Headache, a simple cause may be a concern
In most of the cases, headache is simply ignored. Photo: HASIB BIN AZAD
Headache is the most common clinical syndrome, frequently over-looked as clueless, unless the severity and other manifestations are grossly alarming. Most common diagnoses are migraine, tension headache, cluster headache or malingering (fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives). Headache associated with meningitis, brain tumour or intracranial haemorrhage has characteristic features and symptoms. Other forms of headache caused by Spontaneous Intracranial Hypotension (SIH) is frequently misdiagnosed or confused. SIH was first described in 1938 and much has been learned about this syndrome since introduction of MRI in early1990. Unfamiliarity of SIH among physicians in general, varied spectrum of clinical and radiological manifestations may all contribute to delay in diagnosis or get misdiagnosed. Spontaneous intracranial hypotension is caused by spontaneous cerebrospinal fluid (CSF) leakage. The precise cause remain largely unknown, but an underlying structural weakness of spinal meninges generally is suspected. History of trivial trauma, connective tissue disorders has been elucidated in the causation of CSF leakages along the spinal rootless. Diagnostic criteria of SIH varies in different criteria (both clinically and radiologically) which a physician will find out. Generally the symptoms include diffuse and/or dull headache that worsens within 15 minutes after sitting or standing; headache resolves within 72 hours after epidural blood patching; neck stiffness; tinnitus; hearing a reduced sensitivity to sounds (hypacusia); photophobia; nausea etc. Treatment is offered as follows: a. Conservative approach: Bed rest, oral rehydration, caffeine intake, abdominal binder. Administration of steroid, intravenous caffeine and theophyllines are recommended, if conservative regimen failed then, b. Epidural autologous blood patch or fibrin glue, in severe cases c. Surgical repair of CSF leakage If your headache is spells the mentioned criteria, consult with a specialist physician to find out the underlying cause and treat it correctly.
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