Headaches: How do you know when it’s dangerous?

Mar 25, 2018 Features / Columnists

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By Dr Zulfikar Bux
Assistant Professor of Emergency Medicine

Headaches are common, and many people treat themselves with simple painkillers, drinking extra water, and having a rest, or simply by waiting for the headache to go away. A headache is one of the most common reasons for visiting a doctor.
Almost everyone will experience headaches at some time. Most headaches are not caused by serious or sinister conditions. However, people understandably worry if headaches seem different.
Today we will try to break down this complex condition. The hope is to help you to determine when your headache may be a sign of something more serious.
ARE THERE DIFFERENT TYPES OF HEADACHES?
Yes, there are many different types of headaches. Tension headaches and migraines are the most common causes. Below are the major types of headaches one can experience:

• Tension headaches – Tension headaches are usually felt as a band or across the forehead. They can last for several days. They can be uncomfortable and tiring, but they do not usually disturb sleep. Most people can carry on working with a tension headache.

• Migraines – These are headaches that are one-sided, throb and make you feel sick. They tend to not get better after sleep.

• Cluster headaches – Cluster headaches are very severe one-sided headaches. They occur in clusters, often every day for a number of days or even weeks. Then they disappear for months on end.

• Chronic tension headaches – Chronic tension headache (or chronic daily headache) is usually caused by muscle tension in the back of the neck and affects women more often than men.

• Medication-overuse headaches – This occurs when you use pain medications too often for headaches and your body becomes resistant to them due to overuse.

• Exertional headaches – Exertional headaches are headaches associated with physical activity. They can become severe very quickly after a strenuous activity such as running, coughing, having sex (intercourse), and straining with bowel movements.

• Primary stabbing headaches – Primary stabbing headaches are short, stabbing headaches which are very sudden and severe without a known cause. They usually last between 5 and 30 seconds, at any time of the day or night.

• Trigeminal neuralgia – This is pain to the face from affected nerves that supply your face.
HOW ARE THEY TREATED?
Your doctor will generally tell the likely cause of your headache from talking to you and examining you. Once he or she has discovered the cause then you will be able to decide how to reduce or stop the headaches. This may involve taking medication only when you get the headaches, taking daily medication to prevent them or, sometimes, stopping medication you are already taking. Very occasionally, headaches need further investigation to rule out more serious underlying causes.
WHAT ARE THE DANGEROUS CAUSES OF HEADACHES?
Dangerous headaches tend to be sudden in onset or may progressively worsen over time. Below are the dangerous causes of headaches:
• Bleeding around the brain (subarachnoid hemorrhage)
• Meningitis and brain infections
• Temporal arteritis (an inflamed temporal artery)
• Brain tumours
WHEN SHOULD I BE WORRIED ABOUT A HEADACHE?
The following are signs that your headache may be dangerous:
• You have had a significant head injury in the previous three months.
• Your headaches are worsening and accompanied by high temperature (fever).
• Your headaches start extremely suddenly.
• You have developed problems with speech and balance as well as headache.
• You have developed problems with your memory or changes in your behaviour or personality as well as headache.
• You are confused or muddled with your headache.
• Your headache started when you coughed, sneezed or strained.
• Your headache is worse when you sit or stand.
• Your headache is associated with red or painful eyes.
• Your headaches are not like anything you have ever experienced before.
• You have unexplained vomiting with the headache.
• You have low immunity – for example, if you have HIV, or are on oral steroid medication or immune suppressing drugs.
• You have or have had a type of cancer that can spread through the body.

• You have unremitting morning headaches which are present for more than three days or is getting gradually worse

• Your blood pressure or sugar is very elevated.

WHAT CAN I DO TO PREVENT REGULAR HEADACHES?
Headaches are less likely to occur in those who:
• Manage their stress levels well.
• Eat a balanced, regular diet.
• Take balanced regular exercise.
• Pay attention to posture and core muscles.
• Sleep on two pillows or fewer.
• Drink plenty of water.
• Have plenty of sleep.

Anything that you can do to improve any of these areas of your life will improve your health and well-being and reduce the number of headaches you experience. But remember to visit your doctor if your headache feels different from the ones you usually have.

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