Do you have a migraine or a serious headache? What to do?
Most of us suffer from headache sometimes. It is therefore natural to think of headaches as innocuous and take pain killers occasionally and ignore them. In most cases, that would be OK. But headache should not be ignored if you also have the following symptoms:
Red flags in headache:
1.Headache starting in young children and older adults
Headache is a common problem starting from adolescence till most of productive life. In these age groups, most headaches fall in two types- tension type headache and migraines. But there are other types of headache or facial pains, which are rarer but more severe! In these cases, people usually seek doctors’ help. But if the onset happens in childhood or in 50s or 60s, one should seek doctor’s help early, because the headache can be a symptom of something serious
2.Thunder clap headache
It means a very serious headache, similar to a sudden thunder clap and quite unlike the regular tension headache that we get most commonly
3.Headache waking you up from sleep
This can mean a serious pathology and you are better off seeing a doctor
4. Vomiting before headache
It is common to get nausea or one or two episodes of vomiting after if you have had serious headache for some time, but if vomiting happens before or starts along with headache, go to the doctor
5. Fever, neck stiffness, altered alertness or behavior or weakness/paralysis of face or limbs
This can be due to a serious infection such as encephalitis or meningitis. Seek help urgently
6. Headache increasing in severity over days/months
If your headache is getting more and more severe and now has started to have a negative impact on your work or life
7. Headache along with reddening of eyes or pain in eyes or impaired vision
Serious eye conditions such as glaucoma can manifest as headache . Also some severe headache types, such as cluster headaches can cause reddening and watering of eyes. However, wanting to avoid light is a common feature of migraine
8. Headache associated or increased by bending forward, coughing or lifting something
This can be due to some serious conditions. Seek medical help soon
Even if you do not have these red flags, you should seek medical help if headache occurs often enough or last long enough or is severe enough to disrupt your work or quality of life. It is better than popping a headache pill too often, which can cause its own set of side effects
Common types of headaches: what are their characteristics
Migraine is the more worrisome ‘common’ type of headache and if not managed well can really trouble and wreck a person’s life.
- It is three times commoner in women than in men
- It is recurring type of throbbing headache typically described to affect one side of head. But in 50 % of cases it is not restricted to one side of head and it can be dull and aching instead of throbbing!
- The headache is associated with tendency to avoid light, sound and other stimuli.
- It can last for 4-72 hours and best is to abort an attack of migraine early by taking medication at the very start of an episode as once developed it i more difficult to control.
- Sever cases can have scalp tenderness, visual disturbances, episode of fainting altered consciousness,
and confusional state.
- Prodromes (a premonition of approaching headache) and Auras ( weird sensations) occur in about 25-40% of patients, usually just before, but sometimes after the headache.
- Migraines start typically during adolescence or puberty and wane after 50 years of age. But it can start later in life as well.
It is the commoner of the common headaches. It is described as a headache which although bothersome, does not cause disruption of work . The following are some characteristics of this headache:
- It feels like having a band around your head or pressing/tightening type of headache
- It can last for anywhere between half an hour to days
- There are no neurological or visual disturbances or any other significant disease
- Responds to simple painkillers, but consuming too many pain killers for too long can itself cause induce headache (especially the drug Indomethacin)
Headache secondary to other causes
- Chronic inflammation of para nasal sinuses can cause headache. There will be tenderness on pressing in the sinus area of face (at the root of nose, over the eyebrow, over the prominence of upper jaw). This especially happens with people who have nasal blockage or allergies
- Headache due to refractive errors of vision needing change in glasses
- Headache due to tooth problems
- Other serious causes of headache give rise to one or the other red flag mentioned above. These causes include infection, tumor, high blood pressure causing hemorrhage
What can you do to help your doctor control your headache
Maintain a headache diary
A headache diary can often be helpful in making the diagnosis; this is also helpful in assessing the
disability and the frequency of treatment for acute attacks. Record the following for a minimum of 8 weeks:
• Frequency, duration and severity of headaches
• Any associated symptoms
• All medications taken to relieve headaches
• Anything that precipitates the headache
• Relationship of headaches to menstruation
Looking at your headache diary your doctor will know what type of headache you most likely have. Also she will be able to decide whether to give you only drugs for episode or maintenance drugs as well
RESCUE steps to avoid migraine
- Remain calm and relaxed
- Escape from known triggers (bright light, fasting, exhaustion, too much caffeine)
- Stay away from stress or stressful situations
- Carry your migraine medications with you at all times
- Use medications early
- Eat well (avoid trigger foods), exercise and sleep on schedule.