How do they differ?
Tension Type Headaches:
Tension type headaches are the most common effecting
about 75% of all headache sufferers. Tension type headaches typically are a
steady ache rather than a throbbing one, effecting one or both sides of the
head. Some people will get tension type headaches (migraine headaches) in response
to stressful situations or active day. Tension type headaches may also be chronic,
occuring frequently or even everyday. Rebound headaches need to be excluded
as a cause of this. This is created by patients who take frequent over-the-counter
medications particularly Excedrin and will convert a migraine into chronic
daily headaches.
Migraine Headaches:
Migraine headaches are less common than tension headaches. Nevertheless they
afflict 25-30 million people in the US alone. Up to 80% of women experience
a migraine headache at some time. Roughly 2 out of 3 migraine sufferers are
female. The most distinguished feature is a potential disability accompanying
the headaches, prior headache pain of the migraine. Migraines are usually
felt on one side of the head in about 60% of migraine sufferers, the pain
is typically throbbing in nature. Nausea with and without vomiting, as well
as sensitivity to light and sound, may accompany migraines. An aura, a group
of telltale neurological symptoms, sometimes occur before the headache pain
begins. Typically an aura involves a disturbance in vision and may consist
of bright lights or flickering lights in the pattern that moves across the
field of vision. About 1 in 5 migraine suffers experience an aura usually.
The migraine attacks are occasional and sometimes as often as once or twice
a week but not usually daily.
Cluster Headaches:
Cluster headaches are relatively rare, effecting 1% of the population. They
are distinct from migraine headaches and tension type headaches. Most cluster
headache sufferers are male (85%). Cluster headaches come in groups or clusters
lasting for weeks or months. The pain is extremely severe but the attack
is brief lasting no more than an hour or two. The pain centers around one
eye and this eye may be inflamed or watery. There may also be nasal congestion
on the effected side of the face. These alarm clock headaches may strike
in the middle of the night and often occur about the same time each day during
the course of a cluster. A history of heavy smoking and drinking is common.
Alcohol often triggers the attacks.
Rebound Headaches:
Rebound headaches may occur among people with tension type headaches as well
as those with migraine headaches. It appears to be the result of taking prescription
or nonprescription relievers daily or almost every day contrary to directions
on the package label. If the prescription or nonprescription relievers are
overused, the headache may rebound as the last dose wears off leading one
to take more and more pills. This is a good reason to call your doctor.
Treatment of Headaches:
Headache medication is available in several different
kinds of delivery and formulations. Sometimes patients can pick the type
of derivative they prefer for themselves. Medications are available in oral
tablets or disintegrating tablets, nasal sprays, injections under the skin,
or rectal suppositories.
Acute or Preventive:
Medications discussed referred to as acute (or abortive) treatments for headaches
are used to stop or abort the headache attack in progress. If you have frequent
disabling headaches, you may be a candidate for preventive medications which
can reduce both the frequency of headaches and can make any breakthrough
headaches less severe and easier to treat.
Assessing Headache Treatment Needs:
If you are using medications more than one or two times a week on an average.
Do you have three or more severe hard to treat attacks per month? Do you
like the acute therapies you have tried? Do you have infrequent but severe
disabling attacks? Do you have headaches that are predictable, such as headaches
that increase in frequency during stressful times, travel, holidays, or tax
season? Do you miss work, social events, or family activities because of
headaches? If you answer yes to these questions, you would benefit from preventive
medicine for your migraines.
Preventive Medications:
Preventive headache therapies proven in clinical trials:
Class of medications:
Anti-epileptics (anti-convulsants): Depakote or Topamax
Anti-depressants: Amitriptyline, Nortriptyline, Desapramine
Beta Blockers: Inderal, Atenolol
Serontonergics: Sansert
Anti-inflammatories: Naprosyn, Ibuprofen
Triptans such as Imitrex, Relpax, Amerge, Maxalt, Zomig, Axert
Combination medications such as Midrin, Fioricet
Narcotics: Tylenol with Codeine, Vicodin, Percocet
Injections such as Tordol, IV Depakote, steroids, or narcotics
Cluster headaches may also respond to high dose nasal oxygen.
Sometimes the patient’s headaches do not respond to prescription medications
and require the patient to even come into the Emergency Room or to be hospitalized
and be given IV medications which include possibly DHE with a medication for
nausea, IV steroids, IV Depakote, or a narcotic.
References
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