’s gone black,” she says. Her vital signs show a strong and regular pulse of 94, an unlabored respiratory rate of 18, and blood pressure of 154/90. You administer the Cincinnati Stroke Scale (CSS) and don’t notice any deviation from a normal response. Mary denies allergies to medication, says she uses seasonal allergy medication, and denies specific past medical history.
You administer O2 at 15 LPM via a non-rebreather mask, establish an IV of normal saline and check her blood glucose, which is 94. As you move the patient by gurney to the ambulance and prepare for transport, she begins to complain of nausea and then vomits. Your transport decision is an emergency facility that has head CT available. You arrive at the hospital after an approximately 25-minute transport, provide your hand-off report to the staff taking over her care, complete your paperwork and check on Mary prior to returning to service.
Approximately four hours later, you return to the same hospital with another patient. After turning this patient’s care over to the staff, you ask about Mary and learn that her CT was read as normal and her diagnosis was acute migraine headache. She was medicated for pain control and discharged to follow up with a neurologist.
Your initial impression included consideration of a possible stroke, and you are a little surprised to find this was ruled out in light of her visual disturbances and the severity of her headache. A number of headache types may produce or carry associated symptoms that mimic a stroke or other potential diagnosis. It is important to remember that in the prehospital setting, it is nearly impossible to make such a diagnosis, and EMS providers should avoid snap assessments that may lead to treating a patient inappropriately.
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Do you know that tension headaches are caused by anxiety, nervous tension, eyestrain, poor seating position, or tight muscles in the shoulders and neck? And do you know migraine headaches are caused by expansion of blood vessels in you head. Headache can also be caused by colds or flu, or even digestive problems. Ouch. Not to worry!
Here are 5 effective remedies to chase the headache away easily:
1. To tackle tension headache, massage your temples with some lavender essential oil. Also, you can place your fingers at the top of your spinal column, where your neck meets the skull. Then move your fingers out 5cm along the base of your skull until you find a small little indentation on either side. Apply firm pressure with the pads of your fingers, making a small rotating motion with your fingers. You will feel slightly tender as you apply the pressure. It would be better as you massage deeper. Breathe deeply while you massage, and let yourself relax. Do this for one to three minutes. Repeat as often as you like.
2. Here’s an herbal tea mix that can smoothen the tension in you. Take 250ml water, 1 teaspoon fresh chopped ginger root, and simmer the ginger in water in a covered pot for five minutes. Next add 1 teaspoon dried chamomile and 1 teaspoon dried linden flower and steep for another ten minutes. Strain and drink it hot. Sweeten the tea with brown sugar if desired.
3. Lavender is one great thing to tackle headache as it can ease mental and physical stress. Add five drops of lavender and five drops of marjoram essential oil into a basin of cool water. Then soak two towels in the water and wring it lightly. Lie down on a bed and apply one towel to your forehead and one to the back of your neck. Rest for 30 minutes and you will feel relaxed afterwards.
4. Valerian helps to relieve the pain of tension or migraine headaches. Take half a teaspoon of valerian extract and dilute in warm water. Drink a cup every 30 minutes till the pain is gone. But make sure you can only take up to 3 teaspoon a day of valerian.
5. Lastly, try immersing your feet in a bucket of hot water for 15 minutes. Make the water as hot as you can withstand. At the same time, wring out a towel in ice water and apply cold compress on your forehead, temples, back of neck, or where the pain is concentrated at. This will increase blood flow to the feet and at the same time constricts blood vessel in the head, reducing blood flow and hence reduce pain.
And so here’s 5 easy natural ways to curb the annoying headache. You don’t necessarily need to see a doctor or take pain killer to stop your headache. Home remedies such as these are also great and easy ways to keep the pain at bay.
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In conjunction with June 7–13 being designated as National Headache Awareness Week, Marion Chiropractic Center is doing what it can to help educate the public about the causes and cures of headaches.
