Headache: When not to ignore it

Headache: When not to ignore it

Headache describes the pain felt in the head. In itself, it is not a disease but a symptom. It is one of the most common symptoms and although some headaches can be one of the manifestations of a serious underlying disease most are ordinary with no medical significance. It is also one of the most common reasons for consulting the GP or attending a neurology clinic.

Like many other common symptoms, it is quite easy to ignore headache when you shouldn’t or be alarmed when there is nothing serious. The information provided here will enable you to understand the nature of your headache and whether there is any reason for you to be concerned. There are numerous causes of headache; some are common while others are uncommon or rare.

Common causes of headache

Following are common causes:

• Migraine
• Tension-type headache
• Hypoglycaemia (low blood sugar)
• Sinusitis
• Eye strain
• Ear problems
• Jaw / teeth problems
• Systemic infection
• Dehydration
• Medication overuse
• Coming from the neck e.g. neck strain or neck arthritis
• Alcohol

Uncommon and rare causes

• Cluster Headache
• Meningitis / encephalitis
• Glaucoma
• Neuralgias and other causes of facial pain
• Subarachnoid haemorrhage and other intracranial bleed
• Cavernous sinus thrombosis
• Brain abscess
• Paget's Disease
• Temporal arteritis
• Severe hypertension
• Idiopathic benign intracranial hypertension
• Malignancy – Brain tumour
• Carbon monoxide poisoning
• Following head injury
  
  

Headaches that cannot be ignored

These are headaches that may indicate underlying serious disease. You must take immediate action by seeing your doctor if you notice the following:

• Sudden onset

Sudden explosive headache that feels ‘like a blow to the head’ indicates something serious going on. This is typical of a bleeding into the brain (sub-arachnoid haemorrhage).

• New, severe headache

 New and increasing headache on waking, increased by stooping or straining may indicate a raised intracranial pressure. Sufferer may have the following symptoms in addition to the headache:

• nausea
• vomiting
• drowsiness
• headache made worse by changing position, coughing, sneezing or laughing
• blackout, change in personality or memory

• Progressively worsening headache

Headache that is persistent and has progressively got worse over weeks / months may be caused by an intracranial lesion, for example, a brain tumour. Sufferer may also have the following symptoms:

• progressive neurological deficit, e.g. weakness in one limb, speech problems, visual or hearing problems.
• new-onset seizures / twitching
• mental / personality changes

• Onset of headaches in those over 50 years old

Headache occurring first time in someone over 50 years of age may be due to an inflammation of the arteries of the head (temporal arteritis). The headache tends to affect one side and patient may also feel pain when they press on side of their head or comb their hair. It should be noted, however, that some patients with temporal arteritis may not have pain on side of their head but have one sided headache when they chew. The latter symptom, known as jaw claudication is highly supportive of diagnosis of temporal arteritis.

• Altered level of consciousness

If in addition to your headache you feel drowsy or sleepy or a change of level of consciousness this will raise the suspicion of something serious and you must seek medical opinion immediately.

• Recent head injury

Headache, particularly when severe or progressive following trauma to the head must not be ignored as it may be due to bleeding into the brain. Note also, fracture of the skull may cause pain and tenderness in the fracture spot.

• Seizures (fits)

If you experience twitching, seizures (fits), consider your headache to be potentially serious.

• Meningism

Meningism is a term used to describe symptoms that resemble those of meningitis. A patient is said to demonstrate meningism when he has headache, neck stiffness and intolerance of bright light (photophobia).

• Tender temporal arteries

Tender scalp may indicate temporal arteritis.

• Pregnant woman in third trimester

Severe headache (usually frontal headache) in latter part of pregnancy may be one of the warning signs of impending eclampsia. Other signs include rapidly increasing blood pressure, visual problems, pain in top part of abdomen, facial itching.  

• Associated fever

Whilst it is common to have headache as part of symptoms of non-serious conditions such as common cold or flu, headache can be a symptom of more severe and potentially serious infection. Headache associated with a high fever should not be ignored.

Note

Most headaches are simple and they do not have any significant cause. However, it is often difficult to know which headache is significant and which headache can be ignored as there is often a considerable overlap.  Things are not always clear cut. The bottom line of it is: If you are concerned, see your doctor without any delay.