Ten Minute Headache Report: A Quick Review of Causes and Cures

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Decreased skin turgor, or elasticity, is a sign of dehydration. Skin that is dry, cool and clammy may also indicate dehydration. Muscle cramps may be a sign of dehydration. Cramps are particularly common when dehydration is caused by excessive sweating. Interestingly, sweating can result in a significant loss of both fluid and sodium, which is an electrolyte that plays a role in muscle contractions. Thus, when fluid and sodium become depleted, muscles sometimes contract involuntarily.

This is known as a muscle cramp For this reason, adequate hydration is especially important during strenuous exercise or exercise in high temperatures. Fluid and sodium depletions can lead to muscle cramps. Drinking water is particularly important during strenuous exercise.

Low blood pressure can be a symptom of dehydration Dehydration lowers the volume of blood in the body, which lowers the pressure on artery walls 5 , Interestingly, low blood pressure might make you feel light-headed or dizzy when you go from lying down to standing up When you stand up, it may take a few seconds for blood to get to the brain from the lower limbs.

Nevertheless, a small drop in blood pressure is relatively harmless and usually remedied by drinking water On the other hand, severe dehydration can lead to dangerously low blood pressure. Symptoms like blurred vision, nausea and fainting could indicate very low blood pressure that requires medical attention Dehydration can cause a drop in blood pressure, which might make you feel light-headed, weak and tired. Severe dehydration can cause dangerously low blood pressure that requires medical attention.

Dehydration can cause a rapid heart rate or heart palpitations. Palpitations give you the feeling that your heart is jumping or skipping a beat. Interestingly, these abnormalities are a result of the heart attempting to compensate for the lack of fluid in the body. Your body then works hard to deliver enough blood to your organs by increasing its heart rate, pumping blood more quickly throughout your body 5 , When this happens, you might feel your heart racing, fluttering or pounding extra hard. Fortunately, in most cases of dehydration, this increase in heart rate effectively makes up for the low blood volume.

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Even with less blood pumping through the body, the organs and tissues are able to receive what they need. However, as dehydration becomes more severe, the heart becomes less effective at compensating for the lack of fluid. If the heart is unable to get blood to the organs, they will eventually shut down. Keep in mind that dehydration is not the only condition that affects heart rate. Rapid heart rate or palpitations can also indicate a more serious medical condition.

That being said, if your heart rate does not return to normal after drinking water, you should consult a medical professional. A lack of fluid in the body decreases blood volume. The heart makes up for the lack of blood volume by working harder and faster to pump blood throughout the body. Dehydration can make you grumpy and cause confusion.

Dehydration can have a significant effect on brain function. Studies have shown that even mild dehydration can cause irritability and decreased brain function 10 , Furthermore, brain function can deteriorate significantly as dehydration becomes more severe. Severe dehydration can cause confusion and incoherence In fact, confusion and even delirium are common symptoms among older adults who are dehydrated.

Older adults are particularly susceptible to becoming dehydrated due to their sense of thirst declining with age 30 , 31 , Conversely, drinking plenty of water has a positive effect on mental clarity and brain function. In fact, both children and adults have been found to perform tasks better when they are well hydrated 33 , 34 , In one study, children who were given additional water to drink had improved short-term memory and performed better in school Overall, it appears that hydration status can have a significant impact on mental performance.

Dehydration can negatively affect brain function and cause symptoms like moodiness, anxiety, decreased concentration and confusion. Severe dehydration can lead to very serious complications. Every organ in the body requires fluid to function properly. If dehydration becomes critical, organs will begin to shut down. With such a range of possibilities, a good history, physical examination, and the recognition for the need for early neuroradiological imaging should ensure diagnostic accuracy. Changes associated with pregnancy and motherhood should always be considered when looking for a cause of headache.

These changes can result from fluctuating hormone and hydration levels, caffeine withdrawal as well as various life changes associated with motherhood. An accurate history can highlight simple aggravating factors such as sleep deprivation, or indeed relieving factors such as food or fluid intake and sleep. It is not aggravated by physical activity and is usually self-remitting. There can be associated neck and shoulder pain resulting in a musculoskeletal component. Treatment includes simple analgesia, massage, or physiotherapy.

Migraine headache is usually described as a recurring, unilateral headache lasting 4—72 h. It may be pulsating in nature and associated with nausea and photophobia. Patients with a history of migraine may notice a reduction in symptoms during pregnancy as a result of hormonal changes. Generally, symptoms are milder and follow their typical pattern. It is rare for migraine to manifest for the first time during the postpartum period. Gestational hypertension is commonly associated with headache.

However, when the headache is associated with hypertension, proteinuria, or both, the diagnosis of pre-eclampsia should be considered. It can be associated with HELLP haemolysis, elevated liver enzymes, and low platelets syndrome and so it is important to check liver function for elevated alanine aminotransferase and aspartate transaminase, platelet count, serum urate, and proteinuria, before establishing a diagnosis. Eclampsia is a hypertensive encephalopathy characterized by headache, visual disturbance, nausea and vomiting, seizures, and stupor which may progress to coma.