“We are allowing any chronic headache sufferer to come in during Headache Awareness Week, and receive their exam, consultation and x-rays for just $25,” according to Dr. Vincent Mendes, clinic director at the center.
“We will also give them a chart that shows all types of headaches, and the symptoms of each different type.”
Headaches are a common problem, affecting people of all ages, Mendes said, adding that headaches are one of the most common reasons patients visit a chiropractic office. The most common types of headache are tension headaches, sinus headaches and migraines and chiropractic is helpful at relieving all three,” he said.
Mendes cautions against treating chronic headaches by taking pain medicine every day for years and say that can be dangerous.
“Pain medications have side effects that become more serious the longer you take them. It’s better to get the cause of the problem corrected.”
In rare cases, a headache may be a sign of something serious. “Our exam and x-rays are meant to rule out any cases where a patient’s headache is being caused by a serious medical condition,” Mendes said, adding, “If a patient needs referral to their medical doctor for CT scans or medical treatment related to their headache, we always refer them to their doctor”.
According to the National Headache Foundation, primary or benign headaches are not brought on by an organic underlying condition.
However, common headaches are legitimate biological disorders, not psychological conditions. Among the categories of headaches are tension, migraine, cluster and organically caused ones.
About 78 percent of adults experience a tension or stress headache at some point in their lives. There appears to be a slightly higher prevalence of this type of headache among women and more women than men seek treatment.
According to the them, more than just a “bad headache,” migraine pain and associated symptoms affect 29.5 million Americans, equivalent to 13 percent of the population and one in every four U.S. households has a migraine sufferer.
There are an estimated one million cluster headache sufferers in the United States, the NHF reports, with about 90 percent of the sufferers being male.
An organically caused headache is not a disease itself; rather it is a symptom of another disease or disorder. These conditions can be life-threatening so immediate evaluation by a doctor is recommended. Fortunately, these types of headache are less common than primary headache
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The brain stem—the structures of the brain located behind the eyes and nose—contains an “anti-pain” system. When this area recognizes an incoming nerve signal as painful, it responds with a powerful pain-relieving effect.
The pain from a headache is thought to begin with the trigeminal nerve, which is located in the brain stem. The largest in the head, this nerve carries sensory impulses to and from the face. When stimulated, perhaps by a certain headache trigger, it releases a burst of neurotransmitters (chemicals that pass impulses from one nerve to the next). This, in turn, normally prompts release of yet another neurotransmitter called serotonin.
Serotonin acts as a filter, screening out unimportant signals—for example, weak, repetitive, or familiar background noise like music and other people’s conversations—while admiting signals that demand attention, such as unusual or significant sounds like a baby’s cry or your name being called. The more serotonin, the greater the screening action. High serotonin levels correlate with sleep.
Under ordinary circumstances, pain signals from the trigeminal nerve are counteracted by increased serotonin levels. But in people suffering a headache, serotonin levels often prove too low. Scientific tests have shown a clear relationship. When injected with a drug that depletes serotonin, test subjects got headaches. Likewise, when they were injected with serotonin, the headache went away.
Significantly, lack of serotonin has also been implicated in depression and sleep disorders, two problems that afflict many headache sufferers. The role of serotonin is not, by itself, a full explanation of headache. But as researchers continue to unlock the secrets of our neurotransmmitters and their effect on pain, mood, and other body functions, we can look forward to an ever better understanding of the causes—and cures—of headache.
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Scientists have yet to completely unravel the cause or causes of headaches. It was once believed that constriction and dilation of blood vessels caused migraine headache, while muscle contraction caused tension headache. The constriction of vessels in the head was thought to cause the aura of migraine, as well as the nausea and vomiting. The subsequent relaxing, or dilation, of the vessels then brought on the pounding pain associated with migraine.
These changes are still thought to play a big role in headache pain, but a much more complicated explanation is beginning to emerge from recent scientific findings. Many experts now speculate that migraine and tension headache have the same origins in the brain.
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