Keywords: Chronic headaches, mental health, primary headaches, migraine headache, tension type headache, hypnic headache, cluster headaches.

Introduction.

Chronic Headaches and Mental Health – Nigeria. What are chronic headaches? The different types of primary headaches. What is the link between these headaches and mental health issues? How can one manage the headaches?

A headache is a pain at the head or upper part of the neck. This pain comes from the things that surround the skull or the brain. The things that surround the brain and skull include the meninges, arteries, veins, nerves, periosteum, muscles, etc. It is the inflammation or irritation of these things that can cause headaches.

There are different types of headaches, the primary headaches, the secondary headaches and the cranial neuralgias, facial pains and other headaches. The primary headaches are the chronic headaches that will be discussed here.

Chronic Headaches and Mental Health in Nigeria is quite important. In Nigeria, primary headaches in one study in Lagos showed 39.3% prevalence. Tension type headaches are more prevalent with 72.8%. Even among medical students in Nigeria, tension headaches are higher than other primary headaches. In a study in the southeast, migraine headaches is 6.4%, while tension type headache is 13.8%. Then in Kano, migraine and tension type are the most common of all primary headaches.

What are chronic headaches?

Chronic headaches are headaches that last for many days, especially those that can last for 15 days in a month. These are headaches that can occur practically every day. The types of headaches that are more likely to fit this description of chronic headaches are the primary headaches.

Primary headaches are headaches that occur without causes from the brain or any part of the body. There are 4 types of primary headaches. These are the migraine headaches, tension type headaches, Hypnic headaches, and cluster headaches.

The different types of primary headaches.

The migraine headaches:

These headaches appear at one side of the head and can last for hours. Occasionally it can affect the other side of the head as well as the back of the head.

This type of headache is characterized by attacks of headaches that are very disabling. It is a throbbing type of pain that last for hours to days. The pain experienced at the brain, the brain stem and at the back of the head is over amplified. It can be moderate or severe. But during pregnancy, the headache gets better, especially between the 4 to 9 month periods. And it can reoccur after pregnancy.

The pain comes with nausea and vomiting, as well as being sensitive to light, called photophobia. There is neck stiffness, frequency of urination, and other bowel symptoms.

Causes –

It is due to genetic components, so it runs in the family. This means that it is inherited from parents.

Migraine headaches are also due to reduced level of the neurotransmitter called serotonin. The brain also becomes hypersensitive to internal and external triggers. These triggers affect the nerve called the trigeminal nerve and its blood system. This leads to the processes that affect the neurochemicals as well as cause inflammations in the brain. Sometimes, these inflammatory processes can come on their own without anything triggering them.

These things that can trigger a migraine headache include menstruation in women. And these are associated with hormonal changes during this period. The hormones that are actually fluctuating during the menstruation periods are the estrogen and progesterone. Stress can cause up to 70% of all migraines. Natural and artificial lights are also triggers. Light can activate the nerves going from the eyes to the brain. Strong smell and irregular sleep schedule can precipitate a migraine headache. Even changes in weather such that affect humidity and heat can cause the headache. This is because weather changes can predispose one to dehydration.

Certain foods like chocolate, cheese, sweeteners and some dairy products like yogurt can bring up the headache. Other precipitating foods are, fruits like orange, banana, pawpaw, avocado pears, etc. Even nuts like groundnuts can be triggers. Monosodium glutamates (MSG) in food seasonings and salad creams can be culprits. Also the use of substances such as caffeine and alcohol can trigger a migraine headache.

The headaches are made worse by movements such as walking, etc. So the person will prefer to lie down in a quiet and dark room.

Types of migraine headaches –

There are two types of migraine headaches. They include migraine with aura and migraine without aura.

Auras are presentations or symptoms that come before the pain comes up. These migraine auras can come as visual symptoms such as the person seeing flashes of light. The person can also see the light coming as zig zag patterns. Some people may have momentary loss of vision. The hands, arms, face, lips and tongue may have tingling sensations. The person feels weak and there could be loss of speech, etc. And the auras of migraines last for about 5 to 60 minutes before the pain comes up.

Migraines without auras start straight away with the pain. The headaches last for 4 hours or more, even up to days.

The subtypes –

There are subtypes of migraine which includes episodic migraine and chronic migraine. In episodic migraine headaches, there are usually weeks to months of headache free time. Then in the chronic migraines the pain can last up to 15 days in a month for a period of 3 months. During these attacks the person cannot function.

Tension Type  Headaches:

The headache affects the back of the head, back of the neck, the ears, above the ears. The jaws and above the eyes are also affected.

The person complains of a headache that feels like a tight band around the head or neck. And the pain can last from minutes to days, months and even years. Actually, the headache comes on for 4 to 6 hours in a day. It occurs for less than 15 days in a month. The headache does not really affect the person’s function. That means that the person will usually continue with work, school, social functions, etc. But the chronic type may cause the person to visit the hospital.

Types of tension headaches –

There is the episodic type that lasts for 14 days in a month. And 10 episodes can take place in one day. This episodic type tension headache can last for 30 minutes to days.

The chronic type lasts for 15 days or more times in a month. But it can also be there for 3 months or more. It actually starts gradually in the morning and builds up. But by evening the intensity reduces.

