JUN 25 - Practically everyone has experienced headaches at some point or the other. Characterised by a pain that occurs in and around the head, it might include facial pain, pain in the eyes, frontal throbbing, pain at the back of the head or a unilateral hemi head pain, popularly known as a migraine. Although headaches might be extremely common, they comprise a symptom that should never be taken lightly, especially if these have gotten more and more severe over time. And doctors should be careful while diagnosing these pains as migraines, because while migraines are not dangerous, oftentimes the headache might be a symptom of life-threatening conditions like brain tumour.
A few weeks ago, a young girl of 14 was brought into our emergency ward with a severe headache that had led her to become extremely irritable. Within a few minutes, and even before a CT scan could be conducted, she fell unconscious. A CT scan was immediately done and it showed a huge tumour in the fourth ventricle (the cavity containing cerebrospinal fluid) and it was apparent that the brain had herniated thanks to the immense rise in intracranial pressure, compressing her vital centre for respiration and heartbeat, located in the medulla oblogonta—the stem-like part of the brain. A neurosurgeon was consulted, but to our great dismay, he declared that it was impossible to rescue the patient and we subsequently lost her.
What is tragic is the fact that the girl had already been taken to the emergency department twice in the last two weeks and twice on the same day that she was referred to our hospital after midnight. For all this time, she had been treated with all sorts of medication for migraine and dizziness and not referred or subjected to a CT scan.
Headaches can also be a sign of infection in the brain, indicating conditions like meningitis and encephalitis. Though most cases present with high-grade fever, vomiting, photophobia, along with headache, sometimes the presentation can be very subtle, only progressing over time. Another cause for severe headache could be cerebral venous thrombosis. In this condition the veins draining blood from the brain begin to clot, causing problems. A few days ago, for example, a young man without any significant past medical history complained of mild headache and few episodes of vomiting. He was a pharmacist and working in his shop when the symptoms started. He immediately came to our hospital where a neurologist
examined him, during which a fundoscopy was also conducted. A fundoscopy is the examination of the eye to look for ‘papilloedema’, an early sign of increased intracranial pressure. When he exhibited signs of papilloedema, he was subjected to a CT scan, and further diagnosed with cerebral vein thrombosis and treated with anticoagulant medication.
Doctors should therefore not rush to diagnose all headaches as migraines and should not hesistate to refer cases if one is not an expert on the subject. They should also conduct thorough neurological examination before labelling any headache as a benign one. If it is beyond your capabilities to perform proper examinations, you have no right to keep the patient under your care.
The above mentioned are the more serious causes of headaches. There are les severe causes as well, the most common being the ‘tension headache’. It is defined by a tightening of the muscles in your shoulders, neck, scalp, and jaw, and is related to stress, depression, anxiety, a head injury, or holding your head and neck in an abnormal position.
Migraine is another common cause. It is defined by headaches that usually occur with other symptoms such as vision changes or nausea. The pain may be
throbbing, pounding, or pulsating. It tends to begin on one side of your head, although it may spread to both sides. You may have an ‘aura’ (a group of warning symptoms that start before your headache) as well. The pain usually gets worse as you try to move around. Migraine headaches may be triggered by foods such as chocolate, certain cheeses, or Ajinomoto. Caffeine withdrawal, lack of sleep, and alcohol may also trigger them.
Other types include cluster headache which is sharp, very painful headaches that tend to occur several times a day for months and then go away for a similar period of time, or sinus headaches that cause pain in the front of your head and face. This is due to swelling in the sinus passages behind the cheeks, nose, and eyes. The pain tends to be worse when you bend forward and when you first wake up in the morning.Headaches may also occur if you have a cold, the flu, fever, or premenstrual
syndrome. It may even be triggered by high blood pressure or an eye problem.
To conclude, headaches are very common symptoms and can be due to various causes. Although the more sinister causes of headache are very rare, they should always be at the back of a clinician’s mind while diagnosing so these cases can be identified. Patients should also be wary of the fact that headaches with vomiting can be really serious and should consult suitable clinicians in such situations.
Dr Neopane is the Associate Professor of Medicine at the Kathmandu Medical College Teaching Hospital
Source: http://www.ekantipur.com/2012/06/25/health-and-living/the-truth-about-headaches/356125/
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