The most common headaches are tension headaches which are relatively mild and often look like a tight band around the head or a heaviness in the head. They often occur later in the day and can be precipitated by a bad day at the office, a fight with a loved one, or worrying about a problem. All you need to do is relax, relax your mind, and if necessary take paracetamol and sleep. These headaches are often present for a long time and can be correlated with a stressful situation. Between these headache episodes, the person is usually quite normal.
Migraines and other vascular headaches are usually more severe and are characterized by intense throbbing pain, often accompanied by nausea and vomiting, and the patient is extremely sensitive to light and noise. They can be located on one side of the head, but more often than not can affect both sides. They occur in young adults and decrease in intensity and frequency when the patient reaches forty or fifty years of age. A characteristic feature is the episodic nature of the headache which is severe and lasts several hours or even a few days. A variety of drugs are available to interrupt an acute attack, to alleviate symptoms in an acute attack, and to reduce the occurrence of acute attacks if they are frequent.
Although most headaches do not have serious consequences and are not fatal, in some cases they can signal a serious health problem. Brain infections like meningitis can present with severe headaches, vomiting, seizures, and impaired sensory senses. The infection can be acute usually caused by bacteria, can have a short history of a few days and quickly progresses to headache with high fever. Chronic meningitis can have a longer history of several weeks or months and the progression is slow with a mild fever. This is usually caused by tuberculosis or a fungal infection. Acute and chronic meningitis are associated with a stiff neck and painful restriction of neck movement.
Brain aneurysms and headaches
An aneurysm is a weak spot or swelling in the blood vessels of the brain. It can leak or rupture – causing bleeding on the surface of the brain (subarachnoid hemorrhage) or into brain tissue (intracerebral hematoma). Upon rupture, the person has a sudden, severe headache often described as the worst headache ever. This is often associated with a stiff neck and vomiting. If the bleeding is severe, the patient may pass out or even die suddenly. The hallmark of the headache caused by a ruptured aneurysm is the sudden onset of acute acute in seconds or minutes. A small, unruptured brain aneurysm may not have any symptoms and therefore go undetected. A larger unruptured aneurysm can put pressure on brain tissue and nerves, causing pain or neurological deficit.
There are two common treatment options for a ruptured brain aneurysm:
• Surgical cutting is a procedure to close an aneurysm. This involves removing a section of the skull to access the aneurysm and locate the blood vessel that supplies it. A small metal clip is then placed over the neck of the aneurysm to stop blood flow through the aneurysm while maintaining blood flow through the vessel.
• Endovascular coiling is a less invasive procedure than surgical clipping. This involves inserting a catheter (hollow plastic tube) into an artery, usually in the groin area, and passing it through the vessels to the brain vessel hosting the aneurysm. Then, detachable coils are inserted to completely fill the aneurysm from the inside – so that no blood flow occurs through the aneurysm, causing it to occlude.
The above procedures can also be used to seal an unruptured brain aneurysm and help prevent future rupture. It is the type of headache that requires immediate treatment.
Brain tumor and headaches
A brain tumor is a mass or growth of abnormal cells in the brain. It can be cancerous (malignant) or non-cancerous (benign). Brain tumors can originate in the brain (primary brain tumors), or cancer can start in other parts of the body and spread to the brain (secondary or metastatic brain tumors). The skull is a closed compartment and as the tumor grows and takes up space, it results in increased pressure inside the skull which leads to headaches. And as the tumor grows, the pressure increases and the headache increases in intensity and frequency. Headaches are a common symptom of brain tumor and they get worse in the morning and often wake a person from sleep – unlike other headaches which are worse in the evening. Headaches associated with a brain tumor also increase due to coughing, sneezing, or exercise. They are often accompanied by vomiting or blurring of vision and double vision. The presence of epilepsy or seizures may also indicate a serious cause of the headache. The patient may also have neurological deficits, including weakness or numbness in an arm or leg, difficulty speaking, hearing problems, or changes in behavior. It is important to differentiate the headache of a brain tumor from a simple headache: the presence of persistent pain that continues to increase over time, the onset early in the morning, and the presence of neurological symptoms. partners described above. The diagnosis of brain tumor is easily established with modern MRI imaging of the brain.
Treatment for a brain tumor depends on the type, size and location of the tumor. Surgery is the primary treatment for most brain tumors, especially if they are large. The goal is to completely remove the tumor without causing a new deficit. While this is achievable in most benign tumors, it is not always possible due to the tumor’s proximity to a critical vessel or nerve. For malignant brain tumors – even if we remove all visible tumor – the residual tumor cells can linger in depth that are not visible even under a microscope. These should be treated with radiation therapy and chemotherapy – which for brain tumors is usually a tablet and is easily tolerated. However, not all tumors require surgery, and some small brain tumors can be treated with Cyber Knife radiosurgery – which involves non-invasively delivering highly focused beams of radiation to the tumor without opening the head. This is also used for small residual tumors after surgery and for recurrent tumors. A particular type of secretory pituitary adenoma can be treated primarily with medical therapy.
Brain tumor surgery has advanced tremendously with the advent of new technologies. Neuro-navigation is a computer-aided technique for knowing exactly where the tumor is and where our instrument has reached at all times during surgery (similar to our car’s GPS that tells us where we are at all times). Having an intraoperative MRI machine in the operating room helps us assess the completeness of tumor removal during surgery and do more ablation if necessary. The use of the operating microscope, high speed drills and ultrasonic vacuum cleaner are standard complements in today’s world. Preoperative embolization (blockage) of tumor vessels is performed to reduce vascularity to the tumor and reduce blood loss during surgery. Neuro-endoscopes are commonly used to make surgery minimally invasive. Intraoperative neurosurveillance is used to preserve neural function. The application of all these adjuvants has made the removal of brain tumors much safer and more reliable.
Dr VP Singh, President Neurosciences, Medanta – The Medicity