Headaches and their Significance

Most people get headaches. That can be due to stress, migraine, etc. We decided to find more information about headaches and consulted Dr P P Ashok (HOD Neurology – Hinduja Hospital, Mumbai) for the same.

What is a headache: The head has many structures that can be the source of pain which an individual experiences as a pain in the head and reports to a doctor as a headache.  Often any headache is interpreted as something serious affecting the brain. One must know that the pain can arise from the skin of the scalp, the thin muscles which cover the skull bone, the soft tissue structures like the nose, eyes, teeth and gums. Needless to say that the brain inside the skull can also cause pain, which of course becomes the more serious one to tackle and becomes an emergency.

Types of Headaches: One can broadly divide headaches into 2 types – primary headaches and secondary headaches.  The most common primary headaches are a migraine and a tension-type headache. Migraines are usually seen in young adults, often a strong family history of a similar headache. It occurs in about 10% of the young population. Typically, they are severe throbbing one sided headache associated with a blurring of vision and vomiting and lasts variable time from 30 minutes to even the whole day. During such time, the person can’t stand bright lights or high sounds. The frequency of these headaches again can be variable sometimes daily and sometimes in 3 months.

Tension headaches typically occur in middle ages. Typical story one hears is, “I am alright when I wake up in the morning after a good sleep and later on in the day due to the stress of work I slowly pick up a dull pain in my temples. By the time I reach home it becomes intense. This is because the scalp muscles become painful and need relaxation, either a muscle relaxant or some good sleep.

Secondary headaches are the ones that need urgent attention as some of them can be life threatening. Someone presenting with a sudden “never before” headache with or without loss of consciousness, we must suspect has a brain haemorrhage. On the other hand, a slowly progressive headache increasing over weeks or months raises a suspicion of some space occupying lesion inside the brain like a tumour. When headaches occur rapidly and associated with fever and drowsiness we have to suspect brain infection like meningitis, encephalitis (commonly referred as brain fever). All these situations need hospitalisation and relevant tests to be urgently carried out to treat logically based on test results.

Diagnostic Modalities: Any patient where a secondary headache is suspected needs appropriate tests. Patients with suspected haemorrhage will need minimum head CT scan or MRI. If he is young and not having high blood pressure then we need to do angiography of the brain vessels to see if there is a defect in the blood vessel like aneurysm or arteriovenous malformation. In both these situations, we need to operate on the brain so that we can prevent a fresh bleeding later on. This is apart from immediate treatment to reduce brain swelling.

In suspected tumours, it is best to go for an MRI (head) with contrast.

Brain fever suspects also need a CT scan but more specific is a lumbar puncture where we draw fluid from the spine to detect what infection is suspected, so that appropriate antibiotics can be given.

Treatments: Primary headaches like a migraine can be given abortive drugs for immediate relief. In frequent migraine attacks, we can administer preventive drugs that are safe. We need to avoid pain killers on a frequent basis as they can harm the kidneys in the long run. There are triggers that often cause a migraine to flare up, like chocolates, cheese, red wine, spicy or fermented food, etc. One has to identify the culprits and avoid those. A diary needs to be maintained by these patients so as to detect what causes their migraine.

A tension headache is a lifestyle story. Bad habits, lack of sleep or exercise, obesity, excess alcohol and cigarettes can all cause these headaches. Meditation, yoga, listening to soft music, avoiding too much TV or too much coffee can all go a long way to help.