Headaches: To Worry or Not

A headache is the second most common reason patients come to see a doctor after lower back pain. Most of us will encounter a headache debilitating enough to take a day off from work or school. About 30% of the adult population has chronic headaches that prevent them from doing their daily activities. The good news is if you have a headache, don’t stress too much as the chance of it being something bad is less than 5% 

So, now you have a headache, what should you do next? Well, it helps to know what kind of headache you have. I like to classify headaches as being migraines or not migraines. Migraines are caused because of vasodilation (blood vessels open or swell up) inside your head (but not inside your brain). They are often accompanied by something called an aura, which is an unpleasant sensation that precedes the migraine. An aura can be ringing in your ears, bright flashes in front of your ears, or an unpleasant smell sensation, etc. Although an aura is classically associated with a migraine, only a small percentage of patients have the classic aura. Most of them just have a headache. Migraine headaches are usually one-sided although again lots of patients have it on both sides, dull to a sharp sensation, and it will disable you enough to stop doing what you are doing. Think migraine if the light bothers you and going to a dark room lessens the headaches.

Non-migraines are the vast majority of other headaches that include cluster headaches, tension headaches, high blood pressure, low blood sugar, sinus infection, eye strain, tooth pain headaches, etc. If you have a headache at the end of the day, it's most likely a tension headache, if the headaches come for a few days a month or a few days in the year, they are so-called cluster headaches. If you are diabetic, a headache means time to check your blood sugars. Withdrawal headaches occur when you have stopped taking something like caffeine or alcohol or switched medicines. If you take a medicine called nitroglycerin for your heart, the most common side effect is headaches.

Tooth pain can cause headaches from irritating the facial nerve so can a bad sinus infection that’s usually worse when you gently press your sinus or move suddenly. Eye strain believe it or not can cause disabling headaches, especially in children who say they have a headache at school or the end of the day.

Ok, so enough of the medical jargon. You have a headache and need to know what to do next. Well, follow these steps:

1. The first thing to do is close your eyes, take a few deep breaths, and excuse yourself for a 15-minute break if you are working. Try to go to a quiet place in your office or home. Gently massage the area of the headache using your fingers over the affected area. If you have a pain balm or some essential oils, go ahead and use it over the affected area. 

2. If your headache has an aura, then it's a migraine. If it doesn’t but still fits the description of the migraines as described above, that is the cause. Caffeine is a good help for migraines as it constricts the blood vessels. I recommend you first try (acetaminophen) Tylenol or Aleve (Naproxen ) with some caffeine. This should help along with the first step. Within an hour of taking the medicines mild to moderate migraines should get better. Excedrin Migraine is also a good medicine to take. 

3. If your migraine headaches aren't going away (1-2 days), time for some medical help. A class of medicines called Triptans is very effective for migraines. They come in tablets, sprays, and injections. If you have a primary care doctor make sure you make an appointment and discuss a prescription for these medicines to keep handy. The vast majority of migraines will go away with these medicines. If you have frequent migraines, they will need to be prevented using different medicines that block the dilation of the blood vessels. 

4. So, if it doesn’t fit a migraine, it's something different. Relax, do the first step, and see how you feel. Now, here are some common non-migraine headaches and accompanying symptoms.

(a) Eye problems or eye strain is a very common problem causing headaches. I can say from personal experience that it's much more common than we all think and an eye test is a simple and effective way of excluding it. 

(b) Sinus headaches and toothache headaches are common and are caused by irritation of the facial tissues or nerves. Typically they feel more like pressure or throbbing headaches. Press gently on your sinuses and if you feel pain, it's your sinus. Next step, inhale some steam at home, use a Netti pot or a sinus spray, and the headache will go away. Note if you have a cough, fever, and headache, should see a doctor and get evaluated for bacterial sinusitis and get antibiotics for these. 

(c) High blood pressure can surely cause a headache is typically a dull throbbing type, check your BP and if it shows more than 180mmHg or so, then you have a hypertension headache. Seek your doctor to get medicines and bring it down.

(d) Tension headaches are the most common types of headache encountered, typically feel like a band across your head, but maybe only front or back. The best is to take some caffeine, Aleve, or acetaminophen, or try and take a quick nap. Daily tension headaches mean you need a new job.

Sleep deprivation is the most common cause of a tension headache, and usually happens if you haven’t had enough refreshing sleep for a day or two. The best treatment is to hit the sack for a good at least 6-8 hours of sleep.

(e) Cluster headaches typically don’t go away with your regular medicines. They need to be evaluated by your physicians and usually need a referral to see a neurologist for special medicines to help.

(f) If you are diabetic, take pills or injections for diabetes, and have a headache that is sharp or dull, check your sugar and take some sugar if it's low. If you are not diabetic and haven’t eaten for a while, you likely have a hypoglycemic headache, eat something and the headache will go away.

Most of the time, your headache will eventually go away within a few days. Unfortunately, life is not fair for all of us and some types of headaches have a more serious problem. Let's review them.

1. Headache in the morning with vomiting – these are seen in tumors of the brain and need urgent attention. These typically will last a few days to a few weeks. 

Note: Headaches after a few episodes of vomiting when you have a stomach problem are not an issue usually.

2. Dizziness and headache lasting a few days also are seen in inner ear problems, various tumors, or infections. These need to be checked out.

3. Pulsating headaches near the eye or otherwise need to be seen by your physician.

4. Headache after any head injury needs urgent evaluation.

5. Headaches with vision loss could mean a serious illness like temporal arteritis and needs immediate evaluation.

6. Strokes can sometimes manifest as headaches and weakness in the hands, legs, or face. These need to be urgently evaluated. 

So, that’s the end folks. I hope this helps you understand your headache better and treat it effectively. Please send me your thoughts and suggestions.