Why Do You Experience Headaches?

Why Do You Experience Headaches?
Camille Keene Neurologist Lake Havasu City, AZ

Dr. Camille Keene practices Neuropathology in Lake Havasu City, AZ. Dr. Keene studies, evaluates, diagnoses, and treats conditions that affect the nervous system. Neuropathologists are trained to fully understand and treat such conditions as Alzheimers disease and Parkinsons disease.

Types, Causes and Common Interventions for Headache Symptoms

The most frequent reason for patients to seek the care of a neurologist is headaches. There are multiple headache types; headaches are broadly classified as being either primary or secondary headaches. The majority of headaches are primary headaches; that is, there is no specific, underlying structural or metabolic abnormality causing the headaches. The following are classified as primary headache disorders: chronic tension-type headaches, which is the most common headache type; cluster headaches and other trigeminal autonomic cephalalgias; and migraine headaches. It is not uncommon for patients to experience more than one headache type. Specific headache triggers have been identified in some instances, which include stress, certain foods, hormonal changes, and alteration of sleep-wake cycles.

Common Etiologies

A number of secondary headaches are attributed to disorders associated with facial or cervical structures: temporomandibular joint (TMJ) disorders; cervicogenic headaches, the etiology of which is in the neck; and sinus headaches. However, secondary headaches may also be indicative of a more serious underlying medical problem—for instance, an intracranial hemorrhage, a central nervous system (CNS) infection, metabolic abnormalities, or possibly an intracranial structural lesion such as a brain tumor, arteriovenous malformation, aneurysm, or other structural lesion. Excluding a more serious underlying etiology is the first and most crucial step in the neurological evaluation of a headache.

Diagnostic Procedures

Sophisticated radiological imaging and laboratory studies are used in conjunction with a neurological examination in the work-up and evaluation of headaches. MRI and MRangiography scans provide exquisitely detailed images of the brain and of the intracranial circulation, respectively. CT scans and CT angiography is also utilized. CT scans of the brain are extremely sensitive in identifying an acute intracranial hemorrhage, which is one of the most important abnormalities that must be immediately excluded in a patient with a new and acutely severe headache that is paroxysmal in onset. If an intracranial hemorrhage is suspected and a CT scan proves unrevealing, or if a CNS infection is suspected, then a spinal tap is completed on an emergent basis for further evaluation.

Medical Interventions

Once a more serious etiology has been absolutely excluded and the primary headache type has been defined, then therapy can be initiated. Pharmacologic treatment of primary headache disorders involves utilization of medications that target distinct headache types. Classes of medications commonly employed in the management of headaches include triptans, anticonvulsants, anti depressants, calcium channel blockers, beta blockers, barbiturates, and NSAIDs. Other therapeutic modalities have also proven effective—namely, biofeedback, behavioral modification, neurostimulation, physical therapy, and OnabotulinumtoxinA injections.

At present, there are a number of reasonably effective therapeutic modalities available, both pharmacologic and non-pharmacologic, which have proven to be successful in the treatment of primary headache disorders. And there continues to be ongoing research in an effort to develop newer, innovative treatments for headaches, and to enhance currently available therapies. At this juncture in time, patients now have access to many diverse and realistically viable treatment options specifically geared toward achieving optimal headache relief.