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Headache is one of the most common symptoms a doctor is asked to treat. There are several types of headache and the origin of pain slightly different for each one. The brain itself is insensitive to pain, but many other structures both inside and outside of the bony skull have sensitive pain fibres. These include the arteries and venous sinuses of the brain, the dura mater or membrane surrounding the brain and the external scalp muscles.

Clinical Features

There are some causes of headache which should be treated by a medical expert, such as tumors, meningitis or acute fevers. The following types of headache described below also have various causes. Therefore, in all cases of chronic headache a medical check up is essential.

• v Vascular Headaches are the typically throbbing type and are due to dilation of blood vessels. The headache which accompanies fever and systemic infections is well-known. It is due to dilation of the intracranial blood vessels. A throbbing headache following a simple blow to the head, an epileptic fit, or which occurs at high altitudes or after alcohol consumption, is due to similar mechanisms.

• v Migraine and Hypertensions Headaches on the other hand, are thought to be due to dilation of the extra cranial arteries outside the skulls.

• v Muscle Spasm is one of the most common mechanisms of headache. The muscles of the scalp or the neck go into a spasm due to emotional tension. This produces a most persistent and continuous type of headache which varies in intensity from a feeling of tightness to a true aching pain. It is usually bilateral. Painful, tender areas can usually be felt in the tight scalp muscles, or in the neck muscles. Cervical spondylitis and poor spinal posture in general are frequent initiators.

• v Referred Headache from the eyes is also common. It often accompanies eyestrain and glaucoma. Similarly, inflammation or irritation of the sinuses and nasal passages is often referred to the skull as headache.

• v Psychogenic Headache is the term used to describe headaches caused by emotional or mental tensions. It is often a vascular or tension headache, being experienced as a sense of pressure at the top of the head, or as a tight band around the scalp. Migraine is also of this group.

The Most Common Headaches

The two most common form of headache are migraine and tension headaches.

            Migraine: This severe form of headache occurs more commonly in women than men. It is characterized by periodic headaches which are usually one-sided and are often accompanied by visual disturbances and vomiting. Migraine is thought to caused by swelling of the arteries outside the skull due to instability of the autonomic nervous system which controls the flow of blood into the head. Pain is caused by the stretching of pain nerve endings in the arterial wall.

            Migraine is found to have a family predisposition, with three in four migraine sufferers having close relatives who are similarly affected. It is uncertain as to whether this predisposition is genetic or is behaviorally inherited.

            Migraine usually starts after puberty and continues until late middle life. Acute attacks are often related to emotional stress, occasionally occurring during the period of relaxation when the stress appears to be over. Attacks occur at intervals varying from a few days to several months. The first symptom of an attack is commonly a sensation of white or colored lights, moving spots, wavy lines or visual defects. Loss of sensation or weakness of one half of the body may be experienced or there may be numbness of both hands and around the mouth. These symptoms may last up to half an hour. This period is known as the "migrainous aura". It is followed by the actual pain of the headache, which usually begins in one spot and subsequently involves the whole of one or occasionally both sides of the head. The pain is usually severe and throbbing in character, and is associated with vomiting, photophobia (aversion to light), pallor, sweating and prostration, which may cause severe loss of muscle tone and necessitate the patient taking to his bed in a darkened room. The attack may last from a few hours to several days, leaving the patient weak and exhausted.

            A migraine attack may be precipitated by so many factors, but for each sufferer there is usually a characteristic one. It may be a response to a particular food, especially the tyramine rich foods, such as cheese, chocolate and red wine. It is not always easy to locate the cause immediately but the sufferer should seek to locate the factors which precipitate the attack. Similarly, there are many phases of migraine. Some people have migraine with the rising sun, and it gets better as the sun falls toward the horizon. They may be completely free of attack when conditions are cloudy. In other people, incidence of migraine appears to be related to the lunar cycle. The site of migraine attack also varies. Some sufferers will experience the attack in only half of the head, while other sufferers experience the pain at the top or at the region at the back of the head.

            Tension headaches: Tension headaches are related to migraine but manifest through the somatic nervous system. These headaches are produced by sustained contractions of the external scalp muscles. These headaches are usually constant and non-pulsatile and may be unilateral or bilateral. The sufferer often describes a tight, band-like feeling about the head, or a feeling of the head being in a vice or under great pressure. They usually last for a few hours, but may extend much longer. With prolonged headache, the muscles of the head, jaws, neck and upper back may become tender and tight and movement may be limited. In addition, hardened, localized, painful areas in the scalp muscles commonly arise. Generally poor posture is a major factor.

            Tension headaches commonly follow emotional stress, but sustained muscle contraction may also be a factor in the pain associated with vascular headaches, and with disease of the eyes, ears, nose teeth and sinuses. Similarly, the type of headache which is found to be associated with cervical arthritis (spondylitis) or disc degeneration generally stems from muscular spasm.

            Tension headaches and migraine often occur in the same person. Headache is also a common symptom of constipation and menstrual irregularity. These headaches disappear when underlying condition is recognized and treated.

Medical Treatment of Headaches

The treatment of the various types of headache depends on its underlying cause. Many headaches disappear after removal of their primary cause such as a fever, eye disorder or sinusitis. Otherwise the treatment is symptomatic, as medical science has been unable to provide cure for ongoing psychogenic headaches, such as migraine or tension headache.

            Symptomatic treatment using various drugs which provide temporary relief is all is presently prescribed in the first instance. Muscle tension headaches sometimes respond to aspirin or tranquillizer, psychotherapy, massage and heat. For migraine type vascular headaches the usually prescribed drugs are derived from ergot alkaloids. These are taken at the first sign of the attack if they are to be of any benefit. Rectal aspirin suppositories also help. In general, however, the medical management of chronic, persistent headache symptoms at the present time is fairly ineffective, and the conditions present a real problem for both the patient and the doctor.

Yogic Management

Yogic practices fill the gap in managing those forms of headache which, until now, medical science has found difficult to treat. Psychogenic headache, vascular headaches, including migraine, and muscle tension headache can often be eradicated completely through yogic practices alone.

            Fundamental practices for migraine and tension headaches are the hatha yoga shatkarmas, neti and kunjal. If they are performed at the beginning of an attack of migraine, the sufferer gains immediate relief. These practices release the build-up of psycho-emotional tension which is precipitating the attack. In eradicating headaches these shatkarmas should be practised daily each morning, in conjunction with the following program for two or three months.

• 1. Asana: Pawanmuktasana part 1, surya namaskara.
• 2. Pranayama: Bhramari, nadi shodhana, mild bhastrika.
• 3. Shatkarma: Kunjal and neti daily. Laghoo shankhaprakshalana once a week. Shankhaprakshalana (full practice) should be undertaken in an ashram environment preferably before commencing the program.
• 4. Relaxation: Yoga Nidra daily.
• 5. Diet: A simple vegetarian diet is recommended. Avoid rich foods, especially cheese, chocolate and wine. Avoid overeating.
• 6. Fasting: Skipping a meal and relaxing for ten minutes in shavasana will often avert an impending headache due to mental stress.