Headache is one of the most common medical complaints. Almost
everyone experiences a headache from time to time. In the large majority
of cases, it is a completely benign condition which is a nuisance and
does not represent any significant or long-term medical problems.
However, many people worry about a headache and are concerned that it
could imply something much more serious. We all know the old "It's not a
too-mah!" line and joke about it, but what do headaches really mean?
Can they mean something more serious?
The answer is a definitive
yes. Some very serious medical conditions can be associated with
headache. However, I must state again that the very large majority of
headaches do not imply anything serious. While millions, if not
billions, of people on this planet experience headache in their
lifetime, only a small percentage will every have a more serious,
related condition diagnosed.
So how do you know? What does that
headache mean? That is not an easy question to answer. In fact, there
are physicians who spend their whole career specializing specifically in
headache, its causes and its treatments. While there is no easy answer
that covers all possibilities, this article will supply you with a
handful of the most common causes and types of headaches, from the most
harmless and benign to the medical emergencies. It will explain some of
the differences that help to distinguish one type of headache from
another. This is not an exhaustive list of every possible cause of
headache, there are certainly others. It starts with some of the more
common causes and moves on to more rare causes.
This article is
not intended to offer medical advice. Every patient and headache is
different. Only your personal physician can help counsel you about what
is best for your particular situation. If you are concerned about a
headache or headaches you are having, consult your doctor.
Stress/Tension Headache
By far the largest majority of headaches that most people experience are what is known as a Tension Headache,
or some similar variant. While the exact cause of these headaches is
not known and probably varies from patient to patient, this benign type
of headache is usually associated with stress and muscle tension or
spasm of the neck, facial or head muscles. While their severity,
location and characteristics can vary, they are almost always harmless
and do not represent any more serious underlying problem. This is the
typical headache most of us have experienced when you are over-tired,
over-worked, or stressed. Tension headaches do not cause other
neurological symptoms. If other symptoms are present, it should raise
the question of another diagnosis.
Sinus Headache
The
paranasal sinuses are mucosa-lined chambers in the bone of the skull
and face. There are several of them surrounding the nasal passages.
Normally, mucous secretions that are produced in the sinuses flow out of
openings into the nasal passage. However, if a sinus is obstructed so
that its contents cannot exit, the pressure inside the sinuses can build
up. This can occur with mucosal swelling associated with allergy
(allergic rhinitis or hay fever) or with infection such as a cold or
sinus infection. When pressure builds up inside a sinus, it can cause
pain. While some sinuses (such as the large maxillary sinuses) are in
the face, most are associated with the base of the skull. This pain can
be interpreted and described as headache. While these sinus headaches
can occur in anyone with a "stuffed nose" of any cause, patients who
have chronic sinus problems with recurrent sinus infections can often
have quite severe pain associated with this condition.
Migraine Headache
A
migraine headache is a specific type of headache which is thought to be
of vascular or neurologic origin. They are more common in women and in
some patients can occur regularly, often following a particular part of
the menstrual cycle. While they traditionally are described as causing
pain on only one side of the head, they can occasionally cause pain on
both sides of the head as well. In addition to the headache, other
neurological symptoms usually accompany the headache. For example, many
patients describe having an "aura" prior to the onset of the headache.
These can vary but the patient generally has some symptom that lets them
know a headache is coming. They can even experience seemingly focal
neurological symptoms such as a scatoma (a temporary blind spot in their
field of vision) or other visual changes. Photophobia, avoiding bright
lights, can occur as well. Finally, many patients experience nausea and
even vomiting. All of these neurological effects do not occur in a
typical tension headache and help to distinguish migraines. However,
some of the symptoms of migraine, particularly the nausea and vomiting
and photophobia, are similar to symptoms of more serious causes of
headache such as subarachnoid hemorrhage or meningitis. Therefore, those
more serious disorders should be ruled out before classifying a
headache as a migraine.
