Headache

May be caused by disorders of the face, abnormalities elsewhere in he body or within the head. Causes of headache in the region of the face include otitis media, sinusitis, jaw abscess, dental problems, ill-fitting dentures, colds and focusing difficulties in the eyes. This form of headache is generally nagging, dull or stabbing, but not usually throbbing. Headache can also be caused by all sorts of diseases and disorders elsewhere in the body. These include high blood pressure, kidney disorders, hangover after alcohol abuse, allergy, fever, depression, constipation, anaemia and some nervous disorders. Such headaches can be dull, throbbing or pounding, are usually present on waking, and are associated with other symptoms that indicate the underlying condition. ‘Genuine’ headache, caused by abnormalities or disorders within the head, also has many causes and manifestations. The commonest form is tension headache; psychological stress causes tension in the neck muscles, which impairs blood supply and traps the nerves, causing a tight feeling like a band around the forehead, sometimes associated with nausea and vomiting. Massage of the neck muscles relieves the pain, but the correct treatment is indentification and removal of tension. Use of muscular relaxants may be recommended in the early stages to break the vicious circle. Migraine is caused by dilation of the meningeal blood vessels, which then become rigid and cramped; chemical abnormalities also occur. The pain is pounding and very severe, and associated with nausea and vomiting, sensitivity to light and sometimes neurological symptoms. There are various antimigraine preparations; acupuncture can produce improvement in some patients. Serious concussion and cerebral haemorrhage also cause headache, usually with other symptoms of the underlying condition and requiring specific treatment, possibly in hospital. Headache caused by a brain tumour and increased pressure on the brain is usually present on waking, and often associated with vomiting without nausea and neurological phenomena such as epilepsy, character changes and faculty failure. Various neurological tests are necessary to establish a tumour as the cause. Meningitis and encephalitis also have severe headache as a symptom, often associated with lowered consciousness and high fever, usually making the underlying condition clear. It must be emphasized that it is necessary to establish the cause of a headache and treat the underlying condition; in 95 per cent of cases the cause is not serious.

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