Managing headaches

Headache are a common ailment usually experienced by everyone from time to time. Most people when experiencing a headache tend to self-prescribe over the counter medication, ignoring the fact that some types of headaches require medical attention.

Headaches are categorized into either primary headaches or secondary headaches.

Primary headaches are caused by over activity of or problems with pain-sensitive structures in your head which can be triggered by fasting, alcohol, caffeine and caffeine withdrawal, stress or release from stress, too little or too much sleep, menstruation, fatigue, change in weather, head trauma, exposure to bright lights, loud noises, smoke, and strong scents and foods among others.The most common primary headaches are: Cluster headaches, migraines and tension headaches.

These headaches have distinct features, such as an unusual duration or pain associated with a certain activity. Although generally considered primary, each could be a symptom of an underlying problem. Such underlying problems include:  Cough Associated Headaches

These are triggered by coughing and other types of straining such as from sneezing, blowing your nose, bending etc. Cough Associated coughs can be:Primary cough headaches

• Begin suddenly with and just after coughing or other types of straining

• Usually last a few seconds to a few minutes - some can last up to two hours

• Cause sharp, stabbing or splitting pain

• Usually affect both sides of your head and may be worse in the back of your head

• May be followed by a dull, aching pain for hours

Secondary cough headaches

Secondary cough headaches often have symptoms similar to those of primary cough headaches, though you may experience:

• Longer lasting headaches

• Dizziness

• Unsteadiness

• Fainting

When to see a doctor

Consult your doctor if you experience sudden headaches after coughing especially if the headaches are frequent or severe or you have any other troubling signs or symptoms, such as imbalance or double vision.

Exercise Induced Headaches

These occur during or after sustained, strenuous exercise. Doctors divide them into two:

• Primary exercise headaches are usually harmless, aren't connected to any underlying problems and can often be prevented with medication and last between five minutes and 48 hours.

• Secondary exercise headaches are caused by an underlying, often serious problem within the brain such as bleeding or a tumor or outside the brain such as coronary artery disease .

Secondary exercise headaches may require emergency medical attention.

When to see a doctor

If you experience a headache during or after exercise that last at least a day and sometimes linger for several days or longer, consult your doctor.

A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions varying greatly in severity may cause secondary headaches. Possible causes of secondary headaches include: Acute sinusitis, blood clot, within the brain separate from stroke, concussion, dehydration, dental problems, high blood pressure, medications to treat other disorders and stroke.

Types of secondary headache include:

Spinal headaches

Caused by leakage of spinal fluid through a puncture hole in the tough membrane that surrounds the spinal cord. This leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache.

Spinal headache symptoms include:

• Dull, throbbing pain that varies in intensity from mild to incapacitating.

• Pain that typically gets worse when you sit up or stand and decreases or goes away when you lie down

Spinal headaches are often accompanied by: Dizziness, ringing in the ear, hearing loss, blurred or double vision, nausea and neck stiffness

When to see a doctor

Tell your doctor if you develop a headache after a spinal tap or spinal anesthesia - especially if the headache gets worse when you sit up or stand.

Thunderclap headaches

This is uncommon, but they can warn of potentially life-threatening conditions usually having to do with bleeding in and around the brain. There is no obvious cause for some thunderclap headaches. In other cases, a variety of potentially life-threatening conditions might be responsible, including: bleeding between the brain and membranes covering the brain, rupture of a blood vessel in the brain, a tear in the lining of an artery that supplies blood to the brain, death of tissue or bleeding in the pituitary gland and blood clot in the brain.

Symptoms include pain that:

• Strikes suddenly and severely

• Peaks within 60 seconds

• Can be accompanied by nausea or vomiting

• Altered mental state

• Fever

• Seizures

When to see a doctor

Seek immediate medical attention for any headache that comes on suddenly and severely.

Conclusion

Generally, headaches are a common cause of short-term pain. Headaches are often underdiagnosed and or undertreated. Some patients can benefit from early recognition and elimination of factors that trigger their headaches. Patients and their healthcare providers may need to experiment to find optimal medications and dosages for managing headaches associated pain. 

By Dr Margarita Mwai, Consultant Family Physician at Aga Khan University Hospital