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Headache is deservedly included in the top list of the most common medical problems. From year to year, neurologists and therapists note a steady flow of patients with this noted nuisance. According to statistics, more than 80% of the world's population is affected by the problem, 30% of whom experience recurring pain. In general, it doesn’t matter whether the pain is one-time or periodic – it has the ability to unsettle the most persistent person.
How do drugs work?
The main goal of pharmacology is to create easy-to-take medications with maximum effectiveness and minimal side effects. The ideal option is a medicine that acts locally and does not affect the rest of the body. To achieve this, different forms of drug release are needed in different cases.
To determine the correct functioning of a drug in pharmacology, there are two concepts: bioavailability and half-life.
Bioavailability is the amount of a substance that reaches its intended purpose. This process is hampered by the body's protective barriers. The selection of the dose for treatment and the method of administration depend on bioavailability.
The half-life is the time after which the level of the drug is reduced to half its original level and ceases to have an active effect on the body. It is this period that determines how many times a day you need to take the medicine.
Secondary reasons
This group of headaches is much more serious and dangerous, as it is associated with an underlying disease of a somatic nature or caused by a pathology of the nervous system. In any case, secondary headaches always have a cause. They are represented by the following pains:
- post-traumatic, arising in response to injury to the cervical spine or craniocerebral;
- vascular, manifested as a reaction to vascular pathologies of the head or neck;
- pain due to an intracranial problem of a non-vascular nature;
- caused by a number of infectious diseases (accompanied by fever, chills);
- arising in response to the use of certain medications or their sudden withdrawal;
- developing due to environmental variability;
- caused by pathologies of internal organs and systems.
Separately, it is worth noting symptomatic headaches, the cause of which lies in:
— structural changes in the cervical spine and skull;
- hearing and vision impairments;
— pathological conditions of the paranasal sinuses and nasal cavity;
- dental ailments and brain tumors.
Contacting a specialist should occur as soon as possible if:
- the first severe attack of hypertension, which is unbearable;
- headaches accompanied by increased temperature and impaired consciousness;
- the occurrence of seizures;
- increased headache after head injury.
It is also worth visiting a doctor if:
- episodes of headaches recur more than several times a week and require mandatory medication to relieve them;
- headache changes the usual character, frequency, and duration of attacks.
Why are the shapes different?
Initially, there were only two ways to deliver medicine to the body: swallowed or applied; other options were not available to doctors of the past.
But with the development of medicine, it has become clear that these options do not always work. When swallowed, the drug has a long journey to travel. Before getting to the right place, the tablet passes through the aggressive environment of the stomach. And after absorption, the substances enter the liver through the bloodstream, where toxins are neutralized and the medicine can become inactive before reaching the target organ.
Also, some drugs can negatively affect the functioning of the gastrointestinal tract. Cause nausea, vomiting or simply not work if the stomach or intestines are not in order and absorption is impaired.
“A classic example is when we changed a patient’s drug,” says GMS Clinic therapist Andrey Besedin, “during exacerbations of gastric ulcer, duodenal ulcer, or after surgery on the gastrointestinal tract. In this case, it is better to choose intramuscular or intravenous administration."
There are situations when it is necessary to administer medications intravenously. Most often this is due to urgency, but there are drugs that are destroyed in the gastrointestinal tract. For example, some antibiotics are available only in the form of injections, and in this case injections cannot be avoided.
“Any intramuscular, subcutaneous, intravenous injection is a small operation,” explains Andrey Besedin, “during which we violate the integrity of the body, skin, muscles, depending on what we do. Therefore, if possible, it is better to use tablets and capsules.”
There are medications that have serious effects on the entire body when taken in the form of tablets or injections. For such cases, local forms were invented. Thus, hormones in creams and nasal spray are useful for skin manifestations and allergic rhinitis, but the same hormones in large doses can cause serious consequences with long-term use of tablets or intravenous injections.
For children, medications are available in the form of chewable tablets, drops, or reduced-size tablets, so as not to turn every dose of medication into a battle or cause the association between treatment and pain. Unfortunately, this is not always possible, especially in children's hospitals.
“There are no unambiguous dogmas in medicine,” says Andrey Besedin, “in each situation we choose the type of drug administration individually, depending on what goals we want to achieve with a particular patient.”
