Headaches: no cinch

Headaches are one of the most common complaints among patients presenting to their primary care doctor. According to the National Ambulatory Care Medical Survey, it was the 8th and 13th most common problem seen by family doctors and internists respectively. The majority of headaches are benign, and 90% of these fall under the categories of tension-type, cluster, or migraine headache. Both migraine and tension-type headaches affect women more often than men, while cluster headaches are predominantly a disorder of men.

Tension-type headache

This is the most common headache syndrome.
Other terms used to describe this type of headache include: muscle contraction headaches, tension headaches, and chronic daily headaches.
Features: pressure or tightness around the head; intensity waxes and wanes. Many people report daily headaches for years and do not seek help until late in their course.
Treatment: Simple pain relievers such as Tylenol (acetaminophen), aspirin and other NSAIDS (non-steroidal anti-inflammatory drugs) are the drugs of choice. People with chronic daily headaches should be treated with prophylactic pain relievers. If these medications do not help, your doctor may prescribe alternative medications. Tri-cyclic antidepressants have been used most commonly. Other types of medications include beta blockers or calcium channel blockers.
Behavioral techniques: This is important in managing chronic tension-type headaches. Examples: biofeedback, relaxation, psychotherapy, and physical therapy. Spinal manipulation has not been shown to be helpful.

Migraine headaches

Common condition found in 17.6% of females, and 5.7% of males.
Results in the loss of both workdays and school days.
Hereditary factors do play a role in migraine headaches.
Classification: Migraine without aura or common migraine. Migraine with aura or classic migraine.
Features: In 50-80% of migraine sufferers, a prodrome will occur hours to days before the onset of the headache. Prodrome includes symptoms such as aversion to light (photophobia), aversion to sound (phonophobia), irritability, or drowsiness.
Pain: pulsatile, one-sided, with gradual onset, and duration of 4-72 hours.
Associated symptoms: nausea, vomiting, poor appetite, blurred vision, photophobia, phonophobia, light-headedness, and nasal congestion.
Aura: 10-20% of migraine patients experience an aura, which can last 10-20 minutes. Most common is a visual aura consisting of bright, shimmering or flashing lights. Other, less common auras include: tingling or numbness, weakness, or speech disorders
Triggers: stress, menstruation, alcohol, foods, oral contraceptives, or change in weather.

Treatment

There is currently no cure, but control can be achieved for most sufferers.