When It’s All in Your Head

That throbbing pain in your head can have many causes, says Shahid Rehman, M.D., a neurologist with the Center for Specialty Care, a NorthBay affiliate. “Most often, headaches are a benign condition, especially when they are chronic and recurrent. But, a new, severe headache may be the earliest sign of a serious neurological disease and therefore requires a through and systematic evaluation.”

Headaches are common and occur in all age groups, he adds. They account for 1 percent to 2 percent of emergency department evaluations and up to 4 percent of medical office visits. Headache triggers include emotional stress, fatigue, hunger, a reaction to second-hand smoke or chemical odors, overuse of alcohol, or hormonal changes, among others.

What is not common, however, and should be checked out immediately, is when your child complains of a new headache, or if you experience a severe headache unlike any other, that may also be accompanied by neck pain, nausea, fever or vision changes.

There are multiple headache categories, Dr. Rehman explains, but the most common types are classified as tension, migraine and cluster headaches.

Tension headaches are very common and have a host of causes, Dr. Rehman explains, including sleep deprivation or emotional stress. Skipping meals, not getting good sleep, overusing alcohol, and eye and neck strain from sitting too long at a desk or computer can also cause a tension headache.

“Migraines are caused by a combination of dilated blood vessels, inflamed nerves and increased central pain transmission,” Dr. Rehman says. Migraine headache may be moderate to severe, last for hours or even days, and can cause nausea, vomiting or a loss of appetite. Migraine sufferers may also be sensitive to certain odors, bright lights or noise.

Cluster headache is a common headache syndrome, and can be the most severe and disabling, Dr. Rehman notes. These are seen much more frequently in men than in women. People who get them complain of burning, piercing pain behind an eye or in the region around the eye. These headaches may come and go throughout the day, and may last for days or even weeks.

Surprisingly, a common, and frequently unsuspected, cause of intractable headache is the overuse of pain medications. “The patient, in futile attempts at relief, takes increasing amounts of medications (both prescription and over-the-counter drugs). When the high medication levels drop, even slightly, the headaches rebound. The result is a daily, virtually constant, atypical headache. For this reason, be careful not to use over-the-counter pain medications excessively,” Dr. Rehman says.

If you are experiencing headaches of any kind that last for a few days, it’s best to discuss the frequency and triggers with your primary care physician, Dr. Rehman advises.

Headache Pain Alert!

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:

! An abrupt, severe headache like a thunderclap

! Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking

! Headache after a head injury, especially if the headache gets worse

! A chronic headache that is worse after coughing, exertion, straining or a sudden movement

! New headache pain if you’re older than 50

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