Key role identified for nervous system in severe allergic shock

 A key feature of the severe allergic reaction known as anaphylaxis is an abrupt drop in blood pressure and body temperature, causing people to faint and, if untreated, potentially die.

That response has long been attributed to a sudden dilation and leakage of blood vessels. But in a study using mice, Duke Health researchers have found that this response, especially body temperature drop, requires an additional mechanism -- the nervous system.

Appearing online March 17 in the journal Science Immunology, the study could point to new targets for therapies to prevent or treat anaphylactic shock, which occurs in up to 5% of people in the U.S. annually in response to food allergies or bites from insects or venomous animals.

"This finding for the first time identifies the nervous system as a key player in the anaphylactic response," said senior author Soman Abraham, Ph.D., professor in the departments of Pathology, Immunology, and Molecular Genetics and Microbiology at Duke University School of Medicine.

"The sensory nerves involved in thermal regulation -- especially the nerves that sense high environmental temperatures -- send the brain a false signal during anaphylaxis that the body is exposed to high temperatures even though it is not the case," Abraham said. "This causes a rapid drop in body temperature as well as blood pressure."

Abraham and colleagues, including first author Chunjing "Evangeline" Bao, a Ph.D. candidate in Abraham's lab at Duke, tracked the sequence of events when allergens activate mast cells -- the immune cells that trigger the chemical reactions leading to swelling, difficulty breathing, itchiness, low blood pressure and hypothermia.

The researchers found that one of the chemicals mast cells unleash when they are activated is an enzyme that interacts with sensory neurons, notably those involved in the body's thermoregulatory neural network.

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When stimulated as part of an allergic reaction, this neural network gets the signal to immediately shut down the body's heat generators in the brown fat tissue, causing hypothermia. The activation of this network also causes a sudden drop in blood pressure.

The researchers validated their findings by showing that depriving mice of the specific mast cell enzyme protected them against hypothermia, whereas directly activating the heat sensing neurons in mice induced anaphylactic reactions such as hypothermia and hypotension.

"By demonstrating that the nervous system is a key player -- not just the immune cells -- we now have potential targets for prevention or therapy," Bao said. "This finding could also be important for other conditions, including septic shock, and we are undertaking those studies."

In addition to Bao and Abraham, study authors include Ouyang Chen, Huaxin Sheng, Jeffrey Zhang, Yikai Luo, Byron W. Hayes, Han Liang, Wolfgang Liedtke, and Ru-Rong Ji.

 sources : science daily

Clinical trial to help millions with penicillin allergies

 Penicillin allergy affects more than 25 million people in the United States (up to 1 in 10 Americans) and has been shown to lead to particularly poor health outcomes in pregnant women and surgical patients. It is also a public health threat, leading to antibiotic resistance and infections in hospitalized patients that can be life threatening.

Seventy-five% or more penicillin allergy labels come on by age 3 due to, for example, confusion with a viral rash. The majority of these rashes were never allergic, but the labels 'stick' into adulthood and carry many adverse consequences."

Many low-risk patients with a penicillin allergy were able to have their penicillin allergy label removed through a simple procedure known as "direct oral challenge" as part of a world-first multicenter randomized control trial known as the Penicillin Allergy Clinical Decision Rule (PALACE) study.

In the PALACE study, investigators randomized low-risk penicillin allergic patients to two different approaches to remove their allergy label. They either underwent the current standard of care to have skin testing followed if negative by oral challenge with a penicillin or they went straight to oral challenge ("direct oral challenge") without preceding skin testing.

"The majority of patients labeled as penicillin allergic, more than 90%, have low-risk histories, meaning they did not have a history to suggest a severe or more recent reaction to a penicillin," said PALACE study protocol member and Vanderbilt University Medical Center principal investigator Elizabeth Phillips, MD, the John Oates Professor of Clinical Research. "We would expect more than 95% of these patients to have negative testing and be able to take penicillin in the future."

The study, undertaken by a team of researchers from specialized centers in North America and Australia, enrolled 382 adults who were assessed using a specialized risk assessment tool called PEN-FAST. Participants were randomly assigned to receive either a direct oral penicillin challenge or the standard approach (penicillin skin testing followed by an oral challenge). The primary goal was to determine if the direct oral penicillin challenge was no worse than the standard method of skin testing followed by oral challenge which needs to be performed in an allergist's office.

