The Agony of the Headache

Oh, is my head killing me!  Headaches are among the most common medical complaints. They can range from a mild annoyance to an incapacitating attack and, although most headaches are not associated with a serious illness, on occasion they are the warning of a serious or even deadly condition.

The "primary" headache types include tension, migraine and cluster varieties. These are called primary because the headaches themselves are the problem—as opposed to being a symptom of an underlying disorder.  In the latter case, such "secondary" headaches may be from a number of conditions ranging from glaucoma to infections to strokes to tumors.

The most common condition is tension headache, although its relation to muscle or psychological tension is not 100%.  These headaches tend to be bilateral (cause pain on both sides of the head) and have a waxing/waning course. There are no associated symptoms such as nausea, vomiting or fever. Migraine headaches will last 4-72 hours and are unilateral two-thirds of the time. They tend to build up gradually until reaching an intense level, and patients usually prefer to stop their activity and rest in a dark, quiet room.  Associated symptoms include nausea, vomiting, sensitivity to light and sound and, occasionally, a pre-headache "aura" (visual or other symptoms).  Finally, cluster headaches are always unilateral and affect the area around the eye and the temple. The pain builds up quickly, is excruciating, and lasts 30 minutes-3 hours. Patients often experience tearing of the eye, a runny nose and sweating.

It is very important to be aware of danger signs that may point to conditions which require urgent consultation with your primary care physician.

These include:

•  Sudden onset of a new, severe headache in which intense pain is reached within a few seconds or minutes
• Neurological symptoms such as slurred speech, hand or leg weakness
• A change in mental status or level of consciousness
• Fever associated with a stiff neck
• A new headache in a patient with known cancer, HIV infection or pregnancy

One area of great concern for patients is whether they should have a CT or an MRI as part of the evaluation of a headache.  Most patients with the above warning signs will need one of these studies; without those signs it is best to consult with your physician to get advice.

For an appointment with a NuHealth neurologist who specializes in headaches please call 516-572-6262.