What does the choice depend on?
The doctor determines the form of administration, relying not only on those drugs that are available. He pays attention to the patient’s age, gender, financial capabilities, and even his mood and attitude towards treatment. Children require special attention.
“Choosing the form of a drug is partly a creative process,” says Ekaterina Bokova, a therapist at the 120 to 80 clinic. “There are no ready-made solutions here. But most often we focus on age. If this is a very young baby, then we choose liquid or rectal forms to prevent spitting and choking. This way, the child will receive his dose of the active substance with a greater guarantee. Sometimes you even have to make a choice in favor of an injectable drug. In any case, a child should not be prescribed “adult” pills and divided into parts.”
The wishes of the patient or relatives also matter when choosing the form of the medicine. For older people, it is important to take fewer pills per day, otherwise you can get confused, especially if there are a lot of medications. In such cases, tablet holders or planners help.
“Unfortunately, older people usually insist on prescribing the most affordable drug,” says Ekaterina Bokova, “here, if possible, we will meet them halfway.”
How to choose the right form
Even medications with the same dosage form may differ from each other. For example, capsules and tablets.
“Capsules are more expensive due to the difference in technology,” explains Andrey Besedin. — They hide the unpleasant smell and taste of medications, unlike tablets. The capsules enter the body: the stomach, intestines and, when dissolved, release powder, which is absorbed much more quickly. But there is a factor that many of my patients do not like. The tablets can often be split in half or into quarters and sometimes half the dose is sufficient in an emergency. In the case of a capsule, this will not work, so the choice is made in favor of tablets.”
There are patients who are confident that injections and droppers are much healthier than tablets and specifically insist on this form of treatment. It is believed that in this case the medicine goes directly into the blood and will definitely work. Although this method of administration is more difficult, more painful and most often there is no difference in the result if the same medicine is in the form of tablets or ampoules.
“For example, patients ask for intramuscular or intravenous painkillers for headaches,” says Andrey Besedin. — This type of administration has no advantages compared to oral forms: powders, capsules, tablets, if the patient can take medications by mouth. As a rule, injections are effective if a person has a large loss of fluid or for some reason cannot drink on his own.”
Intravenous and intramuscular delivery methods are more useful in emergency cases of stomach or intestinal disease or in situations where a drug is broken down in the digestive tract, such as heparin or insulin.
Causes primary and secondary
A headache is not always a consequence of a serious illness, but specialist intervention and emergency assistance are often required. It is completely in vain that many people treat a problem of this kind as an absolutely normal phenomenon. The reason for this is ignorance. Surely only a few people know the true causes of headaches. Others habitually attribute their condition to changing weather, putting their health at risk.
To find out about the reasons for the development of headaches, let’s delve into the existing types and analyze each in more detail.
Primary reasons
Primary headaches (PHP) cannot indicate a specific disease, as they are associated with hyperactivity of pain sensory receptors located in the head area. Simply put, discomfort is caused by the chemical activity of brain cells, head and neck muscles, and blood vessels. Many people have a clear hereditary predisposition to the appearance of primary headaches. Let us examine the GBs belonging to this group in more detail.
Tension headaches
Returning to the question of what types of headaches there are, let’s remember their most common type – tension pain. It annoys men and women, regardless of age. Usually the nature of the pain is mild or moderate. The symptoms of tension headaches are probably familiar to many:
- nagging, dull pain;
- monotony of sensations;
- compression of the temples and noticeable tension in the forehead (less often around the entire head);
- increased sensitivity of the muscles of the neck, shoulder girdle and scalp;
- a feeling of discomfort that increases when doing household chores.
A tension headache develops in response to acute or chronic psycho-emotional stress, which is typical for almost every modern person (fatigue, anxiety, and irritability lie in wait for us everywhere).
In addition, tension headaches are also provoked by factors of everyday life: lifting heavy objects, being in an unventilated area, drinking alcohol, and strong winds. Tension headaches are often accompanied by weakness, insomnia, and emotional stress. It becomes difficult to remain calm when exposed to bright lights and unusually loud sounds.
Experts usually divide tension headaches into episodic, which lasts from 30 minutes to a month, and chronic, in which discomfort can haunt a person constantly, lasting for hours and days. The condition is debilitating and often leads to neurosis and depression. There is a way out - immediately contact a doctor.