Only one patient (0.5%) in each group experienced a positive reaction to the penicillin challenge, demonstrating that the direct oral penicillin challenge performs just as well as the standard method. Importantly, there were no significant differences in adverse events between the two groups, and no serious adverse events were reported.

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The findings have wide-ranging implications for patients. By accurately identifying low-risk penicillin allergy patients, health care providers can ensure appropriate antibiotic prescriptions. Patients with a documented penicillin allergy are more likely to be prescribed alternative antibiotics, known as second-line antibiotics, which are often not as effective against certain infections and may have more side effects.

"Patients with penicillin allergy are more likely to get second-line or broader spectrum antibiotics that lead to risk of antibiotic resistance and serious infections such as antibiotic-associated diarrhea due to Clostridioides difficile, which can spread through hospitals and become a major public health problem." Phillips said. "In the U.S. increasingly we also have a major problem with other antibiotic-resistant 'superbugs' such as multi-resistant gram-negative infections, Candida auris and even a resurgence of syphilis for which penicillin is the best treatment and the only treatment that should be used in pregnancy to prevent transmission to an unborn child.

"The evidence provided by the PALACE study will change clinical practice. Many patients in the United States do not have direct access to an allergist to provide specialized testing such as skin testing. Therefore, the ability to go to direct oral challenge with a penicillin in low-risk patients which can be carried out in any observed setting will make it easier for patients in the United States to access health care to safely and effectively remove the label of penicillin allergy," she said.

The PALACE study was led by Ana-Maria Copaescu, MD, PhD, McGill University Health Centre, Montréal, and senior author Jason Trubiano. PhD, Center for Antibiotic Allergy and Research, Department of Infectious Diseases at Austin Health. Cosby Stone, MD, assistant professor of Medicine in the Division of Allergy, Pulmonology, and Critical Care Medicine, was a co-investigator for VUMC.

sources : science daily

Blocking immune system 'messenger' may treat severe asthma

 Asthma is more dangerous than many people realize. An estimated 10 Americans die every day from asthma, and the disease leads to around 439,000 hospitalizations and 1.3 million emergency room trips each year.

"Asthma is one of the most important allergic diseases to study," says Professor Toshiaki Kawakami, M.D., Ph.D., a member of the Center for Autoimmunity and Inflammation at La Jolla Institute for Immunology (LJI).

In a new study, Kawakami and his colleagues at LJI investigated the molecular drivers of severe asthma and rhinovirus-induced asthma exacerbation (a type of asthma that can accompany a common cold). Their findings, published recently in The Journal of Allergy and Clinical Immunology, suggest people with both types of asthma may benefit from therapies that block interactions between a molecule called histamine-releasing factor (HRF) and antibodies called immunoglobulin E (IgE).

As Kawakami explains, many people with severe asthma aren't responsive to current asthma therapies. He hopes two potential drug strategies from his laboratory might inhibit HRF and IgE interactions and deliver relief for these patients. "We hope this approach can be a means of treating severe asthma and asthma exacerbation," he says.

The problem with histamine-releasing factor

Immune cells work as a team, and they secrete molecules to "talk" to each other. One of these molecular messengers is HRF, which is made by many types of cells, including lung epithelial cells and immune cells called macrophages. When a person encounters an allergen, these cells start churning out more HRF. The HRF then courses through the body and looks for special antibodies to bind to. HRF has several different kinds of antibody partners, however, and each interaction sends a different message to the surrounding immune cells.

Kawakami and his colleagues are working to understand how these HRF and antibody interactions drive dangerous allergic reactions. Over the last decade, the researchers have shown that HRF interactions with the IgE antibody drive harmful inflammation in mouse models of asthma.

 sources: sciecnce daily

Early peanut introduction gaining traction among US parents

 In 2017, the National Institutes of Health (NIH) announced a dramatic reversal in its approach to peanut-allergy prevention, recommending parents expose their infants as young as four months old to peanuts to prevent peanut allergy.

In the five years since, early introduction to peanuts has been gaining traction among U.S. parents and caregivers, but more work must be done to communicate the guidelines more broadly, especially to those with less access to health-related information, reports a new study from Northwestern University and the Ann & Robert H. Lurie Children's Hospital of Chicago. Among all surveyed parents and caregivers in the U.S., 13% of parents said they're aware of the guidelines and 48% believed feeding peanuts early prevented peanut allergy, despite knowing about the guidelines or not.

