Thursday, February 02, 2012

Headaches… When to take them seriously

Courtesy - The Island By Dr. R. A. R. Perera

Although headaches are painful and annoying, the vast majority of headaches do not indicate a serious disorder. Tension headaches and migraine account 90% of all headaches. One approach in categorsing headaches is to distinguish ‘urgent headaches’ (those that may be life threatening) from others that may be ‘less urgent.’

‘Urgent’ headaches may be life threatening and should be treated promptly.

Patients typically describe a headache, which is related to a brain haemorrhage, as a sudden "thunderclap" headache; often the ‘worst headache’ of life. After this sudden onset, the pain may persist at a high or low intensity for days. Abnormal neurological symptoms may occur, including brief loss of consciousness at the onset of the headache and a stiff neck or eye-movement abnormalities.

Such a headache mandates prompt evaluation by a physician since a missed brain haemorrhage can result in a stroke or death. A scan of the brain and a spinal tap will show abnormalities and sometimes brain surgery is an essential part of treatment.

Headaches could be due to some inflammation of the medium sized arteries in people over 50 years. Chewing aggravates this headache and there are aches and pains all over the body. This could cause weakening and sometimes loss of vision. Medical treatment can reduce this type of headache.

Meningitis can cause headache with fever and a stiff neck. Medical management includes hospitalisation and treatment with antibiotics.

Though it is a fear for many headache sufferers, the brain tumors are uncommon. The most frequent presentation of a brain tumor is a seizure (a fit) and neurological abnormalities. Walking with a headache is said to be an important sign of a tumor-related headache, although this occurs frequently in chronic headaches. This can be diagnosed with a brain scan.

Another type of headache is called cluster headache. It is characterised by pain that is often situated behind one eye and usually the same eye with redness, tearing and nasal stuffiness. These headaches come very suddenly and without any warning and disappear in about one hour. It is often triggered by alcohol and this will awaken a person from sleep.

Sinus headaches typically occur with a cold and they are usually dull. It is worse in the morning and is localised to one specific area of the face or head.

The headache is made worse by coughing, sneezing, sudden movement of the head, cold weather and alcohol. A person with sinus headaches may have hay fever or allergies.

Eye-strain headache is associated with prolonged reading or staring at computer screen.

Hormonal headaches are related to menstrual cycle, menopause due to use of contraceptive tablets. This headache tends to diminish cyclically, or after menopause is completed or after hormone discontinuation.

Coital headaches occur around the time of intercourse and last from minutes to hours, and may be indistinguishable from a brain haemorrhage.

Post concussion headache includes confusion, dizziness, irritability, memory disturbances, headache and impaired concentration. Mild analgesics and reassurance is generally effective.

Another common type of headache is the migraine headache. A typical migraine headache is proceeded by an aura 9 blinking lights followed in 30-60 minutes by a throbbing, unilateral headache which lasts for 6-8 hours, Generally this is associated with nausea, vomiting and difficulty to see light. Certain foods, strong smell or the menstrual cycle can precipitate a migraine headache. Stress, alcohol or certain food (cheese, chocolate, etc.) can aggravate the pain in the headache. Identification and avoidance of precipitants may prevent attack. Migraine headache is due to dilatation of arteries in the head and cranial vasoconstrictor drugs, given as an injection or orally, is the general treatment.

Another common type of headache is the tension headaches. This headache is located in both sides of the head, and in the neck, and is precipitated by stress and usually occurs later in the day.

Tension headaches can last for weeks or months and the pain may fluctuate in severity. Cognitive therapy with simple painkillers generally cures this. But for some tension headaches, it may be necessary to treat as it is in a migraine headache.