Headache Evaluation and Treatment

Headache is our most common form of pain and a major reason cited for days missed at work or school as well as visits to the doctor. Anyone can experience a headache. Nearly two out of three children will have a headache by age 15. More than nine in 10 adults will experience a headache sometime in their lives. Without proper treatment, headaches can be severe and interfere with daily activities.

Certain types of headache run in families. Episodes of headache may ease or even disappear for a time and recur later in life. It's possible to have more than one type of headache at the same time.

Primary headaches occur independently and are not caused by another medical condition. It's uncertain what sets the process of a primary headache in motion. A cascade of events that affect blood vessels and nerves inside and outside the head causes pain signals to be sent to the brain. Brain chemicals called neurotransmitters are involved in creating head pain, as are changes in nerve cell activity (called cortical spreading depression). Migraine, cluster, and tension-type headache are the more familiar types of primary headache.

Secondary headaches are symptoms of another health disorder that causes pain-sensitive nerve endings to be pressed on or pulled or pushed out of place. They may result from underlying conditions including fever, infection, medication overuse, stress or emotional conflict, high blood pressure, psychiatric disorders, head injury or trauma, stroke, tumors and nerve disorders.

Diagnosing a Headache

Headaches can range in frequency and severity of pain. Some individuals may experience headaches once or twice a year, while others may experience headaches more than 15 days a month. Some headaches may recur or last for weeks at a time. Pain can range from mild to disabling and may be accompanied by symptoms such as nausea or increased sensitivity to noise or light, depending on the type of headache. How and under what circumstances a person experiences a headache can be key to diagnosing its cause.

Keeping a headache journal can help a physician better diagnose your type of headache and determine the best treatment. After each headache, note the following:

• the time of day when it occurred;
• its intensity and duration;
• any sensitivity to light, odors, or sound;
• activity immediately prior to the headache;
• use of prescription and nonprescription medicines;
• amount of sleep the previous night;
• any stressful or emotional conditions;
• any influence from weather or daily activity;
• foods and fluids consumed in the past 24 hours; and
• any known health conditions at that time.

Women should record the days of their menstrual cycles. Include notes about other family members who have a history of headache or other disorder. A pattern may emerge that can be helpful to reducing or preventing headaches.

When to See a Doctor

Not all headaches require a physician's attention. But headaches can signal a more serious disorder that requires prompt medical care. Immediately call or see a physician if you or someone you're with experience any of these symptoms:

• Sudden, severe headache that may be accompanied by a stiff neck.
• Severe headache accompanied by fever, nausea, or vomiting that is not related to another illness.
• "First" or "worst" headache, often accompanied by confusion, weakness, double vision, or loss of consciousness.
• Headache that worsens over days or weeks or has changed in pattern or behavior.
• Recurring headache in children.
• Headache following a head injury.
• Headache and a loss of sensation or weakness in any part of the body, which could be a sign of a stroke.
• Headache associated with convulsions.
• Headache associated with shortness of breath.
• Two or more headaches a week.
• Persistent headache in someone who has been previously headache-free, particularly in someone over age 50.
• New headaches in someone with a history of cancer or HIV/AIDS.

Source: National Institute of Neurological Disorders and Stroke

For more information or to schedule an appointment for headache treatment, please call 304.691.1787.