Migraine, tension-type, cluster headaches and other nerve related pains are the main types of primary headaches. Also, there are some uncommon types such as the ones due to cough, exertion or those that come after sexual activity. Tension-type one is usually episodic but like migraine, it can become chronic, occurring daily or almost daily, for more than 15 days a month. Among the primary ones, the tension-type headaches are most common.

Migraine

Migraine is the most recognised headache syndrome. Its occurrence is more common in women. Migraine can be grossly classified into migraine without aura [common migraine] and migraine with aura. Generally, many hours or a day before the onset of a migraine attack, patients experience varied symptoms like changes in mood or personality. Fatigue also is common, and occasionally hyperactivity occurs as well. Migraines may even trigger nausea and vomiting. Some migraine sufferers even experience a perpetual disturbance known as the aura. The aura is a well-defined visual deficit that lasts for less than an hour and is followed by a headache. Most auras are marked by flashing lights that are initially small, which enlarge or move across the visual field. Migraine attacks can last anywhere between 6 – 72 hours. The throbbing pain caused by migraines is usually one-sided but some patients experience bilateral pain. Migraines may even bring about a morbid fear of light or noise and in rare cases odours. It is best to avoid physical activity after an attack sets in as it exacerbates the pain.

Tension-type headache

This type of headache is characterised by generalised pressure or a sensation of tightness in the head. Unlike migraines, physical activity doesn’t worsen the discomfort caused by this headache. However, in rare cases patients may undergo nausea and fear of light or sound. Tension-type headache could be either episodic [less than 15 days a month] or chronic [lasting more than 15 days a month].

Cluster headache

A cluster headache is most often seen in young men and is a one-sided headache that may involve excess watering from the eyes and a stuffy nose. Its prominent feature is that the attacks occur regularly for a week to a year and are separated by long pain-free periods of a  month or more.

Management of headaches

Treatment usually depends on the specific headache type and a proper diagnosis by a neurophysician. Different medications are available for each type of primary headache. Consult your doctor to find the best medication for you. However, the major trigger of headaches is stress. Reducing stress is all one might need to prevent and minimise the pain of a mild headache. Stress can be comfortably managed with relaxation techniques like yoga, meditation or massage. Applying a cold, moist cloth, an ice-pack or even peppermint oil to the forehead and temples helps in eliminating the headache. Taking over-the-counter pills for headaches more than three times a week can rebound headaches hence they are best avoided. Maintain a headache journal to monitor frequent occurrences and consult a doctor if required. A good posture helps in preventing muscle tension leading to headaches. Last but not the least, live a healthy lifestyle—eat healthy meals at regular times, sleep well and avoid alcohol.

This was first published in the March 2013 issue of Complete Wellbeing.

The post Headache: A throbbing problem appeared first on Complete Wellbeing.

Types and causes

Viral meningitis is the most common of the causes of meningitis, followed by bacterial. Fungal and parasitic meningitis, though uncommon, can occur in individuals with a weak immune system.

Viral meningitis is caused by the herpes simplex virus, varicella zoster virus [known for causing chicken pox and shingles], or even the mumps virus. Causes of bacterial meningitis differ as per age. Some common causes include:

1. Skull injury.
2. People with a cerebral shunt or related devices are at an increased risk of infection through those devices.
3. Head and neck infections.
4. Pneumococcal [type of bacteria] meningitis is seen in recipients of cochlear implants for hearing loss.
5. Cancer that spreads to the meninges.
6. Certain drugs [non-steroidal anti-inflammatory drugs, antibiotics and intravenous immunoglobulin].
7. Inflammatory conditions, connective tissue disorders and certain forms of vasculitis [inflammatory conditions of the blood vessel wall].
8. Diseases and tumours that erode the skull.
9. Cerebrospinal fluid [CSF] leak because of a head injury.

Signs and symptoms

The most common symptoms are severe headache, high fever and inability to flex the head forward due to rigidity of the neck muscles. However, all three features are present in only 44 – 46 per cent of all cases.

A child with meningitis may look unwell, be irritable and restless. Infants up to six months may have a bulging of the fontanelle [the soft spot on top of a baby’s head]. Other signs include leg pain, cold extremities, and abnormal skin colour.

Here is a list of some more signs to look out for:

• Lethargy [decreased consciousness]
• Irritability
• Photophobia [sensitivity to light]
• Phonophobia [intolerance to loud noises]
• Stiff neck
• Skin rashes
• Seizures [fits]
• Altered mental status.

Complications

As the pressure inside the skull increases, it may lead to swelling within the brain [oedema]. This could further lead to the obstruction of the flow of CSF in the brain, causing seizures.

Inflammation of the meninges leads to abnormalities of the cranial nerves that cause facial weakness, hearing loss, loss of vision or difficulty in swallowing. Blood clots are formed that result in a deteriorating sensorium [centre for sensation] and focal neurological deficit [nerve function problem].

Severe infection of meningococcal and pneumococcal bacteria may result in haemorrhage of the adrenal glands [leading to Waterhouse-Friderichsen syndrome], which is often lethal.

Diagnosis

In patients with symptoms, a complete blood examination should be performed along with markers of inflammation [C-reactive protein]. A blood culture should be done in bacterial meningitis to detect associated organisms and sensitive antibiotics to treat the same.

The most important test in identifying or ruling out meningitis is the analysis of CSF through lumbar puncture. However, lumbar puncture is not suggested if there is a tumour in the brain or the intracranial pressure [ICP] is high, as it may lead to brain herniation. So, getting tests done like neuro imaging with brain CT [computed tomography] scan or MRI [magnetic resonance imaging] scan before the CSF is helpful.

CSF study is helpful to indicate the likely causative organism. In severe forms of meningitis, monitoring of blood electrolytes is suggested.

Treatment

Treatment with wide-spectrum antibiotics should not be delayed while confirmatory tests are being conducted. Empiric antibiotics must be started even before the results of the lumbar puncture and CSF analysis are known.

Tuberculosis meningitis requires prolonged treatment with anti-tubercular drugs and is typically treated for a year or even longer. Viral meningitis requires supportive therapy, as most viruses responsible for causing meningitis are not amenable to specific treatment. Fungal meningitis is treated with long courses of anti-fungal medicines.

Prevention

Prevention of meningitis can be short-term [antibiotics] or long-term [vaccines].Immunisation against Haemophilus influenzae type B, which is incorporated in their routine childhood vaccination scheme, has eliminated this pathogen as a cause of meningitis in young children.

Even incidence of mumps meningitis has fallen since immunisation with mumps vaccine. Close contacts like family members and health care professionals may need short-term prophylaxis [prevention], especially in meningococcal meningitis.

The post When the brain catches fever… appeared first on Complete Wellbeing.