Headaches

Cephalgia or headache is pain on any part of the head. Headache is so common that almost everyone will get it at some point in his/her life. In fact, about half of the adult population reports getting a headache at least once a year. Sometimes, it is just a minor pain that can be ignored, but in other times, it can be so severe that it prevents an individual from functioning.

Types of headaches

There are two main types of headaches: primary headache and secondary headache.

Primary headache is the type of headache that cannot be attributed to any underlying disease. This type of headache just happens without any underlying reason. Examples of this type of headache are:

  • Migraine headache - This type of headache is characterized by moderate to severe, one-sided, throbbing pain that lasts for a few hours to 3 days. This is sometimes preceded by an aura or an abnormal perception of light or sound. It can be associated with nausea or vomiting. This type of headache is characteristically worse when exposed to loud sounds or bright light.
  • Tension headache - This type of headache is characterized by mild to moderate, dull, squeezing pain in the head that lasts for a few minutes to several hours. This is usually described like a headband or a helmet that gets progressively tighter and tighter. The pain is distributed and felt across the head.
  • Cluster headache - This type of headache is characterized by severe, sharp, stabbing pain that lasts for 30 minutes to 3 hours. The pain is usually felt on the temples or at the back of the eyes.  This is characteristically associated with tearing or runny nose.

Secondary headache is the type of headache that is due to an underlying medical condition. There are hundreds of possible causes of secondary headache ranging from the simplest colds or alcohol hangover to the more serious, life-threatening ones like brain tumor or aneurysms. Some of the serious causes of secondary headaches are:

  • Meningitis
  • Brain Tumor
  • Brain hemorrhage
  • Brain abscess

When to see the doctor

In general, most headaches resolve spontaneously and very few require a trip to the doctor. However, headaches with certain warning signs or red flags should be taken seriously and consulted with a doctor. These warning signs are:

  • Sudden and severe headache (thunderclap headache)
  • Progressively worsening headache not relieved by pain medications
  • Headache that wakes you up from sleep
  • New onset headache in someone older than 50 years old
  • Headache with fever
  • Headache with stiff neck
  • Headache with seizures
  • Headache with rash
  • Headache with numbness or weakness of an extremity
  • Headache with visual disturbances such as blurring
  • Headache during sexual intercourse
  • Headache after head injury especially associated with vomiting
  • Headache with fever (38°C or higher)
  • Headache with confusion
  • Headache associated with certain medical conditions, such as sickle cell disease, bleeding problems, immune system problems, genetic problems, heart problems, or cancer
  • Headaches >1 per month or age<3 in a child

Diagnosis

Diagnosis of primary headaches requires no special tests but history and physical exam alone. However, if the headache is suspected to be secondary to an underlying medical condition, then a doctor might request for some diagnostic tests to confirm his diagnosis. These might include:

  • Blood tests to rule out infection
  • Lumbar tap to check for brain or spinal infection
  • Brain CT Scan or Brain MRI to rule out brain tumor or hemorrhage

Treatment

The treatment of headaches depends on the type of headache and the underlying cause. Secondary headaches usually resolve with the improvement of the underlying medical condition. Primary headaches, on the other hand, resolve on their own even without treatment. This does not mean to say, however, that you should just endure and wait for your headache to go away spontaneously. Many analgesics (or painkillers) are available for headaches. Some can be bought over-the-counter (like acetaminophen and ibuprofen), and others need a doctor’s prescription (like tramadol and other stronger painkillers). Migraine medicines such as triptans may be used to prevent migraine if taken at the first sign of onset. For children, the dosage of these medications is dependent on weight, so a doctor’s advice might be beneficial. Aspirin, a common pain medication, should not be given to children because it can cause Reye’s syndrome. Reye’s syndrome is a rare but potentially fatal condition that is characterized by rashes, seizures and confusion due to the swelling of the brain and the liver.

Aside from medications, behavioral changes can also help manage the problem of headaches.

  • Most primary headaches have known triggers. Keeping a headache diary can help you identify and avoid the particular trigger of your headache. Tension headaches or muscle contraction headaches are usually stress related but triggers (also for migraines) might include stress, skipping meals or eating too little, certain foods or drinks such as red wines or cheeses, having too little or too much caffeine, alcohol, light, sounds and smells, and certain medications or activities.
  • Learning relaxation techniques can help you decrease the frequency of your headaches.
  • Get sufficient amount of sleep and rest.