Often we hear and also use the word “headache” in our home or at office when somebody bothers you too much and irritates we express that this person” is a headache”.

While somebody gets a headache on smelling a perfume and somebody gets a headache on hearing loud music or sound. The question is how does this headache originate?

Headaches are referred pain to the surface of the head from the deep structures of the skull. The origin of headache is classified in to two types Headache of intracranial origin and extra cranial origin.

Causes of Intracranial headaches (headache begins inside the skull or head)

Inside the skull the brain is covered by different membranes, Generally, a headache originates from the membranes that are outside the brain. A membranous structure is present at the base of the brain called as tentorium(Figure-2) and above this one more membranous structure intracranial vault is present and a stretching effect or damage to the tentorium as well as intracranial vault causes headache. Sometime stretching affects the blood vessels supplying to the membrane that is outside the brain and also causes headache. When any part of our body gets stretched it causes pain, for example if you stretch your finger more than you can you will get pain, this happens as the tentorium and intracranial vault get stretched. Tentorium and intracranial vault are innervated by fifth cranial nerve (Trigeminal nerve) this trigeminal nerve supplies the front half of the head(Figure-2-1) , so if there is any problem that occurs to tentorium and intracranial vault which causes referred headache to the front half of the head. Pain impulses(sensation) from under part of tentorium enter the central nervous system(brain)through the second cervical nerve(present in the upper neck)(Figure2-2) which also supplies the scalp behind the ear, so any problem that occurs to this lower part of the tentorium it causes headache on the back part of the head.

Types of intracranial headaches :


Headache of meningitis:(mening- membranes outside, itis-inflammation) Brain fever or any other infection causes inflammation to the membranes outside the brain(Figure-2-2a), due to this inflammation, little swelling occurs and creates pressure on the vault, and the tentorium causes headache.
Headache caused by tumor: Any tumor occur inside the skull will increase the intracranial pressure and due to this pressure the tentorium gets stretched and causes headache.
Spinal headache: When spinal anesthesia is administered to the patient for delivery of a baby or any other abdominal surgery, likely to get headache due to leakage of cerebrospinal fluid (fluid present between the brain membranes) the headache increases when in an upright posture (position) and decreases in the lying posture. When the volume of cerebrospinal fluid is normal, then the brain floats well and if the volume reduces to as little as 20 ml then the brain directly stretches the tentorium and causes headache, therefore in upright position due to the gravitational force it tends to increase the headache but in the lying position gravity is eliminated so patient feel relieved.
Tension headache: Prolonged emotion or tension causes reflex vasospasm of the arteries to the head, this vasospasm reduces the blood circulation to the brain as a result the blood vessels become flaccid (loss of vascular tone) the blood pressure in these arteries stretches the walls of the blood vessels, excessive stretching in the wall of the blood vessels creates headache and because of this excessive stretching due to this Chronic high BP patients get headache.
Alcoholic headache: If people consume excessive alcohol at night then next day in the morning they will get headache. If they consume less alcohol they will get relief from the headache here the toxic substance present in the alcohol directly affects the meninges (membranes outside the brain) and causes headache, alcohol is a vasodilator, so if in the morning little alcohol is consumed then it dilates the blood vessels and pumps more blood to this area and through this blood toxic substance will washed out from this area and get relief.
Headache caused by constipation: When the toxic substance is absorbed from the rectum, through the blood it reaches the brain and affects the meninges causing headache. Even if the food is not digested it will stimulate the autonomic nervous system (sympathetic nerves, vagus nerve) and cause vomiting and headache, since the autonomic nervous system is connected to the stomach and the head.

Types of extra cranial headache:

Headache caused by nasal (nose) and nasal structures: Any infection that occurs in the nose directly affects the structure and causes pain and results in headache which can be sensed even behind the eyes.while smelling a unpleasant odors or cold air, to avoid unpleasant odors or cold air the entrance of this nasal structure (muscle, blood vessels) contract, this spastic contraction of the nasal structure also causes headache. The frontal sinus (cavity present in the frontal skull bone)(Figure-2-2b) infection also causes headache.
Headache caused by eye disorders: When there is a vision problem(short sight or long sight) in order to get a clear vision, the ciliary muscle present in the eyes contract excessively and for excessive contraction the muscles need more blood, and due to the blood circulation not being sufficient for this continuous contraction of the ciliary muscle, our body tends to stop this activity and then secretes a pain creating substance (Lewis substance-P) (anywhere blood circulation is not sufficient this pain creating substance will secrete. Classic examples are-Continuous muscle contraction in gym.Myocardial infraction-heart disease). Also headache caused by excessive exposure of the eyes to light like arc-welding or ultraviolet light. (This affects the conjunctiva and retina causes pain the headache can felt around the eyes. (Sometime teeth infection may also create headache).

Headache due to nerve compression at neck region:

As explained above impulses (sensation) from under part of tentorium enter the central nervous system (brain) through the second cervical nerve (present in the upper neck) which also supplies the scalp behind the ear. When a problem occurs to this lower part of the tentorium it causes headache on the back, upper and front portion of the head as shown in the (Figure2-1). The dermatomes (particular area of the skin supply by the cutaneous branches from a single spinal nerve), myotomes (segmental nerve supply to the muscle) of these three nerves (Greater occipital nerve, Lesser occipital nerve,Greater auricular nerve)(Figure-2-2)&(Figure 2-3) arises from the cervical area of spinal cord as shown in the (figure-2-4) Greater occipital nerve(C2, C3), Lesser occipital nerve(C2),Greater auricular nerve (C2, C3) . C1 nerve arise between skull and 1st cervical vertebrae,C2 nerve arise between 1st cervical vertebrae and 2nd cervical vertebrae, C3 nerve arises between 2nd and 3rd cervical vertebrae, At this level if any problem happens it will cause a headache.

What are the possible problems that may occur?

Due to muscle weakness the vertebral bone gets displaced from its original position and compresses the nerve causing headache.
Sudden jerk, improper placement of pillow may displace the intervertebral disc and it compresses the nerve causes headache.
To strengthen the bones our body deposits calcium around the vertebral joint, when the deposit is in excess in the area where the nerve arises it may compress the nerve and cause headache, in case if the deposition is more on one side then the headache will also be on the same side one sided headache or migraine which is very prevalent

Symptoms of  headache due to nerve compression:

In this along with headache there is a feeling of heaviness, burning Sensation, tinkling-pin pricking sensation and numbness  starting from the posterior part of the head and spreads throughout the head till the forehead. Many get relief while squeezing or pulling their hair. But some patients complaint that even a little touching cause’s severe burning sensation and pain. Numerous patients complain after prolonged exposure to sunlight or after taking a bath experienced headache. In chronic cases patients experience continuous headache from morning till evening. Role of physiotherapy treatment: To make vertebrae in proper alignment Manzero’s manipulation helps. To maintain the vertebrae to its original position the patient must do proper exercises, improper exercises may increase headache. To revert the intervertebral disc to its original position in Manzero’s manipulation specialized  “GAIT” is used. Removal of excess calcium, ultrasound and shortwave diathermy are the best modalities that should be adopted. If the headache occurs due to dilatation of blood vessel Manzero’s maneuver (maneuver-procedure) and cryotherapy (ice massage) are the best options of treatment. Headache due to nerve compression or other reasons can be easily diagnosed by some simple tests.


Comment on "Headache"

  1. Franklin

    Very useful article. So easy to understand

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