Why Does My Head Hurt? Trivia Quiz

Answer: Sinusitis

Sinusitis is an inflammatory condition affecting the paranasal sinuses, which are spaces in the bones surrounding the nose. The feeling of pressure in the face is due to a build-up of fluid in these spaces, and it usually increases when the person bends over or lies down. If the maxillary sinus, in the cheeks, is affected nerves to the upper teeth can become irritated, causing pain in those teeth. Sinus headaches, as opposed to migraines, with which they are often confused, are usually accompanied by thick mucus from a congested nose.

Sinusitis can be categorized depending on how long the patient has had symptoms: acute, which can last a few weeks and is usually caused by a respiratory infection; recurrent, defined as four or more incidents of acute sinusitis within a year; chronic, which lasts for more than 12 weeks; and subacute, which is in between acute and chronic, lasting from four to twelve weeks. Patients with chronic sinusitis may also experience various exacerbations in their symptoms.

Answer: Epidural hematoma

An epidural hematoma has a mortality of around one in five. It is most often caused by a blow to the side of the head, which ruptures the middle meningeal artery, a vessel running close under the temple, which then bleeds over the dura mater covering the brain. As bleeding continues, pressure within the head increases and the brain is squashed into a smaller and smaller space. Eventually, without treatment, the brain can herniate through the foramen magnum, the hole in the back of the skull.

Although a lucid interval usually means a better prognosis than those who do not regain consciousness following the blow, it can be problematic as patients often think they feel well enough not to seek medical attention. As it is an arterial bleed, death can result as soon as six to eight hours following the impact; symptoms will present rapidly toward this end stage as the blood accumulates: as the blood fills the space on top of the dura mater, it is torn away from the inside of the skull, resulting in an agonizing headache. As the brain matter is further compacted, the brainstem becomes affected, giving symptoms that appear like drunkenness, such as slurred speech, loss of co-ordination, aggressiveness, and finally respiratory arrest.

So, even if you feel fine, it's probably a good idea to seek medical attention if you receive a heavy blow to the head, particularly to the temple!

Answer: Trigeminal

Trigeminal neuralgia (TN) is also called Fothergill's disease, after John Fothergill, the physician who first described it. TN usually occurs in older people, often over the age of fifty, and is difficult to treat. The trigeminal nerve has three branches: ophthalmic, maxillary, and mandibular; TN mostly affects the latter two, but can affect all three branches, resulting in symptoms more or less across the whole face.

The pain experienced in TN is neuropathic pain, meaning it originates from damage to nervous tissue and is difficult to combat, as normal analgesics tend not to improve it. The main method of managing the condition is by the use of medications, particularly anticonvulsants like carbamazepine and gabapentin, which have an effect on neuropathic pain. If taken with gabapentin, strong opiates can also make an improvement in pain levels. Surgical intervention is not as effective, and is usually a last resort step for those whom medication has not sufficiently helped. The most effective surgical procedure is microvascular decompression, which involves releasing the pressure on the nerve caused by a blood vessel constricting it.

Answer: True

More properly called chronic traumatic encephalopathy (CTE), dementia pugilistica is a disease caused by multiple head injuries over a lifetime, and is most often found in professional athletes such as boxers, American footballers, ice hockey players, and so on. It is named from the Latin word "pugil", meaning "boxer", in whom the condition was first discovered. It also occurs among many military personnel. As well as concussive blows, sub-concussive blows (i.e. those not severe enough to cause concussion) can contribute to CTE, and so athletes must take caution even if they do not receive many full concussions.

CTE can only be explicitly diagnosed after death, as the damage caused by concussions cannot be seen in scanning. Symptoms range widely, from effects on mood to dementia-related symptoms such as confusion and memory loss. Patients can also suffer tremors, and thus drugs used to treat Parkinsonism are often used, as are those to treat Alzheimer's. This condition has increased strong medical opinion that professional boxing should be banned.

Answer: Mouth ulcers (or canker sores)

Aphthous stomatitis is characterized by the recurrence of ulcers (or aphthae) in various areas of the mouth. They usually occur in the non-keratinizing mucosa of the mouth and only more rarely in the keratinizing surfaces, e.g. the attached gingiva and the hard palate. The condition is benign and not contagious and can affect up to 1 in 5 people during their lifetime.

Most patients have recurring cycles of ulceration every few months, with ulcers lasting a week or two. These, although painful, are usually mostly an inconvenience to eating and drinking, and soon heal. However, some patients experience severe ulceration, with no ulcer-free stages as each recurrence comes before the previous batch of ulcers has healed. In such cases, eating and drinking may become impossible to the point of severe malnutrition.

The exact causes are unknown. The T cells of the immune system are involved at each stage, and the condition often co-occurs with autoimmune diseases, but aphthous stomatitis itself does not behave like an autoimmune disease. Treatment generally involves topical agents, such as analgesic and antiseptic gels. In the more severe cases, anti-inflammatory medication can be taken.

