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Headaches are Simple. Right?

Of all medical conditions causing pain and disability, headache may be the most common, affecting 40 to 50 million Americans. Headaches are categorized as a primary or secondary headache. Secondary headache disorders are caused by trauma to the head, neck or face, flu or sickness with fever, or infection inside the skull, teeth, eyes or face. Secondary headache disorders make up approximately ten percent of headaches. Secondary headaches are often more easily understood by the afflicted individual, as a known underlying condition exists. Primary headaches usually present without evident trauma, or other recognizable symptoms. Primary headaches present a puzzling and frustrating situation in regard to diagnosis, treatment, and understanding by both the afflicted individual and the health care provider.

A primary headache disorder, one in which no underlying disorder or trauma exists, accounts for about ninety percent of all headaches. Primary headache disorders may generally be distinguished as being episodic, such as migraine or cluster headaches, or chronic, such as chronic tension-type headache.

As many as six percent of all men and eighteen percent of all women, or about twelve percent of the American population, experience a migraine headache at some time in their life. Between seventy to ninety percent of migraine sufferer’s report family members also suffer from them. Migraine is a disorder in which headache is the primary symptom. This is caused by extracranial arterial vasodilatation, extracranial neural inflammation and decreased inhibition of central pain transmission. Associated symptoms are probably caused by sympathetic activation of the peripheral (nausea and vomiting) and central neural levels (photo-and phonophobia). An aura is most likely caused by a similar mechanism that causes excitation or depression. There are several types of migraine headaches; menstrual, abdominal, basilar artery, opthalmoplegic and hemiplegic. 

Cluster headaches are another episodic primary headache disorder, but are relatively rare. They affect about one percent of the population, eighty five percent of which are males. This type is distinct from migraine or tension headaches, because pain is extremely severe but brief, lasting thirty minutes to two hours. Pain centers around one eye and may cause eye inflammation and watering with nasal congestion to that side. The distinct presentation of these headaches lies in their onset in clusters, lasting over weeks to months, often occurring at the same times daily. Sufferers often have a history of heavy smoking and drinking. Alcohol can trigger the attacks.

Chronic tension-type headaches are chronic headaches having a non-specific ache or sense of tightness, pressure or constriction, varying widely in distribution, frequency and intensity. Chronic tension-type headache is known by virtually everyone and is probably the most common type of pain. Seventy eight percent of the population has lifetime prevalence, while females are more commonly afflicted than males and younger subjects more frequently affected than older subjects. Symptoms are typically mild, often being described as having a clearly describable band-like distribution around the head, suggestive of muscular involvement.

Physical therapy can often help in the treatment of headaches that are the result of tension, stress or muscular imbalance.  

Tony Andrejko is a physical therapist assistant and athletic trainer, employed by ProCare Physical Therapy, Moscow.

General Health, Physical Therapy


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