Cause of tension type headaches –

The actual cause of tension headache is not fully known. But it has been linked to neurotransmitters in the brain. It can also be genetic. There are also problems in the brain areas such as the hippocampus, amygdale, and other parts of the brain. Even the trigeminal nerve is implicated as well as the muscles surrounding the skull.

Things that may trigger the headache to come on include stress, mental tension and the daily hassles of life. Other triggers are dehydration, poor positioning, missing meals and lack of physical activities.

Hypnic headaches:

These are headaches that come only at night when the person is asleep and it wakes the person up. For this reason it called the alarm clock headache, because it wakes the person up between 1am and 4am. And the headache occurs at the same time every night.

The pain can be felt at only one area of the head or all around the head. And the pain may last between 15 minutes and 4 hours. It occurs for 10 or more days in a month.

It presents as throbbing, stabbing or burning headache, with accompanying nausea.  The eyes may become watery, with blocked nose.

The causes and risk factors –

Researchers do know that hypnic headache occurs at the Rapid Eye Movement (REM) sleep. So it could be that an area of the brain involved with pain gets activated at that point in time.

It is also believed that it could be caused by low level of melatonin. Melatonin is a hormone that makes one feel sleepy.

There is also sensitivity to light and sound. And some people with hypnic headaches also have migraine headaches.

Cluster headaches:

These are very severe pain that occur at one side of the head, and felt most around the eyes. The pain is severely excruciating and it is the most painful type of all headaches. Females describe it to be worse than labour pains and others say it is worse than bone fracture. It feels as if one is poking a hot rod into someone’s eyes. Because of the pain severity, it is also known as suicide headache.

The pain occurs 1 to 8 times in a day and comes in cycles that last for weeks to months. It can even wake the person from sleep. Each pain can last for 15 minutes to 3 hours. It is consistent with start dates and duration periods. Cluster pains are seasonal and can occur 1 to 3 times in a year. So there are months or years it will not be seen. 

Because of the pain, the individual is unable to lie down or sit still. So the person will be pacing, or doing rocking movement. There is restlessness and agitation. Some will hit their heads on the wall or with their fist, in order to alleviate the pain.

The eye on the affected side becomes red, tearing, swollen, with drooping eyelids.  There is nasal stuffiness and there could be runny nose. Also the affected side of the face will begin to sweat.

Types –

There are two types of cluster headaches. In the episodic type, the pain can last from one week to one year. There is also a one year pain free period. But in the chronic type, the pain occurs without any pain free period. For some there could be pain free periods not lasting more than one month.

Actually, most cluster headaches do not come with aura, but some do. And the aura comes as transient visual disturbances.

Causes and risk factors –

Cluster headaches have genetic origins. It affects the trigeminal nerve and its blood supply system. There are also abnormalities at the hypothalamus of the brain.

The changing weather affects it, i.e.  when there are changes in daytime duration. Also changes in sleep pattern can trigger it. Smoking, alcohol, strong odors from solvents can trigger it.

Chronic headaches and mental health in Nigeria.

The mental health effects of chronic headaches include depressive disorders, anxiety disorders, as well as bipolar disorders. Those suffering from chronic headaches are easily angered and irritable.

Sufferers from migraine are 2.2 to 10 times more likely than other none sufferers to have depressive disorders. In migraine, having depression is a two way traffic. Migraine headaches can predispose one to depressive disorders and depression can precipitate a migraine. In one research, it documented that 44% of those who suffer from migraine headaches also have depressive disorders. Those with migraine headaches worry a lot and are unable to relax.

Those suffering from tension type headaches are more prone to generalized anxiety disorders, major depressive disorders, dementia and suicide. Even those with cluster headaches can have depression, anxiety and suicidality.

These four types of chronic headaches can predispose to sleep problems. Even though these chronic headaches can cause poor sleep, tension type headaches can be triggered by excessive sleep. Those with poor sleep have severe headaches, because poor sleep reduces the threshold for pain.

The belief one has about the headache will determine the disabling effect.  If one believes that the headache is catastrophic, he/she will feel hopeless. But if the person believes that the headache can be controlled, then it will be less disabling.

The effect of chronic headache on functioning:

Headaches can affect the individual’s functioning. It can affect the way the individual functions at home, especially the parenting method used. Thus, if someone suffers from both migraine headaches and depression, it is very difficult to be a good parent.

There will also be problems at work with increase in the number of days of missed work. And getting a job is also a problem. Also there is disruption in functioning in school and social roles. In Benin city Nigeria, the impact of migraine on secondary school students affects their quality of life. It also contributes to school absenteeism.

Social and economic costs:

These include stigmatization and social withdrawal. People may stigmatize them believing that the condition is infectious. And due to this stigma, those suffering from chronic headache will withdraw to self.

Due to loss or lack of work, the person may become poor. Also the frequent hospital visits.

Prevention and treatment of chronic headaches.

Lifestyle changes are very important. Avoid periods of hunger and hypoglycemia, which is a precipitating factor. Also avoid precipitating foods. It is also good to avoid irregular sleep patterns. Reducing stress is important.

Talking to self by reminding oneself that the headache will stop, will reduce the gravity of the headache. And doing whatever makes one happy, as well as connecting with positive people are very important.

Get professional help because the headaches will require treatments. The earlier one gets treatment, the better the result and less the complications. The professionals include the neurologists, psychiatrists and psychologists. The Chronic Headaches and Mental Health – Nigeria can be handled by these professionals.

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