Headache is a very common disease. Common headache are due to migraine, tension headache, chronic daily headache, cluster headache. This is also due to increased blood pressure. Other causes of continuous headache are depression and persistent stress.
Treatment of headache depends on diagnosis. To diagnose it proper history taking and enquiry about work and associated stress is very important. Before starting treatment we must rule out medical cause of headache by investigations. For example dull, severe and continuous headache must be ruled out by brain radio investigation.
Headache is usually of two types primary and secondary. Primary headache is independent in nature and it could be episodic and continuous. Most common cause of episodic headache is migraine, cluster headache and tension headache. Continuous headache could be due to chronic daily headache and depression and stress.
Secondary headache is due to blood pressure, Tumour, post head injury and subarachnoid haemorrhage etc.
Depression is a state of mind in which person biological function like sleep, appetite and bowel habit are disturbed along with low energy lack of interest in work, surrounding and socialisation. It also leads to helplessness, hopelessness and worthlessness. In severe case person start thinking about suicide. Long standing depression may lead to social cut-off and loss of jobs as well.
In less educated people multiple somatic symptoms such as headache, body ache , gas formation , unexplained other symptoms , sleep disturbance , heaviness or lightheadedness are common symptoms . Educated or intelligent people will complain of lack energy, lack of charm or meaning in life, fatigued feeling, hopelessness and worthless feeling along with sleep disturbance and lack or increased appetite are usual symptoms.
Symptoms of depression can be classified into following groups.
(A) DEPRESSED MOOD- this is hallmark of all depression regardless of other associated symptoms. It is sustained emotional state that is characterised by sadness, low morale, misery, discouragement, hopelessness, emptiness, distress, pessimism etc. it is different in quantitative term as it is more intense than normal emotional response in bad situation.
(B) ANHEDONIA- is loss of interest. Patient is unable to draw pleasure from previously enjoyable activities. In severe cases they abandon most of the things they valued in life.
(c)COGNITIVE SYMPTOMS- difficulty in concentrating, negative thoughts, low self-esteem and self-confidence, suicidal idea are some most common cognitive symptoms. In severe case delusions of nihilism are also present.
(D) PSYCHOMOTOR DISTURBANCE - It can be aggression, agitation or retardation. Aggression is usually associated with irritability and restlessness. Retardation is associated with lack of initiative, mask like facial expression, emotional sluggishness and increased time to answer in response to question.
(E)VEGETATIVE SYMPTOMS - this is characterised by increased sleep or decreased sleep, increased appetite or decreased appetite, decreased libido and motivation.
(F) ANXIETY SYMPTOMS- are usually part of depression.
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