HEADACHE

Headache is a very common symptom and is rarely a sign of serious physical illness however there are rare cases of important illness for which headache is the only or main symptom. This makes it difficult for patients and sometimes for doctors as well to know whether in a particular case further investigation is indicated. Headache is discussed elsewhere on the site. (Severe and simple headache). Lets discuss the ways that headaches arise (concentrating on those types of headache that develop more gradually):

• From the spine in the neck (cervical spine). This causes referred pain which may be felt over the back and middle of the head but is unlikely to extend to the front. Arthritis in the neck or something simple such as poor posture at your workstation can cause this type of headache. Movements of the neck may worsen or relieve this type of headache. Good support for the head and neck whilst sitting or in bed at night may improve the situation. A proper ergonomic study of your computer workstation is important and something which you should ask your employer to carry out - not forgetting that it may be your computer at home or DIY activities which could be responsible.
• From the muscles around the scalp and neck - tension headache. There may be a physical cause (e.g. poor posture again) or psychological (stress and strain, anxiety, irritation etc.) Exemplified by the statement - it gives me a headache
• From the nerves - neuralgia. Typically intermittent, sharp and very severe. Usually more of a face pain than a headache as such. Localises to one side and usually triggered by a stimulus such as touch.
• From the eyes. Some eye disease such as glaucoma can cause headache. Typically this is at the front of the head. If the eye is also red and tender this is an emergency and warrants an urgent visit to the eye department. Eyestrain due to inadequate glasses or failure to use glasses may cause a frontal headache but this is more of a nagging type of headache. It is made worse by trying to read or watch TV. It goes off at night on resting and is not usually there on waking.
• From the blood vessels:
  • Migraine is caused by changes in the tone of the muscles in the wall of the blood vessels around the brain. In classical migraine firstly they contract and narrow the blood vessels leading to the typical migraine warning signs such as the visual aura. Then they relax allowing the blood vessels to open up causing the headache. Though by no means does all migraine follow this sequence it is due always to changes in the blood vessels and appropriate treatments almost always work and are so specific that they confirm the diagnosis of migraine.
  • Temporal arteritis is an inflammation of arteries around the scalp. It causes a bad headache and tenderness  of the arteries themselves - often felt in front of the ear. It is almost totally confined to the over 50 year olds for some reason. Untreated it can lead to sudden blindness and so is potentially very serious. Steroid tablets in high dosage always work very quickly but may need to be taken in a lower dose for months or even years.
• From within the skull. Anything which causes the pressure within the skull to increase such as a tumour or oedema (swelling) of the brain will cause headache. Blows to the head and strokes can cause sudden brain swelling and won't be discussed further here. More gradual onset of headache may be caused by either a tumour or a slow bleed subdural haematoma. Typically this type of headache is affected by anything which alters the pressure inside the skull such as posture, coughing, straining at stool, exertion etc. This type of headache usually gets worse on lying down so is particularly bad at night disturbing sleep and is there first thing in the morning before getting up. It may lessen during the day though does not usually go completely. It tends to get worse with time if, as is usually the case, the tumour or bleed is progressing. There are often other symptoms caused by the increase in pressure such as nausea, vomiting, deteriorating eyesight, personality change or by the tumour or blood clot themselves such as numbness or paralysis in a limb or fits. It goes without saying that this type of headache requires prompt attention and investigation to find the cause.

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