What is Causing Your Headaches?

This video is sponsored by Bright. Find the link in the description below. Why do you have

headaches

? Headaches can be one of the most annoying things we have to deal with, but they can also be completely debilitating and are one of the most common medical concerns. for people, so in today's video we're going to talk about the different types of

headaches

that you might be experiencing, some potential causes, as well as some considerations to keep in mind when seeking treatment, so hopefully in the end We will better understand

what

is happening. Continue with this and of course we will use the corpses behind me to go over all the relevant anatomical wonders, so let's jump right into this so we can better understand headaches, first we need to talk about

what

are known as headaches primary versus secondary.

Headaches A primary headache is when the headache itself is the main problem, it is not caused by, say, an underlying disease or condition and, although these primary headaches can become debilitating and really affect the a person's life, they are not considered dangerous or now life threatening, secondary headaches are caused by an underlying illness or condition, let me give you a couple of examples, let's say you had a headache for example, like a sinus infection or a cold or flu, or maybe something more serious, like you had a headache from bacterial meningitis, a traumatic head injury, maybe even something like a brain tumor or even a ruptured aneurysm, so which you can see there's a wide range of potential causes for these secondary headaches and obviously we'd like to focus on that underlying cause so if you were to treat bacterial meningitis it was like antibiotics while you're treating that condition, the headache should get better and resolve or if you cure, say, a cold or flu, eventually that headache will go away, so we will focus again on these primary type headaches because we cannot blame them, let's say, as a cause or condition underlying.

Now these primary headaches essentially 90 of them fall into three different categories or three different types of headaches. These are attention-type headaches, migraines, and cluster headaches, but how can we tell? The difference between these different types of primary headaches, well, let's start with tension-type headaches. Tension-type headaches are the most common of the primary headaches, they are mild to moderate in severity and most often bilateral, meaning they affect both sides of the head. It is usually described as a dull, band-like, non-pulsating tightness or pain around the head, sometimes even radiating to the neck and can last for hours or even days, in some cases, now the pain Attention-type headache is known as a featureless headache.

We are referring to a featureless headache, well, this means that they are generally not associated with other symptoms such as nausea, vomiting, visual changes or even an aura like that which can be seen in migraines. They do not tend to be aggravated by physical activities as other headaches do. and normally you don't see things like photophobia, which is sensitivity to light, or phonophobia, which is sensitivity to sound. There have been some reports where people have said, "Okay, we have a tension headache," people who might have a little bit of light sensitivity or a little bit of sound sensitivity. sensitivity, but if you're starting to get both, you're knocking on the door of things like a migraine, but what are some of the possible causes of a tension-type headache?

Now there are multiple factors that likely contribute to tension-type headaches. But based on the name, you might think that there has to be some type of tension contributing to these headaches. That was the original thought or theory behind the cause of these headaches. It was thought that they were due to sustained or prolonged contractions in the muscles that would be found, for example, in the neck, head and face, so the idea was that because these muscles attach to the skull and not just its connective tissues they blend and become continuous with the connective tissues of the skull, if there are problems with them they could cause pain that would radiate to the head and create these tension headaches, so for example, again, if we look at this muscle, the trapezius, we can definitely see that it attaches to the skull and its connective tissues will blend and become continuous with those of the skull and that is just one muscle, there are multiple muscles, for example, underneath is the splenius capitis muscle, a muscle in the side of the neck called the sternocleidomastoid that joins the skull and its connective tissues become continuous, even the jaw muscles have sometimes been involved, such as the masseter. from the jaw or jaw bone to the skull and those are just a few examples of some of the muscles, there are multiple muscles that attach from the neck to the head, also if you look at people who have headaches from tension type, they will have pain. and tenderness in these muscles, so they're not necessarily sitting there in pain with all of these muscles, but if you feel them, push them, or massage them, you can tend to cause more pain and tenderness than in someone without tension-type headaches. , so you could see why problems with these muscles could have contributed to that original theory of what causes tension-type headaches.

Now, obviously, I'm still saying the original theory because it's no longer believed to be the cause of tension-type headaches. You can definitely see some correlations there, but we're not seeing a direct cause; In other words, just because someone has sustained or prolonged muscle contractions in these muscles doesn't mean they will have a tension headache, but I still think it's fair for people to ask why. There are people who have pain in these muscles and then tension type headaches and this brings us to this discussion about the chicken before the egg, which came first and when we look at things with tension headaches and what the data and research is starting to show. is that there are these pain receptors called nociceptors that become sensitized in the connective tissues of the heads of people who have tension-type headaches.