Cluster Headache
Cluster
headaches are a unique neurological form of headache with an unknown
cause. These extremely painful attacks are usually only on one side and
is often described as a stabbing or boring pain that is located behind
the eye. It usually occurs suddenly and periodically, followed by
periods of remission. In addition to pain, which can be extraordinarily
severe and one of the most painful conditions a human can endure,
cluster headaches are characterized by symptoms that seem to come from
the autonomic nervous system. These include ptosis (a drooping eyelid on
the same side), tearing, runny nose, redness of the eye and even facial
redness, swelling and/or sweating. These symptoms all occur only on the
same side as the headache. Some patients describe certain triggers that
set off attacks, such as ingestion of alcohol or exposure to heat.
Meningitis
Meningitis
is an infection of the coverings of the brain, the meninges, and the
fluid surrounding the brain and spinal cord, the cerebrospinal fluid. It
can be caused by viruses or by bacteria. While the bacterial form is
much more dangerous and has the potential to lead to severe neurological
injury and death if not treated promptly, both have similar
presentations. Both cause headache as one of the hallmark symptoms.
Because of the infection and severe inflammation of the coverings of
brain, any movement of the head and neck can be very painful. Generally
it is a severe headache (with or without a back ache as well) that
progresses rapidly and is accompanied by a high fever. The patient
generally has a very stiff, painful neck as well, called nuchal
rigidity. It is so painful that they keep their neck very rigid to
prevent any movement, even if they are lethargic or unconscious.
Photophobia, as with migraines and subarachnoid hemorrhage, and seizures
can occur as well. In the case of bacterial meningitis, these symptoms
can quickly escalate to a progressively deteriorating level of
consciousness, coma and eventually death if not treated quickly. The
combination of high fever, headache, stiff neck and/or lethargy should
be considered concerning for meningitis until proven otherwise.
Untreated bacterial meningitis can progress quickly and can be
life-threatening. Thankfully it is relatively rare.
Subarachnoid Hemorrhage
Subarachnoid
hemorrhage means bleeding into the space around the brain into the
cerebrospinal fluid. While this can occur with trauma to the head, it
can happen spontaneously due to the rupture of an intracranial aneurysm.
An intracranial aneurysm is an abnormal bulging of the wall of an
artery that feeds the brain. These weakened blood vessels have a
tendency to rupture and bleed. This type of bleeding typically causes a
sudden-onset of severe headache. Most patients describe it as the "worst
headache of my life." It comes on very suddenly and is usually of a
stabbing quality. It can be accompanied by nausea, vomiting, seizures,
stiff, painful neck and/or a depressed level of consciousness. In severe
bleeds it can even lead to coma or sudden death. In patients who have a
history of chronic headaches, such as migraines or cluster headaches,
they will generally say that the character of this headache is
different. Therefore, a sudden, intense, new headache, particularly if
associated with any of the other symptoms, should be considered a
ruptured aneurysm until proven otherwise. An aneurysm rupture, like
bacterial meningitis above, is generally a medical emergency. An
aneurysm which has ruptured is at increased risk of re-rupture. Often
the second rupture is more severe and more devastating than the first.
Again, this is a rare cause of headache, but a potentially deadly one.
Brain Tumor
While
the brain itself does not cause pain, increased pressure inside the
head or irritation of the coverings of the brain can cause headache.
With a brain tumor that does either, one of the presenting symptoms of
these tumors can be headache. Most types of brain tumor, whether primary
or a metastases from another tumor elsewhere in the body, can cause
this symptom. A new headache in the setting of new neurological symptoms
should raise red flags. Other symptoms that can accompany a brain tumor
are seizures, changes in vision, or sensory or motor symptoms such as
weakness of a part of the body. Many different neurological symptoms are
possible depending on the type and location of the tumor. Headache that
is caused by increased pressure in the head is often worse in the
morning or will wake the patient from sleep, getting better when upright
and awake. Again, this is a rare cause of headache, but clearly one
which is potentially a very serious condition.