"There was general awareness of 'If I give these foods early, it will help,' even if families didn't know it came from the NIH guidelines," said Dr. Waheeda Samady, associate professor of pediatrics at Northwestern University Feinberg School of Medicineand director of clinical research at Northwestern's Center for Food Allergy and Asthma Research. "There's still a lot of room for growth in terms of educating families and clinicians about these guidelines."

The study found that having a pediatrician who recommended early peanut introduction was the strongest factor in whether a parent or caregiver was aware of the guidelines.

"This study is taking a look at something still so new to health systems in the U.S.," said senior author Dr. Ruchi Gupta, director for the Center for Food Allergy and Asthma Research, professor of pediatrics and a pediatrician at Lurie Children's Hospital. "As a pediatrician, I'm sensitive to the fact that there is a lot to juggle during a four- or six-month appointment. We need to find ways to support pediatricians in their workflows to incorporate the prevention guidelines."

The study is the first nationwide survey to examine the impact and implementation of the guidelines since their release five years ago. It will be published July 21 in Pediatrics.

The authors said the findings provide an understanding of where American parents land on peanut feeding and where the gaps are. This includes:

• Access to care barriers and systemic racism, which makes this information less known to non-white, less-educated and lower-income parents
• Supporting primary care providers to provide this information in a timely way
• Public health messaging about reactions to peanuts, since this was the main fear reported in the survey

A closer look at the findings:

 sources : science daily

Common origin behind major childhood allergies

 Several major childhood allergies may all stem from the community of bacteria living in our gut, according to a new study led by researchers at the University of British Columbia and BC Children's Hospital.

The research, published in Nature Communications, identifies gut microbiome features and early life influences that are associated with children developing any of four common allergies -- eczema, asthma, food allergy and/or hay fever. The findings could lead to methods of predicting whether a child will develop allergies, and ways to prevent them from developing at all.

"We're seeing more and more children and families seeking help at the emergency department due to allergies," said Dr. Stuart Turvey, professor in the department of pediatrics at UBC and an investigator at BC Children's Hospital Research Institute, and co-senior author on the study. "Hundreds of millions of children worldwide suffer from allergies, including one in three children in Canada, and it's important to understand why this is happening and how it can be prevented."

The study is one of the first to examine four distinct school-aged pediatric allergies at once. While these allergic diseases each have unique symptoms, the Turvey lab was curious whether they might have a common origin linked to the infant gut microbiota composition.

"These are technically different diagnoses, each with their own list of symptoms, so most researchers tend to study them individually," says Dr. Charisse Petersen, co-senior author on the paper and postdoctoral fellow in the Turvey lab. "But when you look at what is going wrong at a cellular level, they actually have a lot in common."

For the study, researchers examined clinical assessments from 1,115 children who were tracked from birth to age five. Roughly half of the children (523) had no evidence of allergies at any time, while more than half (592) were diagnosed with one or more allergic disorders by an expert physician. The researchers evaluated the children's microbiomes from stool samples collected at clinical visits at three months and one year of age.

The stool samples revealed a bacterial signature that was associated with the children developing any of the four allergies by five years of age. The bacterial signature is a hallmark of dysbiosis, or an imbalanced gut microbiota, that likely resulted in a compromised intestinal lining and an elevated inflammatory response within the gut.\

sources: science daily

Genetic biomarker may predict severity of food allergy Offers potential for determining the risk of severe reactions for patients and families with food allergies

 Researchers from Ann & Robert H. Lurie Children's Hospital of Chicago and colleagues reported for the first time that a genetic biomarker may be able to help predict the severity of food allergy reactions. Currently there is no reliable or readily available clinical biomarker that accurately distinguishes patients with food allergies who are at risk for severe life-threatening reactions versus more mild symptoms. Findings were published in the Journal of Allergy and Clinical Immunology.

Dr. Lang and colleagues found that the presence of an enzyme isoform called α-tryptase, which is encoded by the TPSAB1 gene, correlates with increased prevalence of anaphylaxis or severe reaction to food as compared to subjects without any α-tryptase.