Now remember that those connective tissues of the head are continuous with the connective tissues and the tendon insertions of the muscles that we mentioned earlier and so the idea is that as those pain receptors or nociceptors in the connective tissues of the head become sensitized, The associated muscles or those muscles that are continuous, their pain receptors also become sensitized, which helps explain why you can have pain in both areas, but what is

causing

it. the sensitization of these nociceptors, well the frustrating thing is that we don't fully know, again, we can't definitively say that it is a problem that originates in these muscles, for example, sustained or prolonged contractions, we also can't definitively say that it originates purely in the connective tissues. head and radiates to these muscles, however, there is useful information that we can draw from and that is that the most commonly reported precipitating factors for tension-type headaches are things like stress and mental tension, so When a patient comes to the clinic and I suspect they have a tension-type headache.

I talk to them about stress and what's going on in their lives and I often recommend relaxation techniques which can be anything from deep breathing, meditation and even things like light muscle stretches and even gentle massages, and I know that. This is anecdotal, but I have had patients who have improved with these techniques and they are so non-invasive that I almost recommend it to all patients with tension-type headaches because there are not many drawbacks to trying these types of techniques. We can also increase the use of over-the-counter pain relievers, and we have pretty clear data showing that things like tylenol, also known as acetaminophen, and ibuprofen, help reduce the pain of tension headaches compared to placebo, and a lot of the data demonstrated. that ibuprofen is a little better than, for example, tylenol and acetaminophen, and if those pain relievers don't work, you can often turn to combination medications, such as excedrin, for example, excedrin is a combination medication that contains aspirin, caffeine and even tylenol, and you have to be careful when you start taking some of these medications because you can get what's called a medication overuse headache and so it's always wise to talk to

your

medical provider when you start adding medications to help treat

your

headaches and such.

This even applies to some of the other headaches we're going to talk about here. The next primary type of headache is migraine. Migraines are most commonly unilateral and can affect both sides of the head, but more commonly one side of the head and the other. The pain is usually described as this type of throbbing, throbbing pain. It's definitely not a featureless headache like we saw with tension-type headaches. They are often associated with features such as nausea, vomiting, sensitivity to light, sensitivity to sound, even physical activity can aggravate the pain. migraines I get them from time to time and I hate them even when I sneeze and cough, that can aggravate the pain of a migraine.

Now there are often neurological symptoms that can also be associated with migraines, such as visual changes and an aura and these kinds of things can be explained with the idea that a migraine is a phasic headache or in other words, it has four associated phases. These four phases are called the premonitory phase, followed by the auraphase, then the actual headache phase, and then the postdrome. or postdromal phase now, this first phase or premonitory phase is often difficult for people to notice or detect because it can occur a day or two before the headache begins and is also associated with symptoms such as irritability, food cravings and Even more frequent yawning has been reported as part of the premonitory phase and who doesn't occasionally experience symptoms like that.

The second phase is auraphase and aura is defined as a completely reversible neurological symptom. Now not everyone experiences or at least notices auraphase. but there can be different types of auras, like the visual aura which is the most common and that is when you become blurry or with lines or specks in your vision, you will have a sensory aura or on one side of the body you may feel a tingling and then there are also a language aura where you might have difficulty speaking and even a motor aura which would be weakness on one side of the body again, that visual aura is the most common, then the third phase is the actual headache phase we talked about, that one-sided. throbbing pain and that fourth phase, the post drone or postdromal phase, is kind of a residual effect of the headache the next day, so the main part of the headache has resolved, but you may notice that when you turn head or when you cough or sneeze You are reminded that there are still some residual effects or pain there and you may still feel a little unwell the next day and that the post-drone phase can be explained by the sensitization of this nerve called nerve trigeminal.

This trigeminal nerve is now thought to be a major player in the cause of migraines and there are certain sensory pathways, specifically the pain and nociceptive pathways within the trigeminal nerve, that are thought to be more easily activated or sensitized in people who have migraines than in people who don't have them and, again, that sensitization can persist. until the day after which we mentioned in that phase post and what can often cause activation or sensitization of this trigeminal nerve are certain migraine triggers that we can put on the screen here now the trigeminal nerve is one of the twelve nerves cranial which is the fifth cranial nerve and comes directly from the brain stem and is often known as the great facial sensory nerve because it brings sensation to the face, it even connects to the muscles that move the jaw and makes connections with the brain . blood vessels or blood vessels of the brain and even connective tissue structures that surround the brain like the dura mater and the reason I mention all of that is because those pathways can explain the characteristics of the pain and even the location where people get this migraine. headache now one of the most common locations of a migraine is around the forehead and eye and again that can be explained because one of the main divisions of the trigeminal nerve is commonly affected now I think tri means three, there are three divisions or nerve branches coming off the main trigeminal nerve, the division or ophthalmic nerve, the maxilla and themandibular, now ophthalmic refers to the eye and this ophthalmic division or nerve branch would not affect these tissues nor control or innervate the area around the forehead and eye and again can explain why there is pain in that area.

