When is a Headache More Than a Headache?
By Tha Thomas U, M.D.
As featured in the Monday, July 6, 2009, issue of Inside Business.
Nearly all of us have had an occasional headache. We take an over-the-counter pain medication and the headache disappears. As universal as headaches are though, the symptoms are more complicated and unique than you might realize.
What hurts when you have a headache? The bones of the skull and tissues of the brain itself never hurt, because they lack pain-sensitive nerve fibers. Several areas of the head can hurt, including the network of nerves that extend over the scalp and certain nerves in the face, mouth and throat. Also sensitive to pain, because they contain delicate nerve fibers, are the muscles of the head and neck areas, and blood vessels found along the surface and at the base of the brain.
Types of Headaches
The headache types range from tension type to early symptoms associated with serious neurological conditions.
Episodic tension-type headaches occur randomly and are often the result of temporary stress, anxiety, fatigue or anger. It feels like a vice-like ache in your temples, head and neck. Chronic tension headaches are those that occur just about every day. The frequency of it distinguishes it from the episodic one. Each will lead you to go searching for aspirin or other non-prescription medications. A long walk, a good night’s sleep and relaxation methods may also bring relief for this type of headache.
The headache that can put your life on hold for a few hours to several days is a migraine headache. Prompted by biochemical changes in the brain, a migraine lead to a shift of blood flow provoking pain signals into the head and neck areas.
Migraine is a highly prevalent headache disorder that has a substantial impact on the individual, society and the family. The annual direct cost of treatment of migraine in the U.S. was estimated to be more than $ 1 billion, but the indirect costs are even greater. Those include the aggregate effects of migraine on productivity at work, at home and in other roles. The total cost of lost production time due to migraine in the U.S. work force is $20 billion per year and the total cost of lost productivity is about $13 billion per year.
Women experience migraine at least three times more often than men, suggesting hormonal influence is a contributing factor. Since migraine is of higher prevalence in women age 25 to 55 year of age, there is considerable disruption on family life, impacting spouses, children and friends.
Cluster headaches are a rare form of headache notable for their extreme pain and their pattern of occurring in “clusters”, usually at the same time(s) of the day for several weeks. Its onset is swift, usually accompanied by excruciating pain on the one side of the head, often behind or around one eye. The pain usually peaks over 5 to 10 minutes, and then continues at the same intensity for up to an hour or two before going away. Most affected individuals have one to three episodes a day and two cluster periods a year separated by periods of freedom from symptoms. It usually occurs during spring and/or autumn and is often incorrectly associated with allergies.
A sudden, severe headache with no known cause can be an early sign or symptom of stroke. Mild to moderate headaches are associated with transient ischemic attacks (TIAs), sometimes called “mini-strokes”, which result from a temporary lack of blood supply to the brain. The head pain occurs near the clot or lesion that blocks blood flow. Many stroke-related headaches can be prevented by careful management of stroke risks like high blood pressure, high cholesterol, and diabetes through diet, exercise and medication.
Headache can serve as a warning signal of more serious disorders. Not all headaches require medical attention. Some result from missed meals or occasional muscle tension and are easily remedied.
But some types of headaches are forbearers of more serious disorders and call for prompt medical care. These include: sudden and severe headache unlike any other headache you’ve had, sudden severe headache with fever, headache with convulsion, headache accompanied by confusion or loss of consciousness, headache associated with pain in the eyes and ears, or persistent headache in a person who was previously headache-free.
Dr. Tha Thomas U, MD, MPH, is a board certified neurologist with Sentara Neurology Specialists, and consulting neurologist in Suffolk, VA.