Answer: Mastoiditis

Otitis media is inflammation of the middle ear, and if left untreated, it can spread into the air cells of the mastoid process, the lump of bone behind the ear. The area around the mastoid becomes tender and swollen, and the ear can become painful and leak discharge. Patients can also become feverish.

Mastoiditis can be prevented by seeking prompt medical attention for ear infections, but if an infection does develop into mastoiditis, treatment usually consists of antibiotics and a tube in the ear to drain the fluid. In severe cases, that don't respond to these treatments, sometimes a portion of the mastoid bone itself is removed to clear the infection.

The possible complications arise because of the proximity of the mastoid air cells to surrounding structures, including the inner ear and the brain. It can lead to hearing loss as well as ringing in the ears, paralysis of the facial nerve, and Bezold's abscess, which is caused by pus leaking into the sternocleidomastoid muscle in the neck. If it spreads to the brain, then it can become fatal, causing conditions including meningitis, brain abscesses, and inflammation of brain vessels.

Answer: Migraine

Migraine, derived from the Greek "hemikrania" ("half-skull"), is a headache disorder accompanied by various symptoms arising from the autonomic nervous system. Symptoms can vary quite widely between individuals, with some experiencing an aura phase while others don't, and some experiencing autonomic symptoms without headache (an acephalgic migraine).

A migraine attack can last anywhere from a few hours to a few days. There are four main phases, although not every patient experiences all of them. First is the prodrome, which generally has symptoms such as irritability and altered mood. This is followed by the aura phase, which is fairly characteristic of migraine; patients experience visual disturbances, such as blurring in the center of their vision or the loss of one half of the visual field. Some also experience sensory auras, such as pins-and-needles, a loss of proprioception (sense of the position of the limbs), and sometimes auditory hallucinations.

The best known phase comes next, the pain phase, where the patient experiences a severe headache, often accompanied by sensitivities to light, sound, and smells, as well as nausea and sometimes vomiting. Postdrome occurs after the pain has passed, often leaving sufferers feeling hungover, exhausted, and often depressed or euphoric.

The main treatments for migraine are trigger avoidance and medications, including analgesics, anti-nausea and anti-emetic pills. However, using medication frequently to combat headaches can paradoxically make the headaches worse in the long-term and so caution must be exercised.

Answer: False

Meningitis is the inflammation of the coverings of the brain, called the meninges. The most common symptoms are headache and nuchal rigidity (stiff neck), along with photophobia (aversion to light) and phonophobia (sensitivity to sound). Symptoms in small children and babies can be less specific, such as drowsiness and irritation. They can also become floppy, and the fontanelle (the soft spot on the head) can be seen to swell or bulge.

Viral meningitis is often mild and self-resolving. Most patients can recover at home, treating the symptoms such as pain and nausea. The most common cause of viral meningitis is enterovirus infection. Antibiotics are ineffective against viral meningitis, as they only work on bacterial infections. Most cases of meningitis are caused by viruses.

In sharp contrast, bacterial meningitis will almost certainly kill the patient if left untreated. It is usually caused by Streptococcus pneumoniae, causing pneumococcal meningitis. First-line treatment is usually empiric antibiotics, which attack a wide range of bacteria, before diagnosing the specific strain of bacteria and varying treatment accordingly. Pneumococcal meningitis can progress to septicemia, resulting in amputation of gangrenous limbs. With treatment, most people survive.

Answer: Muscles of mastication

The muscles of mastication are those that allow us to chew. Because they are attached to the jaw, they are affected by temporomandibular joint dysfunction. Palpating these muscles can be painful, and other issues such as teeth grinding can increase myofascial pain. The main muscles of mastication are the masseter, temporalis, and medial and lateral pterygoids.

As well as muscular pain, TMJD can result in pain from the joint itself; degenerative and arthritic changes can increase pain and lead to various sounds coming from the joint such as cracking, popping, or grating.

Treatment for TMJD includes the use of occlusal splints, which tend to be worn at night to combat bruxism (teeth grinding), various medications such an analgesics, muscle relaxants, and NSAIDs, and surgery only very rarely. The condition mostly affects healthy individuals between the ages of 20 and 40, and does not always progress to arthritic disease.

Answer: Eyelid

The root "blepharo" is derived from Ancient Greek "blepharon" and refers to the eyelid. Most cases of blepharitis don't result in pain, but in more severe cases, painful symptoms can develop; the main symptoms of the condition are red and flaky eyelids, crusting, and a feeling of grit or sand in the eye. The follicles of the eyelashes or the oil glands (tarsal or Meibomian glands) may become blocked and infected; the blocking of the Meibomian glands causes a cyst called a chalazion to develop. In chronic cases, ulcers can become severe enough to bleed.

Fortunately, blepharitis rarely affects vision. Sometimes blurry vision can develop due to a poor tear film. Patients who wear contact lenses often find that the lenses exacerbate the symptoms of blepharitis and increase irritation. Treatment mainly consists of thoroughly cleaning the eyelids each day and removing any crust that has developed. In more severe cases, or those caused by Staphylococcus, antibiotics are used.