Over time, episodic tension-type headaches can transform into chronic ones.
Migraine
With a migraine, the pain is throbbing and unbearable. Its occurrence can be observed in one area of the head (often it does not change). Migraines are accompanied by nausea and vomiting, photosensitivity and an unusual reaction to loud sounds. When walking, the pain noticeably intensifies.
Often, a migraine attack is preceded by a condition called migraine “aura” : visual disturbances occur in the form of flashes and flickering spots, speech disturbances and a sensitivity disorder in which a person feels numbness in the limbs and parts of the face. As a rule, the “aura” lasts from 20 minutes to an hour, and its manifestations are always the same.
The duration of a migraine attack ranges from several hours to several days. More often it affects women aged 25-35 years.
Despite the overly biased attitude towards migraine, it easily takes you out of your usual state for several days, making a person’s normal life impossible.
Factors that provoke the development of migraine are:
- Psychotraumatic conditions causing instability of vascular tone
- Drinking alcoholic beverages, Coca-Cola, tea and coffee
- Sleep disturbance
- Incorrect power supply
- Hormonal changes
- Excessive fatigue and frequent exercise
- Prolonged stay at altitude
- Adverse weather conditions
Migraine is rightly called a “capricious” disease . A little something is wrong, and it will definitely make itself known. People susceptible to migraines should be especially vigilant to avoid the onset of an attack, since it can sometimes be very difficult to relieve it.
Cluster headache
Another name for headache is cluster headache. The pain is very severe and is often localized in the area of one eye. The reasons for the development of pain of this kind have not been fully determined, but there is an assumption that hormonal imbalance, dilation of the carotid artery and irritation of the optic nerves are to blame.
Cluster headaches often make themselves felt at night. The attacks may continue for a couple of weeks or months, after which a period of remission begins. This type of pain, despite its severity, cannot be called a life-threatening condition. The frequency of attacks is reduced through properly selected medications.
As a rule, cluster headache occurs suddenly. Characterized by the following features:
- unilateral pain with swelling of the corresponding eye;
- lacrimation;
- discharge from the nasal passages on the “sick” side;
- paleness of the skin of the face;
- drooping eyelid on the “sick” side.
Just one attack of cluster headache should be a reason to contact a medical institution in order to exclude serious pathologies and select drug therapy.
More often, cluster headache affects men. Women encounter it much less often and, as a rule, after gynecological operations.
Headache due to neuralgia of the greater occipital nerve.
This pain is typical for osteochnodrosis of the cervical spine. The greater occipital nerve originates from the cervical plexus. The cervical plexus (plexus cervicalis) is formed from the anterior branches of the four upper cervical nerves (C1-C4), which are formed by three arcuate loops, located on the side of the transverse processes of the cervical vertebrae on the deep muscles of the neck. The branches extending from the cervical plexus are divided into cutaneous and muscular.
Cutaneous branches of the cervical plexus:
-n. occipitalis major (greater occipital nerve) - posterior branch of the II cervical nerve. Innervates the skin of the back of the head;
-n. occipitalis minor (C2-C3) (small occipital nerve) - emerges from under the posterior edge of the m.sternocleidomastoideus and is directed behind the auricle to the skin of the lateral region of the back of the head. Innervates the skin of the lateral region of the neck;
-n. auricularis magnus (C3) (great auricular nerve) - goes around the posterior edge of m. sternocleidomastoideus near its middle and goes up to the auricle, ending at the bottom of the latter, as well as to the skin in front and behind the auricle;
-n. transversus colli (C3) (transverse nerve of the neck) - departs, like the previous one. Innervates the skin above and below the hyoid bone;
-n. supraclaviculares (C3-C4) (supraclavicular nerves). Innervates the skin above and below the clavicle and the suprascapular region.
Neuralgia of the greater occipital nerve occurs with degenerative changes in the cervical spine and various complications of osteochondrosis.
The symptoms are similar to headaches and are often unilateral (differential diagnosis with migraine).
The primary group also includes other types of pain, namely:
- Idiopathic, which is often caused by migraine and occurs in the parietal region, eye area or temples
- Cold, which is localized in the frontal region and occurs under the influence of cold
- Radiating to the temporal region (results from a strong and prolonged cough)