This type of headache is as common as migraine. As the name suggests, headache results from spasm or tension in the muscles. Headache may be bandlike, persistent and occur almost daily. Hence the characteristics differ from migraine, Physical examination and X-ray, CT Scan etc. are usually normal. The treatment is also different from that of migraine.
First and foremost it is important to define the factors causing stress and try to eliminate these. Commonly these include familial, social, financial or health problems. It is important to discuss them with patient and relatives, so as to sort out the problems. As mentioned ahead in the chapter on stress and -its management; relief from mental stress benefits the patient. Moreover, exercise, meditation, yogas also have therapeutic benefits. If required we can resort to hypnosis, autosuggestion, biofeedback etc.
Appropriate treatment by a neurophysician or physician and if required psychotherapy by a psychotherapist can relieve the patient from spastic headache. Drugs for anxiety, depression, mood changes etc. are also used. Drugs for relaxing the muscles also help. Dietary modification is suggested. Analgesics (drug for relieving pain) are used sparingly. When abused, these drugs only aggravate the headache.
Also there may be side effects on liver, kidney or, blood cells. These patients suffer from headache of drug abuse. They need to be handled tactfully, by slowly withdrawing the analgesics.
As mentioned earlier, if immediate treatment is given in cases of headaches, which occur due to infections of brain e.g., meningitis, the life of the patient can be saved. Brain tumor can be detected with the help of MRI and CT scan, and can also be treated by proper treatment and surgery. Similarly, intensive treatment of hemorrhage can save lives in most of the cases. The headaches worsen by use of excessive medicines or addiction to painkillers. In some cases headache can have more than one cause like migraine and sinusitis. It is also essential to rule out easily curable diseases which cause headaches like sinusitis, ophthalmic disorders etc.
The symptoms usually associated with headache of serious origin are given below. In such cases immediate diagnosis and treatment can save lives, which is the main intention of this chapter.
i. Seizure, vertigo, blackout, stumbling or paralysis on one side of the body, speech loss or memory loss, unconsciousness.Fever.
ii. A headache immediately after getting up from sleep, pain aggravated by sneezing or coughing.
iii. Severe headache for a few minutes.
iv. Headache in children.
v. A gradually aggravating headache in a person above 50 years. If the temporal artery becomes thick or starts paining with symptoms like exhaustion, low-grade fever, weakness, temporal arteritis may be the cause. In such cases, blood ESR is very high. It can be confirmed by biopsy and treated with steroids carefully.
vi. Pain not controlled even after taking painkiller medicines.
vii. If headache is accompanied by above symptoms then it is necessary to be cautious. The cause of these symptoms may be a swelling in the brain, a tumor or an infection. If the headache is not accompanied by such symptoms then there is nothing much to worry.
One of the other well-known and important reasons for headaches is Neuralgia. We will now discuss the condition called Trigeminal Neuralgia in brief.
The simple meaning of neuralgia is pain in or along the nerves. The pain affecting the area, which a nerve covers i.e. from where the nerve takes the impulses to the brain, is called Neuralgia. It is quite commonly observed in particular nerves like the fifth and ninth cranial nerves ... etc. Such neuralgic pains can occur in the nerves of the chest, stomach, of the skin, and limbs. It is worth noting that Herpes Zoster viral infection occurring on the skin affects and inflames the nearby nerve causing very painful neuralgia.
Trigeminal nerve is the fifth cranial nerve and pain of this nerve is called Trigeminal neuralgia. This pain is shooting and momentary like an electric shock, which is very painful and keeps recurring frequently. This can occur from 1 to 2 to 100 to 200 times in a day, which leaves the patient very helpless and in a lot of agony. The pain may be triggered off by the touch of cold water or air or opening the mouth for eating. Trigeminal nerve is divided into three parts. If the first part gets affected, the ‘pain occurs on the forehead, if the second part is affected the pain affects the cheeks and if the third part gets affected the pain is on the jaw.
Usually, a neurological examination is unremarkable. But if the sensations are reduced in the affected part or signs of disturbance of other cranial nerves are also seen (e.g. sixth or seventh cranial nerve also seems to be affected) or if the patient is below the age of 40 years, then it is essential to do an MRI brain (with contrast) or MR angiography, because in some cases there may be a tumor on or around the 5th cranial nerve or a disease called multiple sclerosis (which is less common in India).
The initial treatment of Trigeminal Neuralgia is done with medicines. The main drugs are - carbamazepine (tegrital, carbatol, zeptoletc). They are effective in 80% of the patients. In other cases phenytoin, gabapentin, clonazapam, baclofen etc. can be used.
Painkillers can also be added to reduce the pain. Local injection of alcohol in the nerve can relieve the pain for 3 to 4 months. Actually, the correct treatment of Trigeminal Neuralgia is to do RFTC Radio Frequency Thermo Coagulation to treat the nerve. This is an effective method, with up to 90 to 95% success rate. In some cases if drugs are not effective, nerve resection surgery (rhizotomy) can be done. All these treatments are available with neurosurgeons in the main centres of India .