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Author: admin, 08.02.2016. Category: Cause Of Ringing In Ears

Doctors categorize headaches as either primary or secondary, which helps to distinguish the many different kinds of headaches and to determine appropriate treatments for each. A headache is considered primary when a disease or other medical condition does not cause it.
Secondary headaches are caused by other medical conditions, such as sinus infections, neck injuries, and strokes. The International Headache Society's classification system includes a category called chronic daily headaches.
Tension-type headaches, also called muscle contraction headaches or simply tension headaches, are the most common of all headaches.
Research indicates that patients with tension-type headache may have abnormalities in the central nervous system, which includes the nerves in the brain and spine, that increase their sensitivity to pain. Tension-type headaches may also be linked to myofascial trigger points in the neck and shoulder muscles. About a third of persistent headaches -- whether chronic migraine or tension-type -- are medication-overuse headaches.
Headaches are rare before age 4 but increase in prevalence throughout childhood, reaching a peak around age 13. Keep a diary of your child's headaches noting time of onset, length and intensity of attack, location of pain, and food triggers.
Avoid changes in child's eating routing (hunger and eating at irregular times can trigger headaches). Nevertheless, although they are not medically dangerous and occur relatively rarely, chronic tension headaches can have a negative impact on quality of life, families, and work productivity. Some types of chronic tension headache may include tenderness upon manual palpitation of the head (pericranial tenderness).
About a third of persistent headaches are the result of the rebound effect caused by the overuse of headache medications.
Usually in such cases, medications have been taken on an ongoing basis for more than 3 days each week. Medications implicated in medication-overuse headache include barbiturates, sedatives, narcotics, and migraine medications, particularly those that also contain caffeine.
The doctor will also need the patient's general medical and family history, particularly concerning headaches or other neurological diseases. Keeping a headache diary is a useful way to identify triggers that bring on headaches, and to help the doctor differentiate between migraine and tension-type headache. In general, similar stimuli seem to trigger all primary headaches, although people with migraines may be more sensitive to some of them (weather, certain smells, light, and smoke) than people with tension headaches. Tracking medications is an important way of identifying medication-overuse headache or transformed migraine. In order to diagnose a chronic headache, the doctor will examine the head and neck to check for muscle tenderness. Imaging tests used for severe or persistent headache include computed tomography (CT) scan and magnetic resonance imaging (MRI). Headaches indicating a serious underlying problem, such as cerebrovascular disorder or malignant hypertension, are uncommon.
Some people find massage therapy helpful for treating acute episodes of tension-type headache. Daily preventive treatment is recommended for patients who experience at least two headache attacks a month.
The goals of preventive treatment are to reduce the frequency and severity of headache attacks, and to improve the response to pain medication. Studies indicate that best results are achieved when drug treatment is combined with relaxation or stress-management training. If headaches develop because of medication overuse, the patient cannot recover without stopping the drugs.
Most headache drugs can be stopped abruptly, but the patient should be sure to check with the doctor before withdrawal. If the patient chooses to taper off standard headache medications, withdrawal should be completed within 3 days or less. No matter which approach is used for stopping medication, the patient must expect a period of worsening headache for a few days afterward.
Most people feel better within 2 weeks, although headache symptoms can persist up to 16 weeks (and in rare cases even longer).
Due to the risks of overuse and dependence, opoids, opoid-like drugs, and sedative hypnotics are not recommended for treatment of tension-type headaches.
Patients should be aware that long-term use of high-dose NSAIDs may increase the risk for stomach bleeding and heart problems, including heart attack and stroke. Acetaminophen does have some adverse effects, however, and the daily dose should not exceed 4 grams (4,000 mg).
Antidepressants known as tricyclics are most often used for prevention of severe chronic tension-type headaches. Tricyclics can have serious, although rare, side effects, including heart rhythm problems, which can be dangerous for some patients with certain heart diseases. Although these antidepressants have fewer side effects than tricyclics, they do not appear to be as effective for preventive treatment of tension-type headaches.
Tizanidine (Zanaflex) is a muscle relaxant that is being studied as a possible preventive drug for chronic tension-type headaches.
Botulinum toxin A (Botox) injections are now widely used to relax muscles and reduce skin wrinkles.
Nitric oxide synthase inhibitors block nitric oxide, which may play a role in increasing nerve activity that leads to headache. Relaxation training uses breathing exercises, guided imagery, and other techniques to help relax muscles and relieve stress.
Cognitive-behavioral therapy (CBT) teaches patients how to recognize and cope with stressors in their life. Massage can help relax tense muscles, and may be helpful during acute headache attacks, although there is little evidence for long-term benefits. Evidence is somewhat stronger on the benefits of spinal manipulation for patients with headaches originating from nerve or muscular problems in the neck. There has been little research evaluating the benefits of physical therapy for tension-type headache.
Several reviews of clinical trials of acupuncture suggest that it may have some benefit for tension headache. Good health habits -- including adequate sleep, healthy diet, regular exercise-- are helpful for reducing stress.. Some patients find relief using two drops of peppermint, eucalyptus, or lavender oil added to one cup of water.
