A very common problem reported at a doctor’s visit involves a headache. There are many different causes so details about the headaches are very important in order to figure out the culprit.
Tension headaches, previously known as stress headaches, are the most common cause of headaches. They usually involve both sides of the head and are mild to moderate in intensity. They are not associated with other issues like nausea or vomiting. They usually occur infrequently but are triggered by stress. It is believed that the tension may cause muscle contractions in the pericranium (layer covering the skull) which is why there may be reproducible tenderness on certain muscles involving the head, neck, and shoulders on exam. Treatment usually includes anti-inflammatory medications, stress relaxation techniques, and ice packs.
Migraines are severe recurring headaches usually associated with nausea and possible sensitivity to light and sounds. It affects approximately 12% of people and may start at a young age. It was initially thought to be caused by the vasodilation of blood vessels in the brain; however, it is now felt to be from activation of several pathways in different parts of the brain. The end result of the activation is the release of neuropeptides which promote inflammation. Migraines are more frequent in women. Possible triggers include stress, hormonal flux in women, hunger, weather changes, food sources, neck issues, lighting, alcohol, and being overtired. Food triggers include excessive caffeine, red wine, aspartame, aged cheeses with tyramine (i.e. brie, blue cheese, swiss, etc.), and MSG. There are medical therapies to try to prevent and treat migraines. They include prescription medications, procedures, and even over the counter supplements like magnesium.
The following headaches should be reported to your doctor as they may be linked to other conditions. Cough headaches occur when coughing or straining. Stabbing headaches that are sharp and jabbing in nature may even make the person wince. Exercise-induced headaches have been seen with malignancies. Headaches during sex tend to be benign in nature and caused by tension in the neck and jaw during sex. Trying to relax them during sexual activity helps. However, headaches induced suddenly by orgasms should be reported as they are linked with the risk of strokes. A common and benign headache is caused by eating something cold. This has the slang of "brain freeze" headaches from eating cold things like ice cream. Another headache may be caused by sinus congestion and is usually present with nasal congestion and drainage.
The following headaches need immediate evaluation in an emergency room setting. Acute onset "thunderclap" headaches occur suddenly and severely. They may be linked to life-threatening conditions like brain hemorrhages or thromboses. If fever is present, meningitis needs to be ruled out. When discussing headaches with your physician it is important to note how old you were when they started, how often they occur, what else happens with them (i.e. nausea), what worsens them (i.e. sound, light), what improves them, and what triggers them (i.e. foods, activities, etc.). Try to see if there is a pattern on when they occur. Family history is also important. What you describe and the physical exam will be important to help diagnose the type of headache present. Brain imaging may be needed depending on the headache. Treatment and prevention methods are formulated once the diagnosis is known.
To help prevent headaches try to get enough sleep, exercise regularly, and try not to skip meals. Watch the dietary triggers listed above, and practice self-relaxation techniques. Caffeine is tricky as it may both alleviate and trigger headaches. Try to avoid having too much caffeine and stopping it "cold turkey" if you drink it regularly.
Please talk to your doctor if you are having frequent or worsening headaches. Seek immediate attention if there are any sudden and severe headaches or if they are linked with a high fever. Headaches are very common, and disruptive to us all, but with the proper treatment and preventive measures, we can manage and reduce their harm.
Dr. Sciavolino-Day is a board-certified physician specializing in internal medicine. For more information about her concierge medical practice in Naples, please visit her website at www.drsciavolinoday.com.
