In neurology OPD most of the patient’s that come with the complaints of headache thought that their headache is migraine headache. Its sometimes funny because in opds as soon as neurologist ask the patient about his Headche complaints patient at once says “sir mujhe kai saalo se migraine hai” .That is a casual approach and that can be disastrous. Accepted that prevalence of migraine among other types of migraine is high, but symptoms and signs of migraine mimics other dreadful conditions like tumours, vascular disorders. So it is wise to contact a neurologist and get the right diagnosis. However, there is now a large body of evidence highlighting the societal impact of headache disorders, their cost and the necessity to educate and provide more basic care for those
Here it becomes very important to know about Migraine and Other conditions that mimics or have symptoms like Migraine.
1. Tension-Type Headache (TTH)
Tension headache, also known as a tension-type headache (TTH), is the most common type of primary headache. It is also the most common headache in the general population , and the second-
most prevalent disorder in the world .The mean global prevalence of TTH in adult is 42% . Due to its high prevalence in the population, TTH causes a high degree of disability. The headache in TTH is
rarely severe. It is often band-like and aching and usually not throbbing affects both sides of the head and may and may not be associated with light and sound sensitivity or nausea and vomiting .
Muscle tenderness in the head, neck, or shoulders is often present. Stress and mental tension are known to be the most common precipitants for TTH.
There are three main subtypes of TTH :
Infrequent episodic TTH, with headache episodes less than one day a month
Frequent episodic TTH, with headache episodes 1 to 14 days a month
Chronic TTH, with headaches 15 or more days a month
Tricyclic antidepressants, including amitriptyline and protriptyline and Simple OCT analgesics are the mainstays of treatment of episodic TTH. However, it is crucial to avoid frequent and excessive use of simple analgesics to prevent the development of medication-overuse headache .. Acupuncture, massage, and relaxation and yoga therapies are sometimes used.
Cluster headache is a rare disorder that affects about 1-2 people in every 1.000 and males are usually more affected.It is characterized by a severe pain in one side of the head, often around the
eye, temple or forehead. The pain may begin quickly and reaches its crescendo and without warning. It is very intense but does usually not last for more than 1-2 hours and a classical feature is its periodicity and is associated with the following symptoms;
A red and watering eye
Drooping and swelling of one eyelid
A smaller pupil in one eye
A sweaty face
A blocked or runny nostril
People who smoke or consume alcohol seem to have a higher risk of getting cluster headaches.
Some cases also appear to run in families.
3. Subarachnoid Hemorrhage (SAH)
The subarachnoid space is a csf filled space between the brain and the skull. Subarachnoid hemorrhage (SAH) is a life-threatening and painful condition caused by bleeding into the subarachnoid space. Hypertension is the risk factor. SAH can be caused by a ruptured aneurysm, vessel malformations (arteriovenous malformations), or head injury. SAH typically presents with asevere headache and patient often describes it as WORST HEADCHE OF LIFE., nausea and vomiting stiff neck, sensitivity to light (photophobia), and sometimes blurred or double vision, loss of consciousness, and seizures.Treatment for SAH varies, depending on the underlying cause of the bleeding, the condition of the patient, and the extent of damage to the brain.
4. Brain Tumor
Headache is one of the most common symptoms experienced by patients with brain tumors. The headache in case of tumor is usually steady but often worse in the morning hours and is generally
much more persistent than migraine headache. It is associated with nausea or vomiting and may worsen with coughing, exercise, or a change in body position and does not usually respond to the
usual headache remedies completely. The signs and symptoms of a brain tumor vary greatly and depend on the brain tumor’s size, location in the brain, and rate of growth.
5. Head Trauma
Headache immediately following a small head injury usually disappears after hours or days.However, sometimes headaches may persist for months or years after the injury. These persistant long-term headaches are called post-traumatic or post-concussion headaches. Post-traumatic headaches typically affect the site of lesion or both sides of the head and often occur daily. They are of mild to moderate intensity with or without nausea and vomiting . However sometimes , bouts of more severe headache may occur and these may be similar to migraine headache with one sided throbbing and pulsatile pain associated with nausea and sensitivity to light and noise.
A stroke or CVA ccurs when the blood flow to the brain is interrupted either there is rupture of blood vessels resulting into bleed or blockage to blood flow leading to infarct. In both conditions If blood doesn’t reach the brain, brain cells will start die resulting into permanent brain damage. A patient in the early or late phases of a stroke may experience a headache. This headache may be accompanied by vertigo, dizziness or vomiting, altered sensorium. However, in most cases of CVA patients will have neurologic deficits as well, such as an inability to speak or move a limb, sensory deficits, slurred speech or an inability to walk.
7. Sinus headache:
URI or Upper respiratory tract infections are a common cause of headache In children and adolescents. Upper respiratory tract infections in the form of sinusitis are the most frequent underlying cause of acute headache (57%). These are further divided into viral upper respiratory tract infection 39%, sinusitis 9%, and streptococcal pharyngitis 9%. In such cases of headache patient
also has fever and a sore throat.patient has sometimes history of recurrent cough and cold, running nose, allergy. However, sinusitis appears to be an uncommon cause of recurrent headaches, and
many patients presenting with sinus headache turn out to have migraine.
8. Encephalitis and Meningitis
In tropical countries like India infectious brain disorders are one of the most common differentials of headache. Encephalitis is an infection of the brain tissue most often caused by a viral and less
common by bacterial infection. It is characterized by fever, severe headache ,seizures, change in behavior, and disorientation. Meningitis is an infection of the membranes that surround the brain.
Here in Asian Neuro Centre, Indore, we are having a “HEADACHE CLINIC” where one of the best neurologist in Indore , Dr Navin Tiwari and his team comprising of counsellor, nursing attendant promised to providethe best treatment of migraine / headache,they take thorough history of patients with headache (as per international guidelines) and educate the patients about various types of headache through various audio and video medium with an intent to create an awareness about headache in society.