What is a Headache?
Headache is one of the most frequent reasons to visit a neurologist. Everyone will experience headaches during his life. There are so many kinds of described headaches; some are frequent others are rare, some are benign others are of concern. The pain in the head does not come from the brain itself, it comes from other head structures: the scalp, muscles of the head, neck, shoulders, blood vessels, cranial nerves, and sinuses.
Most patients come to the clinic fearing a “catastrophic “ cause; a tumor, a stroke, an aneurysm and those causes are not among the most frequent causes of headaches and usually are accompanied by so-called “red flags”. I just remind my patients that a simple viral or bacterial sinus infection or even a generalized infection with fever can come with a headache. Tension-type headache is the most common type of headache, not a tumor or an aneurysm. Do not ignore your symptoms, but contact Dr Iyad for your headache treatment in Dubai.
The headaches are classified as primary in which no structural or organic cause is behind, such as migraine, tension-type headaches and cluster headaches or secondary as a consequence of an underlying cause in the brain or outside the brain.
Diagnosing headaches is essentially based on a good and skilled history taking especially in the primary ones such as migraine, tension-type headaches, cluster headaches or other more rare forms of primary headaches. Brain MRI, that headache’s patients are looking for when coming to the clinic, has no major role in diagnosing primary headaches as it is usually normal.
Taking a good headache history takes time and includes asking questions in order to obtain the answers that guide the neurologist to what kind of headache the patient is suffering from.
Every answer to the precise questions can lead to such or such diagnosis. Starting by the gender, migraine is three to four times more frequent in women, and cluster headaches in men. Migraine starts at teenage or young adult, starting migraine beyond the forties is less frequent. Having headache for one week, six months or six years lead to different possible diagnoses, as does acute onset or slowly progressive chronic headaches. Acute “thunderclap” headaches can have alarming causes, such as subarachnoid or intracranial hemorrhage. Progressive headaches over weeks or months can happen in chronic tension-type headaches but also in the presence of an intracranial mass.
The location of the headache is important; migraine frequently but not necessarily takes half of the head and can change from one attack to another one, while cluster headache is mostly at and around the eye and stay at the same side during a cluster. Tension headache can be at the back side of the head or takes the whole head. The pain in trigeminal neuralgia is felt in one or more branches of the trigeminal nerve.
The nature of the pain in migraine is usually throbbing, pulsating, and tension headache is felt as heaviness or pressure. Trigeminal neuralgia pain is shooting and electrical.
The intensity of the pain also helps; the worst pain is reported by cluster headache patients, migraine pain can also be severe, not always but usually disturb the patient’s day plan. Tension headache is usually compatible with daily life unless it is chronic.
The duration of the headache is essential to the diagnosis. Idiopathic trigeminal neuralgia comes in very short attacks of seconds to minutes, recurring several times per day and lasting for several weeks and typically “triggered” by talking, eating, teeth brushing or even touching the painful zone. Migraine attack can last from few hours up to 3 days or more. Cluster headache attack can last up to three hours and can occur 2-3 times per day.
Timing of the headache can help; migraine starts in the morning, the patient can wake up with a tension-type headache usually appears in the second part of the day. Very specific to cluster headaches is that attacks often are time-locked; the patient knows what time it is when the attack starts, attacks during the night are usual and are related to REM-sleep stages.
Migraine can start with an aura in about 10-20% of cases, and in most cases, is visual as black, white or colorful flashes, zig-zag lines or blurry vision in part of the visual field. Migraine is usually accompanied by nausea, vomiting, increased sensitivity to light and sound, cluster headache by eye redness and congested nose.
The clinical context or associated conditions are to be taken in consideration. Venous sinus thrombosis or intracranial hypertension can occur in a pregnant woman. Morbid obesity is also a risk factor for intracranial hypertension but also for sleep obstructive apnea, where the patient wakes up with a headache due to reduced oxygen levels during the night every night. Tension headache is frequently associated with excessive professional burn-out, personal stress, anxiety or depression. Insomnia can also be associated with headaches. Overuse of “painkillers” in migraine or tension headache worsens the headache and make the treatment more challenging. It is unfortunate to advertise “over-the-counter painkillers” as “the solution” for all headaches.
Patients with headaches behave differently. Migraine patients need to rest in a dark room and try to have some sleep which, in many cases, improves the headache. In the contrary, cluster headache patients can not sit still and keep moving and pacing the floor as the pain is very severe.
Most of the patients say, “I had blood tests, and they are all normal”. The diagnosis of a headache is very rarely “in the blood”.
If the diagnosis is a primary headache and the neurological examination is normal, there is no need for further laboratory or imaging testing. If a secondary headache is suspected in the presence of “red flags” such as fever, change in consciousness level, personality or behavioral changes, seizure, or a focal weakness; further testing will be needed, such as sinus X-rays, a CT or an MRI/MRA. If inflammation or infection is suspected, a lumbar puncture for CSF analysis is indicated.
When do you have to see your neurologist for headache treatment in Dubai?
- Acute, “worst ever”, “thunderclap”, headache.
- A new headache is different from the usual one.
- Increasing headache frequency, not responding to analgesics..
- Headache with excessive use of painkillers.
- A new headache onset over 50 years of age.
- Headache with fever, nausea/vomiting, convulsion, confusion.
- Headache with a weakness in a limb(s), blurry or double vision.
- Headache after a fall or head injury.
Finally, don’t self-diagnose and don’t self-treat your headaches, contact Dr. Iyad for headache treatment in Dubai.