Muscular Diseases (Myopathy)
Multiple Sclerosis- Ms Disease
• Prof. Aytekin AKYÜZ, MD
• Burak PAKÖZ, MD
• Sezgin ÖZTEKİN, MD
• Yaprak ALPER, MD
Why does headache occur?
Headache occurs as a result of physical, chemical or inflammatory effect of structures of head sensitive to the pain. There is no structure perceiving the ache in other words “Nociceptor” in major part of the brain and membrane covering the brain. Structures of the head sensitive to the pain are membranes covering the internal surface of the cranium, periost, veins in the brain, walls of vena and they are scalp and arteries, gingiva and muscles outside of the head. Paranasal sinus diseases, eyes, teeth, head and fascial bone diseases may result in headache.
What’s the risk factor for headache?
• Infections (meningitis, encephalitis, in other words inflammation of cerebral cortex and cerebral tissue, sinusitis, mastoiditis, ENT neck infections)
• Intracranial hemorrhage, head trauma
• Space occupying formation (tumor, cyst, hematoma)
• Systemic diseases (cancers, fever, hypertension, brain edema, hemorrhage, hypoxia in other words oxygen failure, low blood sugar and blood sodium in other words hypoglycemia and hyponatremia)
• Epilepsy seizures and post-seizure
• Procedures (long term tensioning of head during operation, cerebrospinal fluid removal, etc.)
• Increase of intracranial pressure (drugs, vascular inflammation, hypo-vitaminosis)
• Tension, depression, anxiety, stress, psychogenic reasons
Types Of Headache
Acute headache: Headache starting suddenly and severity of which increases may be sinusitis, ear, eye, tooth infection or the first migraine attack if it is local. If there is widespread pain, it may systemic infection, fever, trauma, hypertension, hypoglycemia, central nervous system infection, electrolyte disorder or the first migraine attack.
Migraine: It is the most frequent reason of acute- recurrent headache in children. The frequency of migraine in children has increased for the last 20 years. Headache progresses with attacks, uneasiness, shaking head, joylessness, disturbance by light and sound are observed. Pain is felt behind the eye, on the forehead, behind the ears and is often bilateral and shooting. Vomiting, nausea accompanies the ache. The ache may be triggered by stress, fatigue, lack of sleep, exercise, hunger, noise, travel, cold air, various odors, caffeine, nitrite, monosodium glutamate food.
Aura migrain: Sensual, visual, motor symptoms shown 30-60 minutes prior to headache are defined as aura (symptoms informing that the ache will start. The most frequent aura in children is the paleness, joylessness, loss of appetite and visual signs.)
Migraine without auro-simple: Hyperactivity, uneasiness, depression, over thirst and paleness may occur before the pain. This headache may last for 1-72 hours. The person may be disturbed by the light and noise. The patient can sleep 8-10 hours after the severe pain.
Tension type headache: It occurs due to muscle contraction. Attacks may last for 30 minutes and also 1 week. It is the most frequent headache observed in the society. It is bilateral, causes pressure and is compressive, doesn’t increase with physical activity can extend to behind the head and neck. It is mild and moderate.
Chronic, daily headache: It is the headache lasting for the day and 15 days or more in a month. It was determined that psychological reasons at the rate of 45% accompany this headache.
Chronic progressive headache: It is the headache with the worst prognosis among all headaches. Reasons such as intracranial pressure increase, mass lesions, tumor, abscess, hydrocephalia should be examined.
Cluster type headache: It is observed in children and adolescent rarely. It is unilateral and seen behind the eyes. Redness, wetness and nasal flow are observed.
Treatment Of Headache
Patients having headache apply to the hospital when their pain becomes pain, severity increases or disrupts daily life. History should be learnt examination and tests should be carried out and whether headache arises from an underlying reason or not (infection, tumor, bleeding, etc, secondary headache) should be shown. Mild ache is observed frequently and generally doesn’t require treatment. Moderate-recurrent or progressive headache and headache having adverse effects on daily life, social life, school should be treated.
Non-pharmacological treatments: For especially migraine, avoiding factors known to trigger migraine, determination of foodstuff triggering the migraine, elimination of fabrication food with additive is necessary. It should be known that during headache especially migraine attack, sleeping in a dark and quite room is a treatment method. Behaviour treatment, relaxing exercises, cognitive treatment, stress management is effective for the control of pain at the rate of 80%.
Medication: When headache attacks occur 3-4 times a month, medication approved by the physician can be used to reduce severity and frequency of the pain. If you have used medications more than three and they haven’t had any benefits, psychological factors and depression should be examined. During the onset of acute pain, pain killer and anti-nausea and vomiting medicine should be used and resting at a quite room or sleeping may be good. Pain killers shouldn’t be used more than 2-3 times a week.