This isn't the only potential pain location for migraine, but I'm going to pause there for one important reason. We have a whole video dedicated to migraines and we'll link to this video, so go ahead. And take a look at that after of course you finish this video because now we have to talk about the third type of primary headache and that is cluster headaches, but before we jump completely into headaches in clusters, I want to mention some potential treatments. options for migraines there is some combination with treatment for tension headaches and migraines you could try starting with tylenol or acetaminophen as most people with migraines will say that tylenol alone doesn't do much so we can move on and say like ibuprofen and If ibuprofen alone doesn't work, then we'll go back to those combination medications that tend to work better with that combination of, for example, caffeine, aspirin, and even tylenol, and if we need to step up even further, then we'll be knocking on the door.door of prescription medications there are things that we often refer to as triptons there is a medication called sumatriptin which is this prescription medication for migraines and of course in that case if we get to prescription medications we will try with your medical provider and again It's always wise, as I mentioned, with tension-type headaches to be evaluated and work with them on certain medications that you might use to treat this type of headache.

Cluster headaches are the least common of the three main headaches we've talked about and what causes them. It is not really known, but there is a belief that during a cluster headache there is some activation of this structure in the center of the brain called the hypothalamus that can be seen under the probe and that in turn the hypothalamus will activate certain autonomic pathways during this headache, but what is an autonomous pathway? Well, the autonomic division or part of your nervous system controls things automatically on a subconscious level, so you don't have to think about it, it connects and controls things like the smooth muscle of your digestive tract and even your blood vessels.

The pupils of your eyes actually have smooth muscle so they can contract and dilate. The autonomic nervous system also connects to various glands throughout the body and all of this is relevant because of the symptoms that accompany cluster headaches. They come on suddenly and the pain is described as stabbing and severe. These are unilateral, so they are unilateral in or around the eye or in the temporal region. Due to their sudden onset and severity, they can sometimes be confused with more severe, life-threatening headaches, but there are some other associated symptoms that can help us distinguish cluster headaches and that's where our autonomic discussion comes in. because these cluster headaches are associated with certain autonomic symptoms and these symptoms can include things like ptosis, which is drooping of the eyelid, meiosis, which is conjunctival pupillary injection constriction, which is bloodshot eyes or when the blood vessels of the conjunctiva of the eye begin to expand or dilate, tearing occurs, which produces tear production or tearing, you may also have rhinorrhea, which is a fancy name for a liquid. nose also congestion facial swelling or should I say periorbital swelling which is swelling around the eye and even facial sweating.

Now each episode or individual attack usually lasts between 15 minutes and three hours, but this is where the cluster part begins these headaches or individual attacks. it can respawn as often as once every two days up to eight times a day so you can see we are starting to form these clusters and these cluster periods can last for days, weeks and even months and after these cluster periods usually They are followed by a period of headache-free remission and these remission periods can sometimes last over a year, so obviously these cluster headaches and cluster periods would suck, so it would be good to treat them as effectively as possible. possible and the first line treatment for this acute part of the acute phase of a cluster headache is actually oxygen.

Yes, they give people 100 oxygen with a mask without rebreathing and this is quite effective, we don't know exactly why, but giving oxygen to patients with cluster headaches helps reduce the headaches. The first line treatment is a tryptin that I mentioned earlier in the video, called sumatriptan, which has some overlap with migraine treatment, but those are also effective medications and sometimes people are given both oxygen and sumatriptan in this phase acute. Now I say this acute phase because there is this concern about how long this cluster period will last, so there are also preventative medications, there are two medications that we usually look at and it's one called verampa mill and sometimes these anti-inflammatory steroids like prednisone.

Now you'll use one of the medications or sometimes both, depending on the person's cluster pattern, how long they last, the severity, and a lot of different individual factors that you'll obviously want to go over with your medical provider for those of you who watch a lot of our videos. y You have reached the end of this video, you probably love learning and one of the most important parts of learning is creating a learning environment that is engaging, interactive, fun but challenging enough to take you to the next level and that is why I'm excited. to thank the sponsor of today's video, shiny shiny is an interactive online learning platform for core subjects including mathematics, science, logic and computer science and speaking of this learning environment, shiny courses are set up in a way that they are super fun and interactive. and they will take you to the next level.

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