Home Journal List Journal of Islamic International Medical College Volume-7 Article Details

Headache who to be investigated?

Abstract

Headache is such a common disorder that its lifetime prevalence can safely be presumed to 100% in any population. In fact this is the commonest pain for which patients consult a doctor. Humans are so much annoyed w ith this pain that they label every difficult problem as a "headache". One of the Punjabi proverb says, "bigger the head, bigger are the headaches" meaning people with more responsibilities have more problems to solve. Human beliefs about headache and its treatment have been very interesting and human relation with headache dates back to ancient times. t About 7000 BC, people believed that headache occurred because Of entrance of demons and evil spirits in head. They practiced trepanation (Making a hole in skull bone) to release these spirits from head. Neolithic skeletons have been found to have holes in their skulls. Interestingly, at least some of these patients survived because Of the evidence that some Of these skulls had new bone formation at the edges of these holes. Trepanning seems to continue till seventeenth century because in 1660, William Harvey suggested trepanation to a patient who had intractable headache. Around 1200 BC Egyptians would bind a crocodile made of clay tightly around the head Of headache patients. The linen with which this crocodile was tied displayed names of gods on it. It was believed that these gods would cure the headache. Around 400 BC, Hippocrates not only described aura Of migraine as flashing light Correspondence: Prof_ Ulfat Bashir HOD Orthodontics Departrnent Islamic International Dental College preceding headache, but also defined some Of its triggering factors such as intercourse and exercise. He also believed that vapours arising from bile in the stomach rise to head to cause headache and that vomiting out Of this bile relieve the headache. In 12th century Hildegard of Bingen, a nun wrote a very vivid account Of her headache. She also made drawings of her visual aura.' These manuscripts show that she was suffering from classical migraine. Headaches are broadly classified into three broad 2 primary headaches second ary headaches and cranial neuralgias & Other facial pains. Most important in primary headaches are, among others, migraine, cluster headache and tension type headache. Secondary headache is because of multiple causes, most common being intracranial tumors, aneurysms and giant cell arteritis. Fortunately most Of headaches are primary', they are benign albeit very disturbing and annoying. They do not require extensive investigation. On the Other hand, one shou always remember that headache with serious sequel do occur. so which headache should be investigated is a very important question. Why this question becomes important is because of following facts: Headache being globally common, practically every human being will require investigation at some stage of life, if not fil tered. Investigations for headache are quiet costly so investigating every headache will not be a cost effective practice. Investigations are unrewarding for 52 ****** Result for Image/Page 2 ****** most of primary headaches making it a fu ti le exercise Investigations per se are not free of harm, some of hazards are exposure to radiation, allergic reaction to contrasts, overdose of sedating drugs in case of claustrophobic patients undergoing MRIetc. US headache consortium has laid down following principles for investigation Of headache.' These principles are based on consensus, not any evid ence. mental status and neurological findings also warrant for further in vestiga tion. Apart from all above, there are at least two more very strong indications for investigation Of headache. They are patient's overwhelming concerns about his headache that are resistant to reassurance and physician's sixth sense feeling about probability of some serious underlying disorder.

Download