Headaches: It doesn't hurt to know
A headache is a fairly common ailment, but when does it warrant more serious medical attention than a painkiller?
"There is a need to get the right diagnosis to dismiss the more sinister secondary headaches and to distinguish whether it's a chronic headache, a tension headache or a migraine. One reason is that each involves different medications," says Dr Edward Wong, a specialist in neurology at Pacificare Medical Centre in Tsim Sha Tsui.
A tension headache is the most common, according to Dr N.V. Ramani, consultant neurologist at Raffles Neuroscience Centre in Singapore. "This headache lasts from some minutes to a few hours, typically affects both sides of the head, in the front and/or sides, often like a tight band. It usually occurs towards the end of the day, without nausea or visual disturbances."
The second most common headache is migraine, says Ramani. This lasts a few hours, or even days, and usually affects only one side of the head. It can be severe, and is usually associated with nausea and vomiting, and there is often increased sensitivity to light (photophobia) or sound (phonophobia). "There may be a warning where flashing lights or zigzag lines are seen just before the headache starts," he says.
Another frequent complaint is a cluster headache. These can occur daily or nightly as one-sided front headaches that are frequent, but short-lived, says Ramani. This headache typically disappears after a few days. It can recur up to a year later and may be associated with tears and a reddening of the eyes.
Ramani says these headaches are benign, or non-dangerous, headaches. Secondary headaches, however, are a symptom of some other more sinister health issue. These include conditions such as meningitis, brain tumour, brain aneurysm, stroke or glaucoma.
"Warning signs of a more serious cause include: a headache that starts for the first time above the age of 40; wakes you up from sleep, or is noticed on awakening; worsens after coughing, sneezing or straining; is associated with weakness or numbness or visual loss; occurs after a head injury; or does not respond to usual painkillers.
"Headaches with any of these features need medical attention as soon as possible," explains Ramani.
Wong says patients who have headaches with fever are checked straight away for meningitis. Headaches that occur after trivial injury also warrant a closer look.
If the cause of a headache is not known, at least the triggers should be. Says Wong: "It could be alcohol or even stress. Knowing what triggers them and how to deal with them is very important. Sometimes, some of the triggers can be avoided."
At other times, triggers such as work stress may not be easily avoidable so patients need to learn how to deal with them, Wong says. Headaches from stressful situations, for example, can be eased with paracetamol or a relaxation technique, he says.
"It would be unusual for anyone above the age of 40 to start developing benign headaches for the first time in their life," he says.
Migraines are more common among women, and triggers can include menstruation and certain foods, such as cheese, coffee and red wine, says Ramani. Tension headaches are common in both genders, especially in young people and office workers, he says. The most common causes of such headaches are the tight muscles in the shoulders, neck, scalp and jaw.
Treatment plans for headaches include taking painkillers, or non-pharmacological treatments such as relaxation, biofeedback and cognitive behavioural therapy.
"Relaxation, meditation and lifestyle changes may be helpful to prevent headaches. If headaches occur, take the painkillers immediately at the recommended doses," says Ramani. "But if any warning signs occur, seek medical attention as soon as possible."