Headache is often bilateral, pulsating in nature, and aggravated by physical activity. In both eclampsia and pre-eclampsia, headache can be managed with simple analgesia but control of the underlying condition is imperative to prevent harm to the mother. The incidence of cortical vein thrombosis is increased in pregnancy and is estimated to be between 10 and 20 per deliveries in developed countries and higher in developing countries.

The headache can often be difficult to distinguish from PDPH as it may have a postural component. Indeed, several cases of cortical vein thrombosis have been associated with PDPH, possibly secondary to cerebral vasodilatation after cerebrospinal fluid CSF leak and prolonged dehydration. Symptom control is the mainstay of treatment with the focus on seizure prevention. The use of anticoagulant therapy remains controversial. The incidence of subarachnoid haemorrhage is increased in pregnancy occurring in 20 per deliveries, 1 usually presenting in patients with arteriovenous malformation, cerebral aneurysms, and hypertensive encephalopathy.

The classic presentation is of an acute onset of intense, incapacitating unilateral headache, accompanied by nausea, neck stiffness, and altered consciousness. Diagnosis is confirmed with urgent computed tomography CT and urgent neurosurgical opinion should be sought. First described in after recognition of a consistent syndrome presentation in a diverse group, patients describe a severe, diffuse headache, of an acute or gradual onset, occasionally associated with focal neurological deficit such as loss of vision, seizures, and altered level of consciousness.

This process can be reversed by prompt recognition and supportive therapy which includes aggressive treatment of hypertension and seizure prophylaxis. Neuroradiological imaging shows symmetrical areas of cerebral oedema, predominantly in white matter regions of the posterior circulation. Headaches are usually dull in nature and associated with symptoms of raised intracranial pressure such as nausea and vomiting. Occasionally, focal neurology and altered level of consciousness may be present.

Diagnosis is dependent on history, examination, and neuroimaging. If there is confirmation of a tumour or bleed, urgent neurosurgical opinion should be sought. This is one of the causes of stroke in pregnancy and can occur in the peripartum period. Patients present with a sudden onset of headache, vomiting, seizures, and focal neurological deficit.

Specialist opinion should be sought on appropriate management. Headache is frontal, particularly over the sinuses, and is worse in the morning. Pain is secondary to inflamed paranasal sinuses and associated with nasal congestion, purulent nasal discharge, anosmia, and fever. The severe headache of meningitis may manifest in the first few days postpartum and is classically associated with neck stiffness, photophobia, and fever. Secondary headaches can be harmless or dangerous.

Certain "red flags" or warning signs indicate a secondary headache may be dangerous. Primary headaches usually first start when people are between 20 and 40 years old. Migraines typically present with pulsing head pain, nausea, photophobia sensitivity to light and phonophobia sensitivity to sound. Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms.

Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache pain arising from the neck muscles. Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.

More serious causes of secondary headaches include: Gastrointestinal disorders may cause headaches, including Helicobacter pylori infection, celiac disease , non-celiac gluten sensitivity , irritable bowel syndrome , inflammatory bowel disease , gastroparesis , and hepatobiliary disorders. The brain itself is not sensitive to pain , because it lacks pain receptors.

However, several areas of the head and neck do have pain receptors and can thus sense pain. These include the extracranial arteries, middle meningeal artery , large veins, venous sinuses , cranial and spinal nerves, head and neck muscles, the meninges , falx cerebri , parts of the brainstem, eyes, ears, teeth and lining of the mouth.

Headaches often result from traction to or irritation of the meninges and blood vessels. The nociceptors may be stimulated by head trauma or tumors and cause headaches. Blood vessel spasms, dilated blood vessels , inflammation or infection of meninges and muscular tension can also stimulate nociceptors and cause pain. Primary headaches are more difficult to understand than secondary headaches. The exact mechanisms which cause migraines, tension headaches and cluster headaches are not known.

10 Signs of Dehydration to Look out for

There have been different hypotheses over time which attempt to explain what happens in the brain to cause these headaches. Migraines are currently thought to be caused by dysfunction of the nerves in the brain. Dilation of these extracranial blood vessels activates the pain receptors in the surrounding nerves, causing a headache. The vascular theory is no longer accepted. Currently, most specialists think migraines are due to a primary problem with the nerves in the brain. Triptans, medications which treat migraines, block serotonin receptors and constrict blood vessels.

People who are more susceptible to experience migraines without headache are those who have a family history of migraines, women, and women who are experiencing hormonal changes or are taking birth control pills or are prescribed hormone replacement therapy. Tension headaches are thought to be caused by activation of peripheral nerves in the head and neck muscles [21].

Unusual headaches

Cluster headaches involve overactivation of the trigeminal nerve and hypothalamus in the brain, but the exact cause is unknown. Most headaches can be diagnosed by the clinical history alone. Electroencephalography EEG is not useful for headache diagnosis. The first step to diagnosing a headache is to determine if the headache is old or new.

It can be challenging to differentiate between low-risk, benign headaches and high-risk, dangerous headaches since symptoms are often similar. The American College for Emergency Physicians published criteria for low-risk headaches. They are as follows: A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes which may be life-threatening or cause long-term damage.

