HEADACHE is amongst the commonest disorders to afflict Mankind. Yet a significantly large majority of people go untreated, under-treated, or inappropriately treated.
I will summarize here a few of the usual questions people ask me about headache, and then address these questions in the article here.
- Is my headache serious?
- Do I need to worry about my headache?
- How will I know that my headache is serious?
- When should I visit a doctor for my headache/
- Is my headache because of ….. ?
- I am the most chilled-out guy in the world, yet my doctor said I had stress-related headache?
- Am I getting headache because of my neck pain?
- Are there any foods that I should avoid to stop getting headache?
- When I get a headache, I feel as if my head is going to burst?
- I have been getting headache for ages and ages; I am worried I will suffer some brain damage or develop a brain tumor?
- My headaches are so frequent, I get it 3 – 4 days a week; I am scared I will get dementia?
A headache can be serious for various reasons; I think you are worried that there is some serious underlying problem in the head causing the headache; is that true? In that case, I have the following to say: Firstly, any episodes of headaches which are new or significantly different from previous headaches should be given due importance and evaluated, probably with a brain scan.
“Significantly different” needs to be qualified; say you have had attacks of headache for many years, which occur about once or twice a week on average, last for 10 – 12 hours, are associated with feelings of nausea, and during the episode you prefer to lie down quietly in bed, drawing the curtain, to avoid light and sound, because that worsens the pain. This description fits that of a Common Migraine, and since you have had it for many years that is the most likely diagnosis; any other cause such as a brain tumor would have caused you something more than just a headache, such as visual disturbance, fits or paralysis. Moreover, a brain tumor would be expected to be progressive, and not remain silent for long periods and only cause headache on some days of the weeks.
Now let us say that there has been a change; the frequency has gone up; or it could be that you are now not getting benefit from medicines which were effective before, and the headache recurs for 2 to 3 days. Or, the headache used to be one or the other side of the head, but since the last few weeks or months, the headache is only on the same side of the head.
The description of a headache is based on the following parameters: frequency, severity/intensity of pain, duration, location, associated symptoms – including nausea, vomiting, photophobia (dislike for bright lights), or phonophobia (dislike for sounds). A significant departure from the usual headache that you have rings an alarm bell and the neurologist would then want to evaluate with a CT scan and rule out a brain condition like a tumor.
Having said this, let me also state for the record that these points are only arguments for or against considering a serious underlying condition, and of themselves do not constitute proof. In this day of Evidence-based medicine, it is important for all concerned to collect data and document whatever is found, so that future course of action would be guided better. Even if you have a change in the pattern of an existing headache, that in itself does not constitute proof that a serious cause such as a brain tumor exists.
Let me also reiterate that a headache can be considered serious for reasons other than simply the threat they pose to your life. For example, headaches significantly impair the quality of life; they can decrease our efficiency and speed at work, and also negatively affect our enjoyment of life in general. This can lead to problems at the workplace or in our relationships; for this reason alone, one needs to pay attention to headaches and avail treatment.
A headache can be because of many different reasons, and since treatment can only properly begin after identifying the cause, the physician has to go through the “Diagnostic process”, without which the physician may not be in a position to answer all the various questions. Without this evaluation, the doctor can only talk in a general way or make some intelligent guesses based on the common conditions which cause headache in a person of your age and gender.
You also need to understand the difference between an underlying cause (disease) for a headache, and a trigger – which is the immediate cause for an attack of headache. For example, MIGRAINE is the underlying cause for a headache, but there could be various triggers such as a stressful event or disturbance of sleep.
The underlying diagnosis (here, migraine) dictates treatment and decides prognosis; the trigger is something you could try to avoid in future.
There is also a worry that people tend to have – that repeated episodes somehow damage the brain, and that they may lead to neurodegeneration, dementia, stroke, or brain tumor. First of all, this has never been proven to be so. There is some amount of literature on research in this aspect of the problem, and none of this has supported a link between headache and all the conditions mentioned.
Migraine and stroke are both common problems, and occur together in a significant number of people; the same applies for epilepsy and migraine. The evidence proving a causative link between migraine and stroke, and migraine and epilepsy, is not convincing, and definitely not conclusive. Hence, the scientific position on this point is that migraine does not seem to contribute to these conditions.