Headaches: When to worry

Everybody has experienced some sort of headache during their daily life, sometimes it has just nagging discomfort but it may be so severe that it could disrupt your daily activities or make you home bound, not getting any interest in anything.

Tension-type headaches are the most common variety of headaches that we usually suffer from. It may be experienced as a tight band of pain around your head, a dull ache or pressure. It may cause mild to moderate pain on both sides of the head. It can be triggered by stress, neck strain, missed meals, depression, anxiety or lack of sleep. It may vary widely in frequency and can last from 30 minutes to a week. Most intermittent tension-type headaches are easily treated with over the counter medications like aspirin, paracetamol and Ibuprofen.

Medications combined with behaviour therapies may be more effective. In addition, alternative therapies aimed at stress reduction may help. They include meditation, relaxation training, cognitive behavioural therapy, biofeedback therapy, massage and gentle neck stretches and heat therapy (warm compress or shower).

Migraines affect three times more in young women than men. Migraines may cause pain that is moderate to severe and may pulsate. It may cause nausea, vomiting, or increased sensitivity to light or sound, may affect only one side of your head or may affect both sides of your head, worsen with daily activity, may last from 4 to 72 hours without treatment, it may occur with the women having oral contraceptive pill.

Migraine treatment is aimed at relieving symptoms and preventing additional attacks. If you know what triggers your migraines, avoiding those triggers and learning how to manage them may help prevent and lessen migraine pain. It cannot be cured but lessen your suffering. You can lessen migraine by: resting in a quiet, dark room; hot or cold compresses to your head or neck; massage and small amounts of caffeine; over the counter medications such as ibuprofen, paracetamol and aspirin; asking your doctor to prescribe some preventive medicine. Latest treatment is transcranial magnetic stimulation (therapy using electrical currents to stimulate nerve cells in the brain) for migraine with aura.

Cluster headaches occur on and off for weeks at a time over the course of a few months. These headaches are rare, but most often affect men and smokers. Cluster headaches begin and evolve quickly, becoming intense within minutes. It tends to develop at the same time of day or night. It usually affect one side of your head, often behind an eye. It may occur with tearing, redness or swelling of the eye on the affected side of the head, cause a runny or stuffy nose, typically last from 15 minutes to 3 hours and may cause agitation or a restless feeling. Talk to your doctor so they can arrange the relief as well as preventive therapy.

Medication-overuse headaches occur from overuse of pain relieving medications for headaches for at least three months. Taking pain medication several times per month can increase the risk of developing medication-overuse headaches. These headaches feel dull, achy, throbbing or pounding. It may be most painful when medication first wears off. It can occur daily or nearly daily and sometimes cause nausea, trouble concentrating or irritability. Typical treatment involves discontinuing the medications that cause these headaches. Sometimes medications need to be tapered off, and sometimes they are stopped altogether.

Seek emergency evaluation if you experience:

•             A very severe, sudden headache as it is worst headache you ever have

•             Headache after a head injury or fall

•             Fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking

•             Pain that worsens despite treatment

These symptoms suggest a more serious underlying condition, so it is important to get a prompt diagnosis and treatment. Immediately call your doctor, check your blood pressure and if possible go to the hospital without delay.

Almost everyone gets headaches, and most are nothing to worry about. But if headaches are disrupting your daily activities, work or personal life, it is time to take action. Headaches cannot always be prevented, but your doctor can help you manage the symptoms.

The writer is an Assistant Professor of Medicine at Z H Sikder Women's Medical College and Hospital, Dhaka.