FAQ’s on Headache
What is a headache?
A headache is not a particular disease, but refers to the symptom of pain anywhere in the head or neck region. Headaches be caused by a number of different conditions. The description, location, and associated symptoms may give clues as to the underlying causes of the headache.
The brain itself lacks pain receptors and cannot perceive pain; what is felt as a headache is a disturbance in the pain-sensitive structures like the skull, the sinuses, muscles and other soft tissues.
If your headache has any of the following danger signs, seek medical attention ASAP.
- Sudden violent onset (i.e., “worst headache of your life”, 10/10 on the Visual Analog Scale)
- Progressively worsening headache over a 24 hour period
- Associated vision problems such as blurring of vision, partial or total loss of vision, or diplopia (double vision)
- Severe unilateral (one-sided) headache in one eye, redness in affected eye
- Slurred speech, weakness or difficulty moving arms or legs, loss of balance
- Confusion, loss of memory
- The headache follows trauma to the head
What causes headaches?
Headaches can be classified as primary or secondary headaches. Primary headaches include migraines, tension headaches, cluster headaches and other headaches with no directly attributable cause. Secondary headaches have a triggering event, such as trauma or whiplash injury, vascular malformations (aneurysms), or transient ischemic attacks (mild strokes).
How are headaches diagnosed?
The diagnosis of a chief complaint of headache is only made after a complete history and physical examination. The physician will ask questions describing the quality, frequency and severity of the pain, as well as associated or triggering factors. Additional imaging studies such as X-rays, Computerized Tomography (CT) scans and Magnetic Resonance Imaging (MRI) may be requested, but may not always be necessary.
Migraines present as moderate to severe pain, usually on one side of the head. It is usually described as a throbbing or pulsating pain, and there may be associated symptoms (or “aura”) that include sensitivity to light and noise, or nausea. These usually last for 3 – 4 hours. These occur periodically, and those who suffer from migraines can usually tell when an attack is imminent. An increased risk of ischemic heart disease (heart attacks) has been noted with young patients with migraines.
Cluster headaches are severe attacks of sharp stabbing pain, usually located near the eye or the temple, and can last from 30 minutes to 3 hours. These may be accompanied by teary eyes or a runny nose.
A tension headache is described as a mild to moderate pain, usually characterized as tightness or pressure across the head, with no associated aura. This can last anywhere from 30 minutes to 1 hour.
How are headaches treated?
The treatment of headaches will depend on the underlying cause of the symptom. Primary
headaches are usually treated symptomatically (when attacks occur). Analgesic medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or opioid analgesics may be prescribed to provide pain relief.
Novel treatments have also been explored in the treatment of primary headaches. Greater occipital nerve blocks have been shown to have positive benefits in patients suffering from cluster headaches. Recent studies have experimented with implantable neurostimulation devices to treat chronic migraine, and have been shown to relieve symptoms, although the complication rate remains high.
If the headache is a secondary headache, your physician will need to address the disease causing the headache in order to resolve the symptoms. However, your physician may also prescribe NSAIDs or opioid analgesics to provide temporary pain relief.
Freeman JA, Trentman TL. (2013). Clinical utility of implantable neurostimulation devices in the treatment of chronic migraine. Medical Devices (Auckland, N.Z.). Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/24348076
Lambru G, Abu Bakar N, Stahlhut L, et al. (2013). Greater occipital nerve blocks in chronic cluster headache: a prospective open-label study. European Journal of Neurology. doi: 10.1111/ene.12321
Wang YC, Lin CW, Ho YT, et al. (2014). Increased risk of ischemic heart disease in young patients with migraine: A population-based, propensity score-matched, longitudinal follow-up study. International Journal of Cardiology. doi: 10.1016/j.ijcard.2014.01.005