Headaches: When to Worry, What to Do

  • February 25, 2020

The symptoms of a headache enable a doctor to ascertain its cause and the appropriate treatment. Most headaches do not indicate anything serious, but some may be due to a life-threatening condition that would require emergency care.

Headaches are generally classified by cause:

Primary headaches

Overactivity of or problems with pain-sensitive structures in the head cause primary headaches. It usually does not indicate an underlying disease. Chemical activities in the brain, nerves or blood vessels around the skull, or muscles of the head and neck (or a combination of these factors) can be a cause of primary headaches. Hereditary genes may also play a role in the cause of such headaches. The most common primary headaches are as follows:
  • Cluster headache
  • Migraine
  • Tension headache
A few headache patterns, having distinct features, are also generally considered types of less common primary headaches, and have an unusual duration or pain associated with a certain activity. They may or may not indicate an underlying disease. They include: Chronic daily headaches (for example, chronic migraine, and chronic tension-type headache), cough headaches, exercise headaches, and sex headaches Some lifestyle factors can also trigger a few primary headaches. These include the following: Red wine, certain foods, such as processed meats containing nitrates, changes in sleep or lack of sleep, poor posture, skipped meals, and stress.

Secondary headaches

A disease may trigger a secondary headache, which activates the pain-sensitive nerves of the head. Any number of conditions may cause secondary headaches, like sinusitis, blood clot, brain tumour, meningitis, hypertension, stroke, etc.

Some types of secondary headaches include the following:

  • External compression headaches: Resulting from pressure-causing headgear like tight helmets, head bands, goggles etc. More common in people who have migraine. Pain usually goes away within an hour of removing the tight object. It is usually a professional hazard in people who work in areas that require wearing of a helmet, periodic removal of the headgear can help in reducing the chance of headache. However, if the pain persists, a Doctor’s advice may be required.
  • Ice cream headaches (commonly called brain freeze): Brief stabbing headaches that occur when you drink or inhale something very cold, or your bare head is exposed to extreme cold. Usually have no long lasting effect.
  • Medication overuse headaches: Primarily caused by regular, long-term use of pain medication for conditions like Migraines. This is also called a rebound headache and usually stops when the pain medicines are discontinued. You will need to work with your Doctor to find a more permanent relief.
  • Sinus headaches: Results from inflammation and congestion in sinus cavities. Usually a throbbing sensation. Also may cause a feeling of pressure around the eyes, cheek and forehead. This normally subsides when the inflammation subsides and may not need any medication. However, it is advisable to consult a Doctor if the pain persists.
  • Spinal headaches: Caused by low pressure or volume of cerebrospinal fluid, possibly the result of spontaneous cerebrospinal fluid leak occurring post a spinal tap or lumbar puncture (a procedure used for the purpose of diagnosis or giving spinal anaesthesia), burst spinal cyst, or a skull/face injury. It is a severe headache that eases when you lie down. It usually heals by itself. Drinking plenty of fluids is recommended. Sometimes it may need an intervention by a Doctor.
  • Thunderclap headaches: A sudden, severe headache that is often described as ‘the worst headache of my life’. It usually is a sign of a serious, life-threatening condition like a bleed in the brain. It is advisable to immediately seek medical help.

A headache may be a symptom of serious conditions, such as strokes, meningitis or encephalitis.

Go to a hospital emergency if you’re experiencing the worst headache of your life, a sudden, severe headache or a headache accompanied by:

  • Confusion or trouble understanding speech
  • Fainting
  • High fever, greater than 102F to 104F
  • Weakness, numbness, or paralysis on just one side of the body
  • Stiff neck
  • Trouble seeing
  • Trouble speaking
  • Trouble walking
  • Vomiting or nausea (if not related to flu or hangover)

See a doctor if you experience headaches that:

  • Occur more often than usual
  • Are more severe than usual
  • Don’t improve or worsen with appropriate use of over-the-counter drugs
  • Prevents you from working, sleeping or carrying out normal activities

Your family doctor can help you treat headaches, but you may need a neurologist for more effective migraine relief or if your headaches cause pain on only one side of the head. If you suffer from persistent headaches and have additional symptoms, such as sore ears, blocked nose, or dental and/or pain, you may need to consult an ENT specialist.

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