Neurologist, Dr Pawan Ojha, heading the Headache & Vertigo Clinic with Dr.Orpha Kalel ENT specialist and Surgeon at Hiranandani Hospital, Vashi – A Fortis Network Hospital
Headache and Vertigo affects 1/5 Indians, inflicting considerable discomfort. It impairs the quality of life and adversely impacts involvement at work, home and at the societal level. They are often linked to each other and have common triggers. Headache seen in 14.7% Indians, whereas vertigo is seen in 0.7% of all adults and of 20% that can be due to neurological diseases. It is often seen that people with Vertigo or Headaches self medicate and visit a number of non-expert doctors and complicate their disease before reaching the specialists. In most cases, an early and proper diagnosis is crucial in defining the cause and the course of treatment. Headache is usually dealt separately by Neurologists or Physicians.
Classification of headaches:
- Primary Headaches: A headache condition in itself and not due to another cause. The main three types of primary headaches are: Migraine, Tension & Cluster headache
- Secondary Headaches: Is caused because of another condition such as sinusitis etc. The term is used to distinguish this type of headache from the primary headache disorders like migraine.
iii. Painful Cranial Neuropathies and Other Facial Pain: Chronic or acute sharp shooting facial, neck or head pain
Treatment may include medications, bodywork, complementary medicine, counselling and patient education. If a therapeutic approach is safe for the patient, it should be considered. The main treatment plan categories include:
- Rescue – treatment when a headache is staring you in the face
- Prevention – treatments aimed at keeping headaches from developing
iii. Lifestyle modification – strategies to identify, modify, and eliminate triggers that can contribute to headache
- Complementary medicine strategies and inpatient care
See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate a more serious medical problem:
- An abrupt, severe headache like a thunderclap
- Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
iii. Headache after a head injury, especially if the headache gets worse
- A chronic headache that worsens after coughing, exertion, straining or a sudden movement
Implications of not seeking timely medical help:
Abdominal problems: Certain pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen may cause abdominal pain, bleeding, ulcers and other complications, especially if taken in large doses or for a long period of time.
Medication-overuse headaches: Taking over-the-counter or prescription headache medications more than 10 days a month for three months or in high doses may trigger serious medication-overuse headaches. Medication-overuse headaches occur when medications stop relieving pain and begin to cause headaches. You then use more pain medication, which continues the cycle.
Migrainous infarction: Headache Aura symptoms that last longer than one hour can signal a loss of blood supply to an area of the brain (stroke), and should be evaluated. Doctors can conduct neuroimaging tests to identify bleeding in the brain.
A 26 year old female was admitted to the clinic for complaints of severe headaches which had begun that morning, accompanied by nausea and recurrent vomiting. She informed doctors that she had experienced similar headaches on two previous occasions, 2/3 months apart, for which she took acute pain medications. She also complained of less severe headaches, occurring almost daily for the past 2 months. The headaches occurred during early evenings, while being seated in her office chair which often lasted for a few hours and also occasionally experienced the same after waking up. Migraine headaches too were experienced by her every 1-2 months for over a period of two years along with nausea, photophobia and phonophobia. Photophobia is a condition where a person experiences intolerance towards light whereas phonophobia refers to fear of loud sounds, at times even a person’s own voice. These migraine headaches were triggered by travelling, stress or skipping of meals which were relieved by pain killers or sleep.
The patient had been self medicating for a while and it is only when she developed excruciating pain that she was brought to the hospital. A clinical impression that she had 3 different types of headaches, was made. Doctors at the clinic treated her with emergency medications and evaluated the case further. An emergency MRI-Brain did not reveal any abnormality. Further tests confirmed the diagnosis of spontaneous Intracranial Hypotension CSF leakage in the lumbar spine region.
A therapeutic procedure namely epidural blood patch placement was carried out, followed by a second procedure to close the CSF leak under X-ray (fluoroscopic) guidance. A few hours after the procedure, she felt relieved from the severe headache and neck pain. After further monitoring, the patient was discharged the next day, pain free.