Tips from Staten Island University Hospital
STATEN ISLAND, N.Y. — ALL SHORES — Headaches are one of the most common sources of pain among people. They're also among the most common reasons for neurological consultation. It has been estimated that more than 70 percent of the population in the United States will experience at least one headache within a one-year period.
Fortunately, the vast majority have a benign or nonthreatening cause. But it's often confusing and sometimes difficult to correctly categorize the different types of headaches.
"One way to classify headaches is by acuity. Typically, chronic headaches (months to years) are less likely to have a serious origin, except when it appears in individuals over 50 years old," said Florence Shum, doctor of osteopathy, and an attending neurologist at Staten Island University Hospital. "The most commonly known headaches are those coming from the brain like migraine, tension-type headaches and cluster headaches."
* A migraine is the most common type of headache, with the highest prevalence between 25- and 55-year-olds. They tend to peak in the late 30s to early 40s and decline during the 50s. Prevalence varies, with about 6 percent among men and 16 percent among women.
Symptoms of a migraine include recurrent attacks of headache, each lasting at least four hours, but no more than 72 hours. They are usually one-sided in location, with a pulsating quality, moderate to severe intensity and often aggravated by routine physical activity. Some associated symptoms may include nausea and/or vomiting, photophobia (sensitivity to light) and phonophobia (sensitivity to loud sounds).
"Sometimes, migraines can be preceded or accompanied by an aura, a complex of focal neurological change which most commonly includes different types of visual disturbances," said Dr. Shum. "Occasionally, an aura may consist of unilateral sensory disturbance (numbness or tingling on one side of the body) or even speech difficulty. These symptoms mimic stroke, so an immediate evaluation is needed to rule out this diagnosis."
* Headaches can also be caused by a disorder that could be fatal. These require immediate attention. The warning signs that warrant an urgent evaluation include a sudden onset of headache associated with nausea, vomiting, blurry vision, neck stiffness, paralysis or alteration of consciousness.
"A life-threatening headache could be those that waken you from sleep," she said. "Actually, any significant change in one's headache pattern like increased frequency, intensity or change in quality could be signs."
These symptoms may be clues to a much more serious underlying condition like bleeding inside the brain, infections, tumors, hydrocephalus (excessive water in the brain) and a very elevated blood pressure or elevated pressure inside the head.
* Not as well-known are headaches caused by substance overuse; cervicogenic (pain coming from the neck); eyes, ears, nose and throat; sinuses, mouth, teeth and even the temperomandibular joint (the jaw).
* Depression and other behavioral disorders often cause headaches. It is also not uncommon for patients who have facial pain and other neuralgias to have headaches. Even many general medical conditions like hypertension and thyroid dysfunction can cause headaches.
WHAT TO DO
If you experience any of these symptoms for a prolonged period of time, it is advisable to meet with your physician for assessment as soon as possible. Many of these secondary headaches will only improve after the underlying condition is treated. Patients who suffer headaches should maintain a headache diary to track the timing, quality, duration and other associated symptoms. This becomes a very helpful tool for physicians to accurately diagnose and treat these headaches.
This column is provided as a public service by Staten Island University Hospital.