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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
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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.
Prof Muhammad Iqbal. (2012) Headache who to be investigated?, Journal of Islamic International Medical College, Volume-7, Issue-2.
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