We all get headaches sometime or the other in our lives! I remember my first episode of migraine which I got when I was in 7th grade. My mother rightly diagnosed me to have migraine (being from a family of doctors), gave me some paracetamol and had asked me to go to sleep. I got my eyes checked a few days later, started wearing prescription glasses and never had migraine again for several years. My father told me that only intelligent people got a migraine and that made me very proud of my headache as none of my other siblings had a migraine till then. Apart from Migraine, one can have a headache from many causes such as head injuries, cervical spondylosis, dental caries, sinusitis, high BP,depression, malocclusion and Temperomandibular joint dysfunction etc.

So when should you go to the doctor and hospital immediately?

What are the danger signs in headache?

1. The worst headache in your life or a “bolt out of the blue” type of a headache.

2. Headache associated with slurred speech, visual disturbance, weakness of limbs, inability to walk due to loss of balance, confusion or memory loss.

3. Headache that happens after weight lifting or sex.

4. Headache after a head injury (however mild especially in the elderly)

5. Headache with recurrent vomiting.

6. Headache that wakes you up from sleep or is the worst after waking up in the morning.

7. If you have a chronic headache but its character and severity has changed recently.

Headaches may be classified as primary or secondary to other illnesses. The primary headaches are Migraine, Tension type and Cluster headaches. So lets look at the classic presentation of the common headache syndromes.

Migraine – this headache is usually episodic (can last for a few hours to 3 days) , usually unilateral, throbbing or pulsation and often associated with nausea, vomiting, visual disturbances (aura) and inability to look at the bright lights and handle loud sounds. Sufferers would usually prefer to lie still with their eye closed as the headache could be made worse by movement. Migraines are often precipitated by certain foods (cheese, chocolate, Agina Moto – MSG) sleep deprivation, hunger and stress. Migraine could get much better after sleep and after vomiting. A variety of medicines are available for the treatment of Acute Migraine and prophylaxis (preventive) therapies are available if the patient has more than 2 attacks of migraine a month.

Tension type Headache– this headache usually affects the back of the head and usually in the evenings. It may be associated with scalp tenderness and may be provoked by emotional stress, fatigue,notice and glare. Treatment of anxiety and depression may be needed.

Headache due to Sinusitis – headache due to sinusitis may feel more like head heaviness. The sinus are air pockets in the skull bones that are lined by mucous producing membranes and they drain the mucous produced into the back of the nose. They exist to make the head feel lighter and to provide resonance to the voice. When the drainage passages of the sinuses are blocked, they fill up with mucous, bacteria migrate into the sinuses and the mucous changes colour to yellow. Typically patients have a constant dripping from the sinuses into the back of the throat and there may be tenderness over the affected sinus. Sometimes the headache gets worse on ending downwards.

Cluster headaches are not so common. The headache is severe, unilateral, behind the eye and associated with a blocked or a runny nose on the same side and a red tearing eye. The headache can occur in clusters, lasting 15min to 3 hrs, daily for several days together. They can happen at night and wake the person up from sleep and can have specific triggers like migraine. But in contrast to migraine, the headache is non-throbbing/pulsatile.

Headache due to cervical spondylosis – severe spondylosis affecting the upper cervical vertebrae can give a severe headache which affects the back of the head right upto the vertex ( the top of the head on looking down). Movements of the neck are painful and could be restricted with neck stiffness.

Headaches due to a brain tumour– brain tumours increase the pressure in the brain and cause pain by displacing the pain sensitive structures. The headache is worse on lying down, can wake the person up from sleep or worsen and peak on waking after a nights sleep. Sometimes the headache can worsen after coughing or sneezing. The headache may be associated by visual disturbances or loss of balance, loss of power in limbs, confusion and memory disturbances.

Other headaches occur acutely due to a cerebrovascular catastrophe like a subarachnoid bleeding where it is severe, associated with vomiting, visual disturbance and abnormalities of consciousness. Meningitis can also cause a headache with fever and neck stiffness (inability to bend neck forwards)

Headaches can also occur with high BP usually above a systolic value of 180mmHg. The headache could be quite variable in character as well as in severity.

So what must you do if you have a headache?

The first thing is to see if it has any danger signs. If yes, please go to the emergency department of a good hospital. If not, you could take a paracetamol tablet, go to sleep and fix an appointment to see you doctor the next day. Most headaches are curable and they just require the doctor to find the best medicine for its control or cure.

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