People who have a bleeding or blood clot disorder, or who take blood-thinning medications such as coumadin (Warfarin), should not take feverfew.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. BackgroundMost people are familiar with headaches, the all too common affliction marked by throbbing, piercing, or vise-like pain around much or a part of the head. Migraines are vascular in origin, and may be preceded by visual disturbances, loss of peripheral vision, and fatigue. About 2% of headaches are secondary to abnormalities or infections in the nasal or sinus passages, and they are commonly referred to as sinus headaches.
They may originate as tension headaches, migraines, or a combination of these or other headache types. It usually occurs on both sides of the head and is often experienced in the forehead, in the back of the head and neck, or in both regions. Headaches occur at least once but not more than 15 days per month for at least 3 months (a minimum of 12 days but not more than 180 days per year).
Probable tension headaches may be classified as probable frequent episodic, probable infrequent episodic, or probable chronic. Several types of neurotransmitters have been identified as playing a role in increasing activity in pain pathways in the brain and affecting how the brain reacts to pain stimulation. These are the result of a rebound effect caused by the regular overuse of headache medications.
Working or sleeping in an awkward position can contribute to posture problems (especially those that affect muscles in neck and shoulders) that trigger headaches. Rapid consumption of ice cream or other very cold foods or beverages is the most common trigger of sudden headache pain, which may be prevented by warming the food or drink for a few seconds in the front of the mouth before swallowing. Intense physical exertion (including athletics or sexual activity) as well as lack of physical activity can trigger headaches.
Jaw clenching or teeth grinding, especially during sleep, are signs of temporomandibular joint dysfunction (TMJ, also known as TMD). Hormonal changes, such as those that occur during the menstrual cycle or perimenopause, can affect headache occurrence.
The rest are secondary headaches, caused by an underlying disorder that produces headache as a symptom. Many children with tension-type headache episodes also suffer from some form of emotional disorder. Many children who experience chronic daily headaches suffer from sleep disturbances, especially difficulty falling asleep.
This includes maternal illness or separation, family bereavement, relationship problems, mental illness in a family member, and other stressful family events.
According to a National Headache Foundation survey, nearly 30% of children miss school because of headaches. PrognosisBoth episodic tension-type headache and chronic daily headache affect quality of life.
Several studies have reported lower quality of life with any chronic daily headache compared to those no headaches or only episodic ones. Tracking times of medications, withdrawal, and headache, using the headache diary, is usually very helpful in diagnosis.
There are different scoring symptoms available that help communicate the severity of the pain to the doctor.
The doctor may also perform a neurologic examination, which includes a series of simple exercises to test strength, reflexes, coordination, sensation, and mental function.
In this age group, it is particularly important to first rule out age-related disorders, including stroke, low blood sugar (hypoglycemia), fluid accumulation in the brain (hydrocephalus), and head injuries (usually from falls).
TreatmentManagement of tension-type headaches focuses in the short term on treating acute attacks, and in the long term on preventing recurrent episodes of headache. Simple over-the-counter pain relievers such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) can treat mild symptoms. Preventive treatments do not work as well when patients are overusing pain-relief medication, so doctors may recommend stopping and withdrawing from analgesics before beginning preventive approaches.
Certain non-headache medications, such as anti-anxiety drugs or beta-blockers, require gradual withdrawal under medical supervision. MedicationsThe standard treatments for tension-type headaches are non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, and tricyclic antidepressants, usually amitriptyline (Elavil).
Acetaminophen (Tylenol) is a good alternative to NSAIDs when stomach distress, ulcers, or allergic reactions prohibit their use.
Patients who take high doses of this drug for long periods are at risk for liver damage, particularly if they drink alcohol and do not eat regularly. Newer selective serotonin-reuptake inhibitors (SSRIs) antidepressants are also sometimes used in milder cases.
Secondary amines may have fewer side effects than tertiary amines, but they are just as toxic in high amounts. A headache diary can help the patient and the doctor assess the effectiveness of the treatment. Selective serotonin-reuptake inhibitors (SSRIs) work by increasing levels of serotonin in the brain. Botox is also becoming popular as a treatment for chronic daily headaches, which include tension-type headache. Drugs are currently being investigated in clinical trials for migraine treatment, and may also be studied for tension-type headache.
Lifestyle ChangesPsychological and behavioral techniques, and lifestyle changes, can have a beneficial effect on tension-type headaches.
Biofeedback uses a device to record a patient’s bodily responses (heart rate, surface skin temperature, muscle tension). It can help patients understand how their thoughts and behavior patterns may affect their symptoms, and how to change the way the body responds to anticipated pain.
