Headache

Headache in Adults

Introduction

Headache is one of the most common symptoms encountered in clinical practice. It affects people of all ages and can range from a minor nuisance to a disabling condition that significantly impacts quality of life. While many headaches are benign, some can be a sign of serious underlying ENT or neurological diseases. Hence, a holistic evaluation from both perspectives is essential.

These are most common types:

Tension
Cluster
Sinus
Dehydration
Rebound
Migraine

Classification

Generally divided into two broad categories:

Primary – Not caused by other medical conditions.

Migraine
Tension-type
Cluster and trigeminal autonomic cephalalgias

Secondary – Result from another medical disorder.

ENT causes (sinusitis, ear infections, nasal obstruction, pharyngeal pathology)
Neurological causes (intracranial tumors, meningitis, stroke, vascular malformations)
Systemic causes (hypertension, metabolic disorders, eye strain, dental disease)

ENT Perspective

Sinus-Related

Pathophysiology:

Inflammation or infection of the paranasal sinuses (sinusitis) leads to mucosal swelling, impaired drainage, and pressure build-up.

Clinical Features

Dull, constant pain over the affected sinus (frontal → forehead, maxillary → cheeks/upper teeth, sphenoid → vertex or occiput, ethmoid → between eyes).
Worse in morning or on bending forward.
Associated with nasal congestion, discharge, post-nasal drip, fever.

Diagnosis:

Nasal endoscopy, CT scan of paranasal sinuses.

Management:

Antibiotics (if bacterial), decongestants, nasal corticosteroids, steam inhalation, functional endoscopic sinus surgery (FESS) in chronic cases.
Ear-Related Headaches

Otitis media/externa → Pain radiates to the temporal or occipital region.
Eustachian tube dysfunction → Pressure-type headache with ear fullness.
Referred otalgia (tonsil, pharynx, temporomandibular joint disorders) → Misinterpreted as headache.

Throat and Oral Cavity Causes

Tonsillitis, pharyngitis, dental infections can refer pain to the head and face through cranial nerves (V, IX, X).

Anatomical Variations

Deviated nasal septum, concha bullosa, turbinate hypertrophy can contribute to chronic pressure headaches.

Neurology Perspective

Migraine

Epidemiology:

Common in young adults, more in females.

Pathogenesis

Neurovascular dysfunction, serotonin imbalance, cortical spreading depression.

Clinical Features

Unilateral, pulsating headache lasting 4–72 hours.
Associated with nausea, vomiting, photophobia, phonophobia.
May have aura (visual, sensory, or speech disturbances).

Management:

Acute: NSAIDs, triptans, antiemetics.
Prophylaxis: Beta-blockers, antiepileptics, antidepressants, lifestyle modifications (sleep hygiene, avoiding triggers).

Tension Related

Clinical Features:

Bilateral, band-like tightness, mild to moderate intensity.
Not aggravated by routine activity.
Often associated with stress, anxiety, poor posture.

Treatment:
Analgesics, muscle relaxants, stress management, physiotherapy, yoga/meditation.

Cluster

Clinical Features:

Severe unilateral orbital/temporal pain.
Occurs in clusters (daily attacks for weeks, then remission).
Associated with ipsilateral tearing, nasal congestion, eyelid edema, restlessness.

Treatment:

Oxygen therapy, triptans for acute attacks; verapamil, lithium for prevention.

Neurological Red Flags (Secondary Headaches)

Sudden, severe “thunderclap” headache → Subarachnoid hemorrhage.
New headache in age >50 → Temporal arteritis or malignancy.
Progressive headache with neurological deficits → Brain tumor.
Headache with fever, neck stiffness → Meningitis/encephalitis.
Headache with visual changes → Raised intracranial pressure, glaucoma.

Dehydration

A dehydration headache happens when your body loses more water than you are replenishing. This can easily happen, for example, after a long workout or if you’ve had a stressful day and forgot to sip enough water throughout.
Pain can be felt around the entire head – the front, the back and the sides. But you usually wouldn’t feel any pain in your face.

These signs point to a dehydration headache:

Pain anywhere around the head
Extreme thirst
Less frequent urination or dark urine
Dizziness and confusion

Treatment is Rehydration. Sipping of water, ORS in mild and moderate dehydration. Intravenous fluid administration is required for Severe Dehydration.