"Determining whether or not a patient with food allergies has α-tryptase can easily be done in clinical practice using a commercially available test to perform genetic sequencing from cheek swabs," said lead author Abigail Lang, MD, MSc, attending physician and researcher at Lurie Children's and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "If the biomarker is detected, this may help us understand that the child is at a higher risk for a severe reaction or anaphylaxis from their food allergy and should use their epinephrine auto-injector if exposed to the allergen. Our findings also open the door to developing an entirely new treatment strategy for food allergies that would target or block α-tryptase. This is an exciting first step and more research is needed."

Tryptase is found mainly in mast cells, which are white blood cells that are part of the immune system. Mast cells become activated during allergic reactions. Increased TPSAB1 copy number which leads to increased α-tryptase is already known to be associated with severe reactions in adults with Hymenoptera venom allergy (or anaphylaxis following a bee sting).

Dr. Lang's study included 119 participants who underwent TPSAB1 genotyping, 82 from an observational food allergy cohort at the National Institute of Allergy and Infectious Diseases (NIAID) and 37 from a cohort of children who reacted to peanut oral food challenge at Lurie Children's.

"We need to validate our preliminary findings in a much larger study, but these initial results are promising," says Dr. Lang. "We also still need a better understanding of why and how α-tryptase makes food allergy reactions more severe in order to pursue this avenue for potential treatment."

Rajesh Kumar, MD, MSc, from Lurie Children's is the co-senior author on the study. Dr. Kumar is the Interim Division Head of Allergy and Immunology and Professor of Pediatrics at Northwestern University Feinberg School of Medicine.

This work was supported in part by the Midwest Allergy Research Institute (MARI) Food Allergy Pilot Research Award and NIAID-sponsored T32 grant AI083216. This project was funded in part with federal funds from the Division of Intramural Research of the National Institute of Allergy and Infectious Diseases, NIH. This project has also been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. 75N91019D00024.

 sources:science daily

Allergy study on 'wild' mice challenges the hygiene hypothesis

 The notion that some level of microbial exposure might reduce our risk of developing allergies has arisen over the last few decades and has been termed the hygiene hypothesis. Now, an article published in Science Immunology by researchers from Karolinska Institutet challenges this hypothesis by showing that mice with high infectious exposures from birth have the same, if not an even greater ability to develop allergic immune responses than 'clean' laboratory mice.

How microbes may prevent allergy has been a topic of great interest in recent times. Studies have suggested that certain infections might reduce the production of inflammatory antibodies to allergens and alter the behaviour of T cells involved in allergies. It has also been suggested that good bacteria in our intestines may be able to switch off inflammation in other parts of our body.

Robust allergic responses

Researchers have now compared the allergic immune response in 'dirty' wildling mice to those of typical clean laboratory mice. They found very little evidence that the antibody response was altered or that the function of T cells changed in a meaningful way. Nor did anti-inflammatory responses evoked by good gut bacteria appear to be capable of switching off the allergic immune response. On the contrary, wildling mice developed robust signs of pathological inflammation and allergic responses when exposed to allergens.

"This was a little unexpected but suggests that it's not as simple as saying, 'dirty lifestyles will stop allergies while clean lifestyles may set them off'. There are probably very specific contexts where this is true, but it is perhaps not a general rule," says Jonathan Coquet, co-author of the study and Associate Professor at the Department of Microbiology, Tumor and Cell Biology at Karolinska Institutet in Sweden.

More like the human immune system

The wildling mice are genetically identical to clean laboratory mice but are housed under seminatural conditions and have rich microbial exposures from birth

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"The immune systems of wildling mice better represent the human immune system and so we hope that they can bring us closer to the truth of how microbes act upon the body," says Jonathan Coquet.

The findings contribute to our general understanding of how allergies may arise and may also have clinical implications. In clinical trial settings, researchers and clinicians have recently made attempts to treat patients suffering from inflammatory diseases with experimental infections. For example, infecting people with worms or performing faecal transplantations has been proposed as a tool to combat inflammatory diseases. Newborns delivered through C-section, have had maternal faecal transplantation and bacterial supplementation with the aim of promoting good bacteria in the baby's gut and the child's future health.

sources: science daily

What different types of headaches are there?

 There are many different types and causes of headaches, such as migraine, tension-type, cluster, sinus, and hypnic headaches. Medication overuse can also lead to a headache when a person stops using pain relief or other drugs after using them for some time.