Although some small studies have suggested that spinal manipulation by chiropractors or osteopaths may have some benefits for preventing tension-type headaches, there is insufficient evidence overall to confirm their effectiveness for tension-type headache pain reduction. Some researchers believe that tension-type headaches relieved by spinal manipulation are probably really caused by neck problems. Still, a physical therapist may be helpful in teaching specific exercises for strengthening and stretching muscles or improving posture. Acupuncture involves the insertion of tiny sterile needles, slightly thicker than a human hair, at specific points on the body. An ancient remedy for tension headaches uses pressure applied to the head (such as a headband or a towel wrapped around the head) plus either heat or cold.
It is important that anyone taking herbal or so-called natural remedies be aware of the lack of regulations governing their quality and effectiveness.
Some patients report that magnesium supplements can help prevent migraine headache attacks, but there is little evidence that magnesium is helpful for tension-type headaches. There have been few studies to confirm the effectiveness of these or other herbs for headache treatment.

Feverfew can interfere with these medications and can affect the time it takes blood to clot.
High doses of valerian may cause blurred vision, excitability, vivid dreams, and changes in heart rhythm. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. The global burden of headache: a documentation of headache prevalence and disability worldwide.
A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. There are many different kinds of headaches, and they range from being an infrequent annoyance to a persistent, severe, and disabling medical condition. Tension-type headaches are the most common type of long-duration chronic (recurring) headaches. Because these headaches occur infrequently, they do not impact a patient's quality of life as severely as frequent episodic headaches and may not require attention from a medical professional. They have most, but not all, of the symptoms of tension-type headaches and are not attributed to migraine without aura or other neurological disorders. Although tension-type headaches were once thought to be primarily due to muscle contractions, this theory has largely been discounted.
Trigger points are knots in the muscle tissue that can cause tightness, weakness, and intense pain in various areas of the body. In particular, serotonin (also called 5-HT) and nitric oxide are thought to be involved in these chemical changes. Tension-type headache episodes are rarely disabling, however, and rarely require emergency treatment. In one study, nearly half of patients with frequent or chronic tension-type headache were not experiencing headaches when examined 3 years later. People with tension headaches tend to relieve pain by massaging the scalp, temples, or the nape of the neck.
Such patients should immediately call a doctor if the quality of a headache or accompanying symptoms has changed.
In general, short-term treatment of tension-type headache involves drugs (mainly pain relievers) while long-term preventive measures include both drug and non-drug approaches. Aspirin or ibuprofen (generic, Advil, other brands) are usually the first choices, followed by naproxen (generic, Aleve).
In addition, side effects most often reported include dry mouth, constipation, blurred vision, sexual dysfunction, weight gain, trouble urinating, heart rhythm problems, and dizziness.
SSRIs used for tension-type headache preventive treatment include paroxetine (Paxil) and citalopram (Celexa). A physical therapist may also be able to advise on ergonomic changes to the patient’s workplace environment. Generally, manufacturers of herbal remedies and dietary supplements do not need approval from the Food and Drug Administration (FDA) to sell their products. Pregnant women or women hoping to become pregnant should not take this herb, as it may potentially harm the fetus. Instead, researchers think that tension-type headaches occur due to an interaction of different factors that involve pain sensitivity and perception, as well as the role of brain chemicals (neurotransmitters). Release of these chemicals may activate nerve pathways in the brain, muscles, or elsewhere and increase pain.
If they do, there is usually a migraine component occurring with the tension-type headache.
People with migraines are more likely to compress the forehead and temples (tying a scarf around the head) or to apply cold to the area.
With medications, relaxation training, lifestyle changes, and other therapies, nearly all patients can be helped. Some patients may also find helpful medications that combine a pain reliever with caffeine. Midrin (a combination of a drug that narrows blood vessels, a mild sedative, and acetaminophen) may also be helpful for tension-type headaches. After that time, the doctor will slowly reduce the dose while continuing to monitor the frequency of headache attacks. Other antidepressants used for tension-type headache are mirtazapine (Remeron) and venlafaxine (Effexor), which target both serotonin and norepinephrine.
To date, relaxation training and biofeedback have the strongest evidence for improvement in tension-type headache outcomes. Research indicates that CBT and stress management is most effective when combined with relaxation training or biofeedback. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Genetic factors are likely be involved in chronic tension-type headache, whereas environmental factors (physical and psychological stress) may play a role in the physiologic processes involved with episodic tension-type headache.
Some patients with TMJ may see improvement in tension-type headaches from procedures or exercises therapies that specifically address the dental condition. While fear of brain tumor is common among people with headaches, headache is almost never the first or only sign of a tumor. Even after successful medication withdrawal, relapse is common, particularly with drugs that contain caffeine, so doctors should check for this type of headache even in patients who have previously been treated.
They also tend to isolate themselves, lie down, induce vomiting, and use more pillows than usual. In clinical studies, relaxation training and biofeedback, both alone and in combination, have led to improvements in tension-type headache.
Studies report that people who visit the emergency room with disabling headache are often misdiagnosed as tension-type headaches instead of migraines. Any duplication or distribution of the information contained herein is strictly prohibited. It is important to choose a doctor who is sensitive to the needs of headache sufferers and is aware of the latest advances in treatment.

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