Headache is one of the commonest disorders that can contribute to poor quality of life in women. Leading to irritability, depression and insomnia, headaches may get further aggravate and become chronic at times. In such a situation we should try and figure out the etiology of headache as it would help us decide the best management modality.
1. Migraine – one of the commonest headache syndromes that affects a woman. It is usually one sided but may change the side of the head, throbbing, may be associated with nausea and vomiting, may or may not lacrimation or nasal congestion. Many patients with migraine have prodromal symptoms that are called aura – that precede headaches and may be in the form of scintillating lights in the visual field, some vague sensory symptoms etc. Migraine episodes may last from few hours to up to 72 hours and may be relieved by sleep. Most of the patients might have sensitivity to lights and sounds and may have particular trigger factors like sleep deprivation, excessive physical stress, hormonal changes (during a woman's menstrual cycle), certain foods (e.g., chocolate, aged cheeses), beverages (e.g., red wine), strong odours etc. It is not uncommon to experience mixed tension-migraine headaches. Migraine is more common in females, may be familial and many patients report more episodes during the time they have their periods. Few patients of migraine may turn chronic and convert into chronic daily headache and these are the patients who might need aggressive management.
2. Tension type Headache – TTH: An episodic headache that is usually affects the whole of the head and is associated with stretching sensation or band like sensation inside the head, which is most of the times associated with scalp muscle contraction. It is not related with sleep but a lot many times may be associated with psychological and physical stress. Patients might report associated insomnia and depression along with it.
3. Cluster Headache – : It is again a common type of headache in young populations though have slightly more predisposition for males. It occurs on one side often head, would occur in clusters and these episodes are usually associated with tearing, eyelid drooping and nasal congestion on the side where the headache is prominent. Pain may last about 20 to 90 minutes at a time. They typically start during sleep. Alcohol and seasonal change might trigger the bouts of these types of headaches.
4. Trigeminal Neuralgia – Sharp shooting electric current like pain on one side of the head that may last for few seconds but may be the most severe pain that patient might have experienced in life. It is a neuralgic pain and is because of involvement of the trigeminal nerve that supplies the sensations on the face.
5. TM Joint dysfunction – It occurs in the pre-auricular region i.e just in front of the ear and is increased by movement of the jaws.
6. Hypertension – Increased blood pressure is yet another cause of acute headache.
7. Medication abuse headache – Many times overuse of painkillers taken for chronic headache also may lead to Medication abuse headaches.
8. Sinusitis: The patient with sinusitis will have bi-frontal headache that is associated with running or stuffy nose and heaviness on the forehead. They may follow upper respiratory tract infection such as cold and coryza. For sinusitis ENT specialist might order few specific tests and may prescribe oral tablets and nasal spray.