Headaches are one of the most common reasons for medical consult. While most cases are not life-threatening, some may have a serious underlying disorder. Headaches are classified as primary headache disorder if they are not due to another disease and secondary headache disorder if caused by another disease.
The most common types of primary headache disorders are tension-type headache (TTH) known by older terms – tension headache, stress headache, muscle-contraction headache, psychomyogenic headache, psychogenic headache; migraine headache; and cluster headache.
TTH is the most common headache in the general population. These are felt as tightness on both sides of the neck or the head. They are usually steady and non-throbbing, mild to moderate in intensity, and not worsened by activity. There is no associated nausea (the urge to vomit), vomiting, aura or sensitivity to light, motion, and noise.
TTH may occur less than one day a month (infrequent), one to 14 days a month (frequent episodic), or 15 or more days a month (chronic). The causes and treatment for these types of headache vary. They should not be simply attributed to stress or tension as the term connotes especially if the headaches become frequent or chronic. Both environmental and hereditary or genetic factors may play a role.
Migraine headache is made worse by noise, light, and motion. There may be associated nausea and vomiting. Women are affected more than men and most migraine headaches start during puberty or childbearing years. Headaches are more severe than TTH and may last for a few hours to three days. In some cases, there may be numbness and weakness.
Cluster headaches are less common but could be severe and associated with restlessness or agitation. The pain usually occurs suddenly, unlike in migraine headaches where an aura may occur before the headache. The headache is usually severe, continuous, and deep. Headaches may occur several times a day for weeks to months then followed by headache-free periods. Peak occurrence is at age 25 to 50 but the headaches may begin at any age.
What are the signs that a headache could be due to a serious illness? Immediate consult should be done if the following are present and these are considered medical emergencies:
The headache is severe and is associated with history of fever and stiff neck.There is associated history of syncope (passing out), change in sensorium, and change in behavior.
The headache occurs suddenly and is severe.
It is a new headache and is associated with numbness, weakness, or blurring of vision; and
The headache is associated with change in behavior, with seizure/s, syncope, or change in sensorium.
For headache types that do not require emergency care, your doctor will establish the cause and type of your headache based on history and physical examination and relevant basic tests. Not all headaches need procedures like X-rays, CT scan, or magnetic resonance imaging. Your doctor will also observe your response to lifestyle changes that he advised, simple initial medications that he prescribed, and the pattern of your headaches.
Further, work up is done if the headaches worsen. Do not respond to simple medications, as there is change in the pattern of headaches, or if there is a suspected underlying disorder. It is important to inform your physician of any history of trauma, use of medications, food types that trigger the headache, or co-morbid conditions. Self-medication and habitual intake of pain relievers is not advised since frequent intake of analgesics can itself lead to medication overuse headache.
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