Headache? Or Something More Serious?

If your head hurts, take comfort: "Headache is a universal human experience," says Richard B. Lipton, MD, director of the Montefiore Headache Center, Edwin S. Lowe Professor, vice chair of neurology, professor of epidemiology and population health, and professor of psychiatry and behavioral sciences at the Albert Einstein College of Medicine in Bronx, NY.

Headaches may be caused by a head injury, flu, hormonal changes, tension, or a hangover, but you may be most familiar with the kind that can't be attributed to any of these conditions—you just have an aching head. Most headaches fall into one of these categories:

• Tension-type headaches are very common. "These usually involve pressure on both sides of the head. Tension headaches are generally relieved by analgesics, or relaxation," says Lipton. Though the cause isn't known, these headaches can be long-lasting but don't typically include symptoms beyond head pain.
• Migraines may be characterized by a throbbing or pulsing pain on one side of the head, and are usually accompanied by nausea and/or sensitivity to light, sound, or odor. Many migraine patients require prescription medications to help relieve the worse symptoms.
• Cluster headaches tend to cause severe pain behind or around one eye. Attacks occur in close proximity, sometimes at the same time of day, for weeks or months, and may be followed by remissions lasting months. Cluster headaches typically last from 30 to 90 minutes. Common treatments include preventative daily medications (such as calcium channel blockers), and fast-acting treatments to shorten attacks, including injectable sumatriptan and oxygen.

"Headache is so common the challenge is determining which headaches need medical attention and, among those, which need attention from a specialist," Lipton admits.

Headache Red Flags

While many headaches respond well to over-the-counter treatments, in certain cases, "A headache can sometimes be a symptom of a serious ongoing or acute health problem," according to Lipton. If you experience any of the following "headache alarms," promptly call your doctor or go to the ER:

• The very sudden onset of a severe headache could suggest bleeding in the brain.
• A headache accompanied by a fever and stiff neck could indicate meningitis.
• The onset of a headache that's different than any other headache you've had, and you're over 55. This could be a symptom of a brain tumor, blood vessel inflammation, or neck problems.
• Progressive headaches, or headaches that were originally easy to treat but have become more frequent, severe, or don't subside with over-the-counter medicines. This could be a warning sign of a serious medical problem.
• New onset headache can be associated with cancer or HIV.
• A headache accompanied by these symptoms: fever, nausea, or vomiting that is not related to another illness; confusion, weakness, double vision, loss of consciousness or sensation, convulsions, shortness of breath, or weakness in any part of the body.
• Recurring headache in children.
• Headache following a head injury.
• Two or more headaches a week
• Headaches that interfere with your life. If your headaches are making work, study, or socializing difficult, see a doctor.

When it's Time to Consult a Specialist

In most cases, your internist or family doctor is the expert of choice for headache advice and relief. However, says Lipton, consult a neurologist or headache specialist if:

• Your primary care doctor doesn't know your diagnosis.
• The diagnosis you receive doesn't make sense to you.
• The therapy prescribed doesn't bring adequate relief after several attempts at treatment.
• You want to consider treatments not offered by your primary care doctors, such as trigger identification and avoidance, biofeedback (techniques to help adjust heart rate, lower blood pressure, and decrease muscle tension), injectable treatments, or stimulators (devices that stimulate nerves or the brain in order to relieve pain).

What You Can Do

Understand the source of your problem and help lessen headache frequency and severity by taking these steps:

• Keep a headache diary: Headache triggers are the prompts—often foods or circumstances—that initiate a headache. Avoiding headache triggers can help prevent headaches, but unfortunately, identifying these triggers can be tough: "Alcohol, particularly red wine, is the most universal trigger, but triggers vary from person to person," Lipton says. Keeping a detailed headache diary can shed light on the source and help you learn your own personal triggers. Lipton advises patients to make note of the circumstances, including the times, days, and foods eaten, in which headaches occur. If you are female, be mindful of any correlation between the onset of headaches and your menstrual cycle.
• Commit to a healthy lifestyle: "Eating regular meals, drinking enough water, getting sleep and physical exercise, managing stress, and avoiding known headache triggers—all these lifestyle management activities can help prevent or lessen headaches," says Lipton.

Richard B. Lipton, MD, reviewed this article.

Sources:

Richard B. Lipton, MD. Phone interview 13 January 2014.

National Institute of Neurological Disorders and Stroke. "Headache: Hope Through Research," Web. Last updated 8 November 2013. Accessed 10 January 2014. http://www.ninds.nih.gov/disorders/headache/detail_headache.htm#247013138