"Primary Headaches of Patients - A Challenge for Primary Care Physicians"

Abstract

Headaches, medially known as cephalalgia, is one of the most common disorders of the nervous system. Approximately half of all adults have had a headache during the past year, and it is the sixth cause of disability in the world. It is the most disabling conditions and can have a substantial impact on quality of life of those affected. If it occurs repeatedly, it may be called as headache disorder. The latest International Classification of Headache Disorders has broadly classified headache disorders into primary and secondary based on their origin. Primary headache the subject of this paper is triggered by lifestyle factors, like alcohol, particularly red wine, processed meats that contain nitrates, changes in sleep or lack of sleep, poor posture, skipped meals & stress. Majority of those with headache have primary headache disorder especially migraine, tension-type headache, and medication-overuse headache. The tension-type headache (TTH), episodic TTH of less than 15 days/month, is reported by more than 70% in some populations. Stress is one of the main aggravating factors across geographies, more so in millennials and females. The Global Burden of Disease Study 2019 estimated that migraine caused 41.1 million YLDs 5.4% of Total YLDs, and tensiontype headache 5.5 million years of life lived with disability. Headache disorders are most troublesome in the productive years of life with lost working days and reduced productivity. Without proper treatment, can become chronic or recurring affecting the well-being of an individual and predispose them to other illnesses.Self-care with simple analgesics in managing primary headache disorders can help reduce frequency of attack and severity with positive effect on physical symptoms and functional capacity. Paracetamol (acetaminophen) is a safe analgesic with good gastrointestinal tolerance and is first line option. Caffeine's anti-nociception enhancing effect when given with acetaminophen significantly improves efficacy over use of paracetamol alone. Ninety percent of headaches seen in practice are due to a primary headache disorder where there are no confirmatory tests, and neuroimaging studies, if done, are normal. In this review use of a logarithm is suggested that makes first an emphasis on the recognition of red flags that help in the identification of secondary headaches, referral or management and expects establishing good referral mechanisms in the health system. This also emphasises most importantly a good history taking that allows the physician to recognize a pattern that in turn leads to the correct diagnosis for better management. A comprehensive history needs time, interest, focus and establishment of rapport with the patient. When to ask what question to elicit which information, is an art that is acquired by practice and improves with experience. Methods & Materials:This review is based on eight case studies of various types of headaches, and literature review and a logarithm suggested by