Headaches are a common complaint — the World Health Organization (WHO)Trusted Source estimates that almost half of all adults will have experienced at least one headache within the last year.

While they can sometimes be painful and debilitating, a person can treat most of them with simple pain relievers, and they will go away within several hours. However, repeated attacks or certain types of headaches could indicate a more serious health condition.

The International Classification of Headache Disorders defines more than 150 different types of headaches, which it divides into two main categories: primary and secondary.

A primary headache is not due to another condition — it is the condition itself. Examples include migraine and tension headaches. In contrast, a secondary headache has a separate underlying cause, such as a head injury or sudden caffeine withdrawal.

This article explores some of the most common types of headaches, along with their causes, treatment, prevention, and when to speak with a doctor.

1. Migraine

A headache with migraine often involves intense throbbing pain on one side of the head.

A person may experience a heightened sensitivity to light, sound, and smell. Nausea and vomiting are also common.

Around 25%Trusted Source of people with migraine experience an aura before the headache starts. These are visual and sensory disturbances that typically last 5–60 minutes and include:

• seeing zig-zagging lines, flickering lights, or spots
• partial loss of vision
• numbness
• tingling
• muscle weakness
• difficulty speaking or finding words

Be aware that aura symptoms could also indicate stroke or meningitis. Anyone experiencing these for the first time should seek immediate medical attention.

Migraine headaches tend to be recurrent, and each attack can last from a few hoursTrusted Source to several days. For many, it is a lifelong condition.

Health experts do not understand the causes of migraine fully. However, it often runs in families and is more common in people with certain preexisting conditions, such as depression and epilepsy.

Triggers of migraine could include:

• stress and anxiety
• sleep disruption
• hormonal changes
• skipping meals
• dehydration
• some foods and medications
• bright lights and loud noise

Treatment

Treatment will depend on various factors, including how severe the symptoms are, how often they occur, and whether the person experiences nausea and vomiting.

Treatment options includeTrusted Source:

• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, aspirin, or acetaminophen
• triptans, such as sumatriptan, which need a prescription
• antiemetics, such as metoclopramide, to manage nausea and vomiting

Neurostimulation techniques, such as transcranial magnetic stimulation, may also help.

A person can also ease attacks by:

• resting in a dark, quiet place
• placing an ice pack or a cold cloth on the forehead
• drinking water

People with chronic migraine should speak with a doctor about preventive treatment. A healthcare professional may diagnose chronic migraine if a person has an episode on more than 15 daysTrusted Source per month or if symptoms occur on at least 8 days a month for 3 months.

Drug options for migraine prevention include:

• topiramate (Topamax)
• propranolol
• amitriptyline

Other management choices to consider are dietary changes, stress management, and acupuncture.

2. Tension-type headache

Tension-type headaches affect most people at some time. They present as a dull, constant pain on both sides of the head. Other symptoms can include:

• tenderness of the face, head, neck, and shoulders
• a feeling of pressure behind the eyes
• sensitivity to light and sound

These headaches can last from 30 minutes to several hours.

What causes tension headaches is unclear, but stress, anxiety, and depression are common triggers. Other potential triggers include:

• dehydration
• loud noise
• lack of exercise
• insufficient quality sleep
• posture
• skipped meals
• eye strain

Treatment

Over-the-counter (OTC) painkillers, such as ibuprofen, acetaminophen, and aspirin, are usually very effective in stopping or reducing pain. Individuals experiencing headaches on more than 15 days per month over 90 days should consult a doctor.

Lifestyle changes and some treatments may help prevent tension headaches. These can include:

• getting enough sleep
• regular exercise and stretching
• improving sitting and standing posture
• having an eye test
• management of stress, anxiety, or depression
• acupuncture

• 3. Cluster headache

  Cluster headaches are severe and recurrent headaches. They are six times more likelyTrusted Source to affect males than females. People describe an intense burning or piercing pain behind or around one eye.

  Other symptoms can include:

  • watering eyes
  • swollen eyelid
  • a blocked or a runny nose
  • sensitivity to light and sound
  • restlessness or agitation

  Cluster headaches usually come on suddenly and without warning and last between 15 minutes and 3 hours. People can experience up to eight attacks a day.

  These attacks tend to occur in daily clusters and can persist for weeks or months. They also tend to start at consistent times, often a couple of hours after falling asleep at night.

  Any person experiencing these symptoms, which can sometimes resemble hay fever, should consult their doctor.

