Wednesday, July 20, 2016

When Headache Isn't Just A Headache.....

Headaches are common and almost everyone has had one during the lifetime. In majority of the people, headache is not a bad omen and occurs due to common conditions such as stress, fatigue, lack of sleep, hormonal changes, hunger, medications and changes in weather. The three most common types of headaches are tension, migraine and sinus.

Tension Headache: It is the most common type of headache wherein there is a feeling of a tight band around the head. the pain is mild to moderate and diffuse with a sensation of tightness around the forehead or on the sides and back. Unlike migraine, tension headache is not associated with visual disturbances, nausea or vomiting and is not aggravated by physical activity.

Migraine: It is usually a severe throbbing or pulsating pain, usually on one side of the head and commonly associated with nausea, vomiting and extreme sensitivity to light and sound. Warning symptoms (aura) such as flashes of light, blind spots, difficulty speaking, tingling on one side of the face, arm or leg can occur before the onset of headache. Prodromal symptoms may include constipation, mood changes, food cravings, neck stiffness, increased thirst and urination and frequent yawning. A migraine attack may last from a few hours to 3 days followed by the postdromal phase wherein confusion, moodiness, dizziness, weakness and sensitivity to light and sound may occur.

Sinus headache: This headache is caused by infection of the sinuses (sinusitis). The sinuses are small air spaces in the skull, found behind the nose, eyes and cheeks. They open out into the nose, allowing mucus and other secretions to drain and air to circulate normally. A sinus headache is a constant, throbbing pain felt in the face (around the eyes, cheeks and forehead), usually only on one side. It tends to be at its worst in the morning and may get better as the day progresses. 
The pain may also get worse when you move your head, strain or bend down, and when you experience extreme changes in temperature (such as going from a warm room into freezing air outside). It can also spread to your teeth, upper jaw and other parts of your head.

When should a person with headache be evaluated further?

  • Age - >40 years or <15 years at onset of new headache
  • First, worst or headache that is different from usual headache 
  • Progressive headache (over weeks)
  • Persistent headache precipitated by cough, sneeze, bending or exertion
  • Thunderclap headache (explosive onset)
  • Additional features - Atypical or prolonged aura (>1 hour) 
  • Aura occurring for the first time in woman on combined oral contraceptive 
  • New onset headache in a patient with a history of cancer or HIV
  • Red Eye or blurring of vision (Acute angle closure Glaucoma)
  • Concurrent systemic illness
  • Neurological signs
  • Seizures
  • Symptoms/signs of Giant Cell Arteritis (e.g. jaw claudication)