Scalp, skull, and brain
The brain is housed inside the skull bone. The skin covering the head is called the scalp. Many muscles, nerves, and blood vessels crisscross the thickness of the scalp.
Tension or stress headaches
Emotions, both bad and good, can cause headaches. More commonly, in the case of headaches, bad emotions fire up the muscles of the head and face.
The frontalis muscle stretches over the forehead and the occipitalis covers the back of the head. The temporalis muscle is located on the sides of the head. The masseter muscle is in the cheek area and parts of the trapezius muscle extend to the upper neck.
Nearby nerves pick up noxious tensions from these muscles and transmit them to the pain awareness center of the brain.
Unlike a tension headache, which is clearly known to arise from the tightening muscles of the head and neck area, the cause of a migraine headache is still debated. A disturbance of the brain’s biological and physiological elements-hormones, peptides, dilatation and constriction of brain blood vessels-is implicated.
Other causes of headaches
Headaches also often go with many illnesses. Malaria, ear infection, sinus infection, throat infection, runny nose, and toothache are examples of diseases which come with a headache. This kind of headache goes away once the illness has run its course.
Three pictures of headaches recently seen in my private office
- Take the case of a seventeen-year-old female who has had headaches on and off over a couple of months. She wears music earphones and plays music all night long. A constant bombardment of music to the ear, together with a lack of sleep, contributed to her headache.
- There was an 18-year-old boy who presented with a headache for the first time. He goes to school from 7 am until 5 pm, and then works in a factory from 6 pm until 11 pm. In between school and job, he has plenty of personal errands to run. He hardly sleeps.
- Then there is a nine-year-old male whose mother has been picking him up twice a week from school because of headaches in class. He throws up when a headache comes. Light and sound bother him a lot during the headache episodes. His mother and grandmother have suffered from migraine headaches their entire lives. The child saw a neurologist, who sent him for imaging studies, MRI of the brain, which was normal. I then confirmed he was also suffering from migraine and started preventative medication.
Evaluating children with headaches
When presented with a child who complains of a headache that comes and goes, be it at a daily, weekly or monthly interval, the practitioner must consider one of these conditions.
- Is the child merely repeating what they hear from the nearest caregiver, for example a grandmother, mother, or older sister, who goes around saying ‘I have a headache’? I have singled out women because men tend to internalize suffering.
- Does the child genuinely have a common-type headache, also known as a tension headache, which many adults experience? Sufferers feel a dull aching pain and pressure over the forehead, sides and back of the head, and sometimes neck.
- Does the boy or girl have a particularly agonizing kind of a headache called migraine headache, that runs in the family, lasts for hours at a time, is worsened by exposure to light and sound, occurs on one side of the head, and is accompanied or preceded by tummy-ache, nausea, and vomiting?
- Does the youngster, especially when under age five, have a more ominous medical condition such as infection around the brain, bleeding in the brain, or a tumor in the brain? Clues include a headache which begins early in the morning, keeps the child awake at night, and is worse when coughing, sneezing, urinating or passing stools.
- Is this a one of a kind headache, a headache so severe that it surpasses any pain the patient has suffered in the past? This description may point to a lethal condition: bleeding in the brain, the ballooning or aneurysm of vessels in the brain, and other surgical emergencies.