  The cause of cluster headaches is unclear, but they are more likely to occur in smokers. People should avoid alcohol during attack periods.

  Treatment

  Treatment aims to reduce the severity and frequency of the attacks. Options include:

  • oxygen therapy
  • sumatriptan
  • verapamil
  • steroids
  • melatonin
  • lithium

  Deep-brain stimulation and vagus nerve stimulation also show promise in treating cluster headaches that do not respond to medication.

  4. Exertional headache

  Exertional headaches are due to strenuous physical exercise, with the following triggers:

  • running
  • jumping
  • weight lifting
  • sexual intercourse
  • bouts of coughing or sneezing

  These headaches are usually very short-lived but can sometimes last up to 2 days. They present as a throbbing pain throughout the head and are more common in those with a family history of migraine.

  Individuals experiencing cluster headaches for the first time should see speak with a doctor, as they could be a sign of something serious.

  Treatment

  Treatment for exertional headaches includesTrusted Source using:

  • OTC pain relief
  • beta-blockers, such as propanolol
  • indomethacin

  Sometimes, exertional headaches may result from cardiovascular problems. If so, a doctor may recommend tests to check a person’s cardiovascular and cerebrovascular health.

  5. Hypnic headaches

  A hypnic headache is a rare condition that usually begins when people are in their 50s, but it can start sooner. People also refer to them as “alarm clock” headaches, and they wake individuals during the night.

  A hypnic headache consists of mild-to-moderate throbbing pain, usually in both sides of the head. It can last for up to 3 hours, while other symptoms may include nausea and sensitivity to light and sound.

  People can experience several attacks each week. The cause of hypnic headaches is not clear, and there are no known triggers.

  Although hypnic headaches are harmless, an older adult who experiences any unusual headaches for the first time should seek medical advice. A doctor may wish to rule out migraine and cluster headaches.

  Treatment

  Treatment options for hypnic headaches includeTrusted Source:

  • caffeine
  • indomethacin
  • lithium

  • 6. Medication-overuse headache

    A medication-overuse headache (MOH) — sometimes known as a rebound headache — is the most common type of secondary headache. A MOH features frequent or daily headaches with symptoms similar to those of tension headaches or migraine.

    These headaches initially respond to painkillers but then reoccur sometime later.

    A doctor may diagnose MOH if a person has a headache disorder and has also taken pain relief medication on at least 15 days in a month.

    Drugs that can cause MOH include:

    • opioids
    • acetaminophen
    • triptans, such as sumatriptan
    • NSAIDs, such as aspirin and ibuprofen

    A MOH can still occur despite taking these medications. However, a MOH mainly seems to develop in people taking painkillers specifically to treat a headache.

    Treatment

    The only treatment for MOH is to stop taking the medication causing the headaches. However, anyone stopping medication should only do so under the supervision of a doctor. The doctor can help devise a plan and may prescribe alternative medicines to ease the withdrawal process.

    After stopping the drug, a person is likely to experience:

    • worsened headaches
    • nausea and vomiting
    • increased heart rate
    • low blood pressure
    • sleep disturbance
    • restlessness, anxiety, and nervousness

    A doctor may prescribe medication, such as antiemetics, to help relieve these symptoms to manage nausea and vomiting. The symptoms usually last for 2–10 daysTrusted Source but can persist for up to 4 weeks.

    A doctor will advise on suitable pain relief medication to use after resolving a MOH.

    The following steps can help prevent MOH:

    • avoiding the use of codeine and opioids
    • limiting the use of pain relief medication for headaches
    • using preventive medications for a chronic migraine

    • 7. Sinus headaches

      Sinus headaches occur with sinusitis — an inflammation of the sinuses. It usually results from an infection or an allergy.

      The symptoms consist of a dull, throbbing ache around the eyes, cheeks, and forehead. The pain may worsen with movement or straining and can sometimes spread to the teeth and jaw.

      Other possible symptoms includeTrusted Source:

      • facial pressure or pain
      • reduced sense of smell
      • nasal discharge
      • a blocked nose
      • fever
      • fatigue
      • ear pain
      • bad breath
      • cough
      • dental pain
      • a general feeling of being unwell

      Sinus headaches are quite rare. If there are no nasal symptoms, a headache of this nature is more likely to be a migraine attack.

