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Understanding Primary and Secondary Headaches: Causes and Management

We often suffer from headaches that bother us greatly and make us unable to carry out our daily lives normally. Doctors try to divide headaches into different categories, and the two main categories are primary headaches and secondary headaches. Primary headaches are headaches that have no other medical cause, and migraines and tension headaches are examples of these headaches. Secondary headaches have another underlying medical cause. Although primary headaches can be very debilitating and affect quality of life, they are usually not serious.
However, secondary headaches can be very serious, and management of the disease often varies greatly.

Brain anatomy

In order to understand high pressure and low pressure headaches, the basic anatomy of the brain must be understood.
The skull is basically a tight box with no flexibility. Inside the skull is the brain and the spinal cord that comes out from the bottom.
The brain is covered by a very dense fibrous sac called the meninges. Inside this sac (the meninges) there is a clear, colorless fluid called cerebral spinal fluid (CSF). Our cerebrospinal fluid is formed in the center of the brain, in an area called the ventricles, by the choroid plexus.
We have about 150 ml of cerebrospinal fluid floating around the brain and spinal cord, and the choroid plexus produces about half a liter a day. We also have an absorption system, which includes small granules at the top of the brain.
Our brain weighs about a kilogram and floats in cerebrospinal fluid, which performs an important function. If we focus on the brain itself and turn it upside down, we will find that there are a lot of important structures.
At the bottom of the brain are the vessels and nerves, and if we did not have fluid, and the brain did not float, all these structures could be compressed, and the brain itself would not feel any pain, but the meninges that cover the brain and the nerves and vessels are very sensitive.

Low pressure headache

Dizziness, tinnitus, and double vision are among the most prominent symptoms of low-pressure headaches (Source: Freepik)

Low-pressure headaches occur when there is not enough cerebrospinal fluid, not enough buoyancy to keep the brain afloat, and this usually occurs when cerebrospinal fluid is lost faster than it can be replaced.
In terms of symptoms, the classic symptoms you experience are: Headaches that are much worse when sitting or standing rather than lying down.
Sensitive structures located in the lower part of the brain can cause various symptoms as these nerves exit to the eyes and ears. As cerebral spinal fluid levels decrease, people can experience double vision, as well as dizziness and tinnitus. In very severe situations, confusion, decreased consciousness, or possible coma may occur.

Causes of low pressure headaches

There are a number of different causes that can lead to a low-pressure headache.
Trauma to the skull is one possible cause of this type of headache. A fracture in the bone also ruptures the sac that keeps the fluid in place. Patients with low-pressure headaches can also feel clear spinal fluid coming out of their ear or nose.
Sometimes, in order to diagnose certain neurological conditions, a sample of spinal fluid is needed. This sample is collected by injecting a needle between the spinous processes in the back. This injection creates a small hole, and there is a possibility that the hole will not close. When the hole does not close itself, fluid can leak out (but this is relatively rare). Doctors use a small needle in this procedure.
Another reason may come from the epidural, which is an area of ​​the brain that many women use to manage pain during labor, and the idea of ​​epidural anesthesia is that it gets very close to the dura and spinal fluid, but it does not cross that area.
Anesthesiologists are trained professionals who perform this procedure regularly, but sometimes they may go a little too far and puncture the dura. They have a much larger needle bore, so it makes a bigger hole, and people often have an annoying headache.
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Another less common cause of low blood pressure headache occurs in people who develop spontaneous leakage, which occurs from a tear in the meninges in the spine. This type of headache can be very sudden at first, but it may also have a gradual onset. The intensity of pain changes with movement of the body.
There are many different theories about what causes spontaneous cerebrospinal fluid leaks, and some doctors believe it could be the result of a small disc (disc) in the spine coming out and damaging the dura. Interestingly, about two-thirds of people with this type of problem have abnormal connective tissue. Connective tissue is the tissue that holds everything together, and is the structure between skin, fat, muscle and bone.
Some people suffer from hypermobility or abnormal joint flexibility, which is usually due to a difference in connective tissue, so people with abnormal connective tissue or hypermobility may be more susceptible to this type of tear.

Headache resulting from high pressure

Blood clot and hydrocephalus are among the causes of high-pressure headaches (Source: Freepik)

Regarding the causes of hypertensive headaches, there can be too much cerebrospinal fluid, which is called hydrocephalus.
Excess fluid may be caused by a blockage of the fluid that flows into the spinal cord. This can also occur after an injury, or it may be due to a congenital defect that a person is born with.
Reabsorption of cerebrospinal fluid can be affected by several factors. Infections, such as meningitis, may cause high-pressure headaches, and bleeding in the brain can also affect the reabsorption of fluid.
In these scenarios, cerebrospinal fluid production may be normal and healthy, but the brain is unable to absorb it to maintain homeostasis.
Another cause could be a blood clot in a vein. The arteries take oxygenated blood from the heart and deliver it to the brain. The veins then drain this fluid, and the veins help absorb and remove spinal fluid.
Just like deep vein thrombosis in the leg, people can also develop blood clots in the veins of the brain, and these clots are more common in women after childbirth, smokers, or those who use hormonal contraceptives. It is also more common in people with active cancer.
Another situation that can occur is when there is high pressure but there is no excess cerebrospinal fluid. This condition is referred to as idiopathic intracranial hypertension (IIH), which is a health condition that occurs more often in younger women and is usually… More common in overweight women.
Symptoms of IIH are often headaches and visual changes due to high blood pressure. It can also lead to pulsatile ringing in the ears. IIH must be diagnosed because if left untreated, it can cause permanent vision loss.
The cause of IIH is still not fully understood. Weight loss can help manage overweight people. There are medications that can be used to lower cerebrospinal fluid pressure, and if necessary a shunt can be surgically inserted to help reduce the pressure.
Health problems involving the brain such as a tumor, stroke, bleeding or inflammation can also lead to headaches and associated symptoms such as high blood pressure, which is why it is important that if someone experiences a new headache, they have a brain scan (usually an MRI).
You may also be interested in knowing the symptoms of a stroke.

*Source: Headache Australia

**Note from Sayidaty Net: Before applying this recipe or treatment, consult a specialist doctor.

2023-09-30 10:05:48

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