Diagnostic Approach

History Taking

Onset, duration, frequency, location, intensity.
Nature (pulsating, pressure, stabbing).
Triggers (foods, stress, posture, environment).
Associated symptoms (nausea, vision changes, nasal obstruction, ear discharge).
Past medical history (hypertension, trauma, sinus disease).

Clinical Examination

ENT examination (nose, ears, throat, sinuses).
Neurological examination (cranial nerves, motor/sensory, funduscopy).

Investigations

Blood pressure, blood tests (CBC, ESR, thyroid).
Imaging: CT/MRI brain, CT sinuses.
Endoscopy: Nasal, laryngoscopy if indicated.

Management Principles

Lifestyle and Preventive Measures

Adequate sleep, hydration, balanced diet.
Regular physical activity, yoga, meditation.
Avoiding triggers (alcohol, smoking, certain foods, stress).

Medical Treatment

According to cause: Analgesics, antibiotics, nasal sprays, anti-migraine drugs.

Surgical Interventions

FESS for chronic sinusitis.
Removal of nasal polyps or septal correction.
Neurosurgical management for intracranial lesions.

Conclusion

Headache is a multifactorial condition requiring careful differentiation between benign and serious causes. From an ENT perspective, sinus, ear, nasal, and throat disorders are common culprits, whereas from a neurological perspective, migraines, tension-type headaches, and intracranial pathologies dominate. A collaborative, multidisciplinary approach ensures accurate diagnosis and effective management. Early recognition of warning signs and timely intervention can prevent complications and improve patient outcomes.

Ayurveda Perspective / आयुर्वेद दृष्टिकोणमा टाउको दुखाइ

Terminology / परिभाषा

Headache in Ayurveda is described as शिरोरोग (Shiroroga) or शिरःशूल (Shirashoola).

Charaka Samhita, Sushruta Samhita and Ashtanga Hridaya mention various causes and types.

Causes (Nidana) / कारणहरू

दोष imbalance (Vata, Pitta, Kapha)

Ama (toxic by-products of undigested food)

Suppression of natural urges (Vegas)

Stress, irregular sleep, unhealthy diet

Excess exposure to sun, wind, alcohol

Types (Shiroroga classification) / प्रकारहरू

According to Ayurveda Samhitas:

Vataja Shiroroga – Severe, throbbing, shifting pain

Pittaja Shiroroga – Burning pain, redness, aggravated by heat

Kaphaja Shiroroga – Dull, heavy pain with nasal congestion

Sannipataja Shiroroga – Mixed type with severe symptoms

Krimija Shiroroga – Due to worm infestation in sinuses/head

Shankhaka – Unilateral severe headache, considered incurable in classics

Ardhavabhedaka – Classic description of migraine (unilateral splitting pain, episodic)

Ayurveda Management / आयुर्वेद उपचार

Shodhana – Purification Therapies)

Nasya Karma (नस्य): Medicated oils/ghee through nostrils (e.g., Anu Taila, Shadbindu Taila)

Virechana (विरेचन): Purgation therapy for Pitta-related headaches

Shirodhara (शिरोधारा): Continuous pouring of medicated oil/decoction on forehead

Raktamokshana (रक्तमोक्षण): Bloodletting in specific conditions (Pittaja, localized swelling)

Shamana – Palliative Therapies

Herbal formulations: Dashamoola, Brahmi, Jatamansi, Shankhapushpi, Yashtimadhu

Ayurveda lifestyle: Dinacharya, Ritucharya, Sadvritta

Diet: Light, easily digestible, avoid spicy, oily, junk food

Preventive Ayurveda Lifestyle / आयुर्वेद जीवनशैली रोकथाम

Nidra (Sleep): Early to bed, early to rise (Brahmamuhurta)

Aahara (Diet): Satvik, fresh, seasonal diet; avoid Viruddha Ahara (incompatible foods)

Vihara (Lifestyle): Yoga, Pranayama, meditation for stress reduction

Rasayana (Rejuvenation): Regular intake of Medhya Rasayana (Brahmi, Mandukaparni, Ashwagandha) for strengthening mind and nerves

Ayurveda + Modern Integration

ENT/Neurology approaches treat infection, inflammation, or structural causes.

Ayurveda emphasizes holistic prevention (diet, lifestyle, stress management) + Shodhana & Shamana therapies for root-cause correction.

Together, they offer a comprehensive approach for better long-term outcomes.