Causes and risk factors
CDH can be of two types – primary or secondary. In primary CDH, the cause is unknown. Some of the causes include chronic migraine, chronic tension type headache, new daily persistent headache, chronic cluster headache, hypnic headache, hemicrania headache. Secondary causes of CDH include medication related such as medicine overdose, side effects of medicine. Posttraumatic such as whiplash or neck injury. Disorders of intracranial pressure, structural problems like temporomandibular joint dysfunction, myofascial pain; neuralgias like trigeminal neuralgia; vascular causes such as subdural hematoma, ischemic or hemorrhagic stroke, venous thrombosis, hypertension; infection such as sinusitis or meningitis. Metabolic causes include obstructive sleep apnea, thyroid disease, etc. Refractory errors like myopia or hypermetropia can also cause CDH. The CDH is also classified as short lasting or long lasting depending upon the duration of headache. Risk factors include anxiety, depression, obesity, snoring, straining muscles of neck or back, sleep disturbances.
Clinical presentation
Clinical presentation depends upon the type of headache. Tension headache is the most common type of CHD and it is caused by tight muscles in the shoulders, neck, and scalp. It most often occurs in women above 20 years of age. Tension headaches are recurrent and last for several minutes to several days and it affects both sides of the head. Migraine is a severe type of headache which occurs with other symptoms like nausea, vomiting, and extreme sensitivity to light and sound or vision changes. It can cause intense throbbing or a pulsating pain in one area of the head. A few people with migraine have warning symptoms [aura], like flashes of light, blind spots, or tingling in the arm or leg before the actual headache begins. Cluster headache is sharp and very painful and can last for long, known as the ‘cluster period.’ Cluster headache occurs every day and often more than once a day. It affects one side of the head and can cause tears. New daily persistent headache are pressing and tightening on both sides of the head. They are accompanied by nausea and sensitivity to light and sound. Hemicrania is characterised by daily and continuous type of headache which is experienced only on one side. Accompanying symptoms include tearing, nasal congestion, and constriction of pupils.
Investigation
Medical history by the patient and clinical examination by the doctor helps in the diagnosis. Imaging studies such as MRI or CT scan of the brain is useful for further evaluation. Routine blood tests are recommended. Lumbar puncture may be advised.
Treatment
Treatment depends upon the underlying cause. Medications like analgesics or NSAIDs may help in relieving headache in the first few hours. Antidepressants, anti-seizure medications may be required. Home care such as taking rest in a quiet and dark room, avoiding dehydration by drinking water, covering head with a cool cloth, maintaining a headache diary to note down things that trigger headache, and stress reduction contributes further to the treatment.
Other Modes of treatment
The other modes of treatment can also be effective in treating CDH. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates is also found to be effective in treating CDH.
