Extracranial Headache - Types, Causes, and Treatment

What Is a Headache?

Every person experiences a headache at some point during a lifetime; headaches vary in intensity and duration according to the cause. Most headaches occur due to disturbances in the structures in and around the brain and the head; the structures responsible for headaches are present either in or around the skull. Based on this, the headaches can be classified as

Extracranial Headaches: Extracranial is caused by the dilation of the external blood vessels. This is mainly caused by fatigue or strain on the eyes or spinal problems.

Intracranial Headache: A headache that originates from dilation of the blood capillaries or due to suddenly increased blood flow to the brain is called an intracranial headache. Common causes of intracranial headaches are fever, meningitis, or high blood pressure.

What Are the Types of Headaches?

Some common types of headaches classified based on their cause are as follows:

• Tension Headache: Tension headaches are amongst the most commonly occurring types of headaches; as the name suggests, these headaches arise from tension, stress, anxiety, depression, or on overexertion. Patients with tension headaches often complain of having pain on both sides of the head (in the temporal region). The pain is usually not very severe and caused due to distension of the extracranial arteries or contraction of the head and neck muscles. The pain is commonly relieved by taking mild analgesics like aspirin. Rest is the key to pain relief in such patients; if complete rest is taken, these headaches subside on their own and do not require any visit to the physician.

• Cluster Headache: Cluster headaches are the most severe headaches commonly affecting males. The headache is called severe as the pain is severe, throbbing, and intense. The site of pain is usually around the eye (periorbital pain) and is unilateral. Cluster headaches are often experienced by the population between the ages of 20 to 60 years. People with cluster headaches have watery eyes, and the episode lasts around two hours and may have a frequent recurrence. The cause of cluster headaches is considered to be aggravated by alcohol consumption or stress.

• Migraine Headache: Migraine headaches are characterized to be caused by external stimuli. Patients with migraine headaches are often sensitive to loud noise, flickering DJ lights, and extreme cold. The pain can be aggravated by all or any one of these factors. The pain in patients with migraine is extreme and sometimes can be accompanied by nausea and vomiting. The condition is also aggravated by hormonal changes, like during menses. The migraine headache is commonly unilateral and lasts for about 12 to 24 hours and subsides on having medications. The pain in some patients is so severe that it becomes unbearable.

What Is an Extracranial Headache?

Extracranial headaches are caused by dilation and distension of the extracranial arteries supplying the head, tissues, and muscles around the neck and face. This type of headache is called An imploding headache, as a person feels something being banged on his head to compress the head. This type of headache is caused due to neck muscle pain due to long hours of sitting or visual aura due to watching screens and monitors for long hours. This type of headache differs from an intracranial headache by the type of pain, patients with intracranial headache experience pain that feels like the head would burst or blow out, which is the opposite of the pain of an extracranial headache.

What Are the Causes of Extracranial Headaches?

Extracranial headaches can be caused by any of the following:

• Stress.

• Excess fatigue.

• Neck problems are commonly due to long hours of sitting or improper posture.

• Eyestrain hematoma.

• Head and neck tissue damage.

• Edema.

What Are the Symptoms of Extracranial Headaches?

Some common symptoms presented by patients with extracranial headaches include

• Muscle tenderness in the head and neck region a few hours before the onset of the headache.

• Imploding headaches: the characteristic feature of extracranial headaches is the imploding headache; a person feels like his head is being compressed or hit upon by a hammer.

• Extracranial headaches originate from extracranial dilation of the blood vessels that supply the head and neck regions.

• Patients with extracranial headaches find relief in administering Onabotulinumtoxin A.

How Are Extracranial Headaches Diagnosed?

Headaches are diagnosed based on their clinical presentations and symptoms. Still, to confirm the diagnosis, a few medical tests are carried out, which even help confirm the origin of the headache, which are as follows:

• Erythrocyte Sedimentation Rate: A blood test used to detect inflammation

• Magnetic Resonance Imaging (MRI): MRI gives detailed image of the internal structures of the body.

• Computed Tomography (CT): This scan help detect injuries and diseases.

• Digital Subtraction Angiography: It is a non-invasive test or a test that is minimally invasive. This test is used to view the blood vessels in the brain by using iodine dye and an X-ray.

• Spinal Tap: This is the diagnostic test used to determine any abnormalities or infections in the brain which can be the probable cause for headaches.

How Are Extracranial Headaches Treated?

Extracranial headaches are mainly governed by external factors like overexertion, stress, or abnormal posture. Therefore the condition is mainly improved when the cause is treated. Apart from this, the treatment mainly depends on the type of headache. Therefore following are a few categories that help tailor the treatment in patients with extracranial headaches:

• Rescue: This includes analgesics and measures for instant relief of pain and discomfort.

• Prevention: In cases where the trigger is known, like in patients with migraine, trigger environments like loud noise and flickering lights should be avoided.

• Lifestyle Modification: Regular exercise and a healthy diet are recommended in cases with extracranial headaches, as muscle tenderness is the aggravating factor for the condition.

• Complementary Medicines: Medications like analgesics are given at first, but if the pain does not subside, medications like Onabotulinumtoxin A, a medication of choice in patients with extracranial headaches.

• Inpatient Care: Patients with chronic headaches who do not feel better even after practicing all the above methods must visit the doctor. The doctor can conduct a further diagnostic evaluation to find the cause of the headache.

Conclusion

Extracranial headaches are a type of headache that originates from the dilation of the blood vessels supplying the head and neck region. The main cause of this type of headache is stress, abnormal sitting posture, or muscle fatigue in the head and neck region. These headaches are diagnosed clinically based on symptoms and heal if the cause is removed.