Headache is a fairly common complaint in any family doctor clinic.
It is important to ask for
nausea,
vomiting,
stiffness of the neck,
fits,
stress,
lack of sleep,
flashes of light in the eyes, and
weakness of one side of the body.
I always check for any high fever (one of the common causes) and high blood pressure in all my headache patients.
The most common cause of headache is
tension headache which can present as a 'tight band' especially over the temples.
There may associated tight neck muscles .
It is usually related to stress.
Treatment is by simple painkillers, rest and removal of aggravating factors.
Migraine is also frequent in some patients with a heavy throbbing pain usually over one side of the scalp, forehead and around the eye caused by abnormally dilated blood vessels. There may be nausea and sensitivity to loud noises or bright lights .
It may be triggered by menstruation, alcohol or anxiety. Treatment is by special anti-migraine drugs that reduce the dilatation of blood vessels and painkillers together with resting in a cool, dark and quiet room.
Referred headaches are caused by any pain in structures around the head.
Common ones are earaches, toothache causing pain over an entire part of the face and temporamandibular joint dysfunction from mechanical pain from the jaw joint.
Serious Types of Headaches should be referred to hospital for MRI brain investigation and further treatment:
Meningitis / Encephalitis headaches which is due to infection of the brain tissue (encephalitis) or the membranes surrounding the brain (meningitis).
One of the most cause of encephalitis here is dengue hemorrhagic fever.( A Simple Guide to Dengue Fever)
There is usually stiffness of the neck, fever and vomiting.
Cerebrovascular Accidents (A Simple Guide to Stroke) happens when a blood vessel in the brain is blocked or bursts.
There is weakness of one side of the body.
Bleeding in the brain blood vessel aneurysm (A Simple Guide to Cerebral Aneurysm) can cause a sudden severe headache.
One of my patient had what he describes as the 'worst headache ' he ever had followed by difficulty in swallowing. He was sent for brain scan which show bleeding from a swollen blood vessel in the brain. Because he was in China, his wife got hold of the SOS and manage to get him back to Singapore where I manage to get a neurosurgeon waiting to check on him on arrival. Luckily for him his bleeding was mild and his operation to clip the aneurysm was successful.
For prevention I usually advise patients to:
Lie down in a dark, quiet room.
Try muscle relaxation techniques or a gentle massage.
For tension headaches, take a warm bath.
For migraines, put an ice bag or cold towel on your forehead.
Headache is a symptom which all of us have experienced at one time or another.
Most of the time it is not serious but in certain cases headache may be a symptom of something more sinister and dangerous.
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