These "red flag" symptoms means that a headache warrants further investigation with neuroimaging and lab tests. In general, people complaining of their "first" or "worst" headache warrant imaging and further workup. Other red flag symptoms include: Old headaches are usually primary headaches and are not dangerous. They are most often caused by migraines or tension headaches.

Migraines are often unilateral, pulsing headaches accompanied by nausea or vomiting. There may be an aura visual symptoms, numbness or tingling 30—60 minutes before the headache, warning the person of a headache. Migraines may also not have auras. However, some symptoms from both headache groups may overlap. It is important to distinguish between the two because the treatments are different. If 3 characteristics of POUND are present, migraine is 3 times more likely a diagnosis than tension type headache likelihood ratio 3.

Another study found the following factors independently each increase the chance of migraine over tension type headache: Cluster headaches are relatively rare 1 in people and are more common in men than women.

Temporomandibular jaw pain chronic pain in the jaw joint , and cervicogenic headache headache caused by pain in muscles of the neck are also possible diagnoses. For chronic, unexplained headaches, keeping a headache diary can be useful for tracking symptoms and identifying triggers, such as association with menstrual cycle, exercise and food.

While mobile electronic diaries for smartphones are becoming increasingly common, a recent review found most are developed with a lack of evidence base and scientific expertise. New headaches are more likely to be dangerous secondary headaches. They can, however, simply be the first presentation of a chronic headache syndrome, like migraine or tension-type headaches.

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One recommended diagnostic approach is as follows. If the headache is sudden onset thunderclap headache , a computed tomography test to look for a brain bleed subarachnoid hemorrhage should be done. If the CT scan does not show a bleed, a lumbar puncture should be done to look for blood in the CSF, as the CT scan can be falsely negative and subarachnoid hemorrhages can be fatal. If there are signs of infection such as fever, rash, or stiff neck, a lumbar puncture to look for meningitis should be considered. If there is jaw claudication and scalp tenderness in an older person, a temporal artery biopsy to look for temporal arteritis should be performed and immediate treatment should be started.

The US Headache Consortium has guidelines for neuroimaging of non-acute headaches. If a person has the characteristic symptoms of a migraine, neuroimaging is not needed as it is very unlikely the person has an intracranial abnormality. All people who present with red flags indicating a dangerous secondary headache should receive neuroimaging. Non-contrast CT is best for identifying an acute head bleed. Magnetic Resonance Imaging MRI is best for brain tumors and problems in the posterior fossa , or back of the brain.

The American College of Radiology recommends the following imaging tests for different specific situations: A lumbar puncture is a procedure in which cerebral spinal fluid is removed from the spine with a needle. A lumbar puncture is necessary to look for infection or blood in the spinal fluid. A lumbar puncture can also evaluate the pressure in the spinal column, which can be useful for people with idiopathic intracranial hypertension usually young, obese women who have increased intracranial pressure , or other causes of increased intracranial pressure.

In most cases, a CT scan should be done first. Other classification systems exist. One of the first published attempts was in It contains explicit operational diagnostic criteria for headache disorders. The first version of the classification, ICHD-1, was published in The current revision, ICHD-2, was published in The classification uses numeric codes. The top, one-digit diagnostic level includes 14 headache groups.

The first four of these are classified as primary headaches, groups as secondary headaches, cranial neuralgia , central and primary facial pain and other headaches for the last two groups. The ICHD-2 classification defines migraines , tension-types headaches, cluster headache and other trigeminal autonomic headache as the main types of primary headaches. The daily-persistent headaches along with the hypnic headache and thunderclap headaches are considered primary headaches as well. Secondary headaches are classified based on their cause and not on their symptoms.

Headaches caused by cranial or cervical vascular disorders such as ischemic stroke and transient ischemic attack , non-traumatic intracranial hemorrhage, vascular malformations or arteritis are also defined as secondary headaches.

This type of headaches may also be caused by cerebral venous thrombosis or different intracranial vascular disorders. Other secondary headaches are those due to intracranial disorders that are not vascular such as low or high pressure of the cerebrospinal fluid pressure, non-infectious inflammatory disease, intracranial neoplasm, epileptic seizure or other types of disorders or diseases that are intracranial but that are not associated with the vasculature of the central nervous system.

ICHD-2 classifies headaches that are caused by the ingestion of a certain substance or by its withdrawal as secondary headaches as well. This type of headache may result from the overuse of some medications or by exposure to some substances. The ICHD-2 system of classification includes the headaches associated with homeostasis disorders in the category of secondary headaches. This means that headaches caused by dialysis , high blood pressure , hypothyroidism , and cephalalgia and even fasting are considered secondary headaches. Secondary headaches, according to the same classification system, can also be due to the injury of any of the facial structures including teeth , jaws, or temporomandibular joint.

Headaches caused by psychiatric disorders such as somatization or psychotic disorders are also classified as secondary headaches. The ICHD-2 classification puts cranial neuralgias and other types of neuralgia in a different category. According to this system, there are 19 types of neuralgias and headaches due to different central causes of facial pain.

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