      Treatment

      Sinusitis usually goes away within 2–3 weeks.

      Treatment options include:

      • rest
      • drinking fluids
      • OTC pain relief
      • nasal decongestants
      • saltwater nasal sprays or solutions from the pharmacy
      • antihistamines
      • steroid nasal sprays, available on prescription
      • antibiotics, if a doctor finds there is a bacterial infection

      People should speak with a doctor if symptoms do not improve within a week or become severe.

      To diagnose the underlying cause of sinusitis, a doctor may refer an individual to an ear, nose, and throat specialist. In some cases, minor surgery may be necessary to drain the sinuses.

      Tips for preventing sinusitis include avoiding smoking and known triggers.

      8. Caffeine-related headaches

      A high caffeine intake — more than 400 milligrams (mg), or around 4 cups of coffee per day — can sometimes lead to headaches.

      In people consuming more than 200 mg of caffeine daily for over 2 weeks, withdrawal may result in migraine-like headaches. These typically develop 12–24 hours after stopping abruptly. They peak at 20–51 hours and can last 2–9 days.

      Other possible symptoms include:

      • tiredness
      • difficulty concentrating
      • reduced mood or irritability
      • nausea

      The effects of caffeine vary from person to person, but reducing intake could decrease the risk of getting headaches. Limiting caffeine consumption may help people who have chronic migraine.

      9. Head-injury headaches

      Sometimes, a person develops a headache immediately or soon after a head injury.

      OTC pain relief often resolves this. However, if symptoms are severe or get worse over time, an individual should seek immediate medical attention.

      Always call an ambulance for a serious head injury or if the following symptoms occur after a head injury:

      • unconsciousness
      • seizures
      • vomiting
      • memory loss
      • confusion
      • vision or hearing problems

      Post-traumatic headaches can also develop months after the original head injury, making them difficult to diagnose. They can sometimes occur daily and persist for up to 12 months.

      10. Menstrual headaches

      Headaches are often due to changes in hormone levels. Migraine may occur around menstruation from changes in estrogen levels.

      Hormone-related headaches often develop 2 days before or 3 days after a period or during ovulation. Symptoms are similar to migraine without aura, but they can last longer.

      Hormone-related headaches can also result from:

      • oral contraceptives
      • menopause
      • pregnancy

      Treatment

      Treatment for a menstrual headache is the same as the treatment for migraine without aura. Doctors can advise about possible preventive measures, such as:

      • hormonal therapy
      • taking a triptan or NSAID around the time of periods
      • alternative oral contraception plans, such as omitting the pill-free break
      • hormone replacement therapy for those undergoing menopause

      What is a menstrual migraine?

      11. Hangover headaches

      Consuming excessive alcohol can lead to a throbbing headache the following day or even later that day. These migraine-like headaches usually occur on both sides of the head and can worsen from movement.

      Someone with a hangover headache may also experience nausea and sensitivity to light.

      Treatment

      There are no cures for hangovers, but it is possible to relieve symptoms by drinking plenty of water and eating sugary foods. OTC painkillers may help reduce or stop the headache.

      Symptoms of hangovers tend to go away within 72 hours.

      Ways of reducing the risk of a hangover include:

      • drinking in moderation
      • not drinking on an empty stomach
      • drinking water between alcoholic beverages and before going to bed

    • When to speak with a doctor

      Headaches are a common problem, but most people can manage them with OTC pain relief, such as acetaminophen.

      However, anyone who experiences severe, persistent, recurrent, or worsening headaches should consult a doctor. An individual should seek immediate medical assistance if they haveTrusted Source a headache:

      • that starts suddenly and is extremely painful
      • following a significant blow to the head
      • with confusion or disturbed vision, balance, or speech
      • with numbness or weakness
      • with fever, seizures, or unconsciousness
      • with a stiff neck or rash
      • with persistent vomiting

      Children who have recurring headaches should also speak with a doctor as soon as possible.

      Summary

      Headaches can affect many people. Often, taking OTC pain relief, such as NSAIDs, will resolve them. However, in some cases, headaches may indicate a medical issue.

      Cluster, migraine, and medication-overuse headaches are all types of headaches that may benefit from medical help and possibly prescription medication.

      Anyone with concerns about persistent headaches should seek medical advice, as they can sometimes indicate an underlying disorder.

    • Source - Medical News Today