SEVERE HEADACHE

Headache is very common. Most people get headaches and some get them quite often. It is understandable that people often think of conditions such as meningitis, stroke, blood pressure and brain tumours in association with severe headache and so may feel that they need urgent attention. All of these conditions are rare causes of headache. Much more common are conditions like migraine, sinusitis, viral infections, tension and musculo-skeletal conditions. However there are serious causes of headache and they can necessitate an emergency call-out.

SERIOUS CAUSES OF HEADACHE

MENINGITIS. This is an inflammation of the meninges or membrane around the brain. It is often very serious and untreated can quickly cause the death of the patient or cause permanent damage leaving the patient disabled. If the patient (who is often a fit young person) has meningitis then they need to be transferred to hospital as soon as possible. However in the early stages it may resemble much commoner conditions such as the 'flu. Usually patients have a severe headache, find light very uncomfortable, have difficulty bending the neck forward and may occasionally have a rash that looks like blood spatters which does not fade with firm pressure (this rash only relates to meningococcal infection and there are quite a few different "bugs" that cause meningitis. Also the rash sometimes occurs without meningitis and this is also very serious). Confusing conditions - migraine causes aversion to the light but the patient can usually recognise the condition and anyway migraine does not cause a fever or stiffness of the neck and may cause the patient to see flashing lights. Fevers can cause quite bad headaches and there may be some slight aversion to the light and muscle pains in the neck and back - if in doubt seek advice. Very young children may not have the typical symptoms and may just be hot and seem very unwell.
SUB-ARACHNOID HAEMORRHAGE. This is due to a bleed in the space between the brain and the arachnoid layer of the meninges. Some of the symptoms - bad headache, light sensitivity, neck stiffness, confusion - are very similar to meningitis but since the bleeding irritates the meninges this is hardly surprising. The characteristic of this condition which frequently occurs is that the headache starts instantaneously - often described as being like a very hard hit over the back of the head. Like meningitis this is always to be regarded as a very serious condition requiring immediate hospital admission.
STROKE. Can frequently cause headache - but there will always be other signs and symptoms
BLOOD PRESSURE. On its own hardly ever causes headache - though we often take the opportunity to check it.
BRAIN TUMOUR. As with stroke it is uncommon for there to be no other symptoms. Usually the onset is gradual over a period of weeks. The headache is usually made worse by lying down, bending forward, coughing and straining at stool.
TEMPORAL ARTERITIS. This is due to inflamation of the arteries in the scalp - typically the temporal artery in front of the ear. It is more of a head pain than an ache and the patient finds the affected blood vessel very tender to touch. Its most serious consequence, if untreated, is to cause blindness by interfering with adequate blood supplies to the back of the eye. It is rare under fifty years of age. Treatment is with steroids - which are very effective.

OTHER CAUSES

MIGRAINE. This is a condition that recurs - usually to some sort of pattern. The very first attack can be a problem to diagnose and we would be happy to discuss this with you over the phone, if necessary, and if there is still some doubt we would want to see you. The "classic" migraine attack consists of a headache to one side of the head associated with vomiting and an aversion to light and this is preceded by visual symptoms in the form of coloured wavy lines or other shapes. More commonly migraine may just be a very severe headache with one or two of the other symptoms. Typically the patient recognises what is wrong and if the attack is very different from previous ones and there is genuine doubt then ring for advice.
SINUSITIS. Often there is a severe pain behind the cheek bones or above the bridge of the nose and this may be associated with a blocked nose etc. STEAM and PAINKILLERS often relieve the symptoms. If your eyes themselves are very painful and red, if your vision is continuously affected or if you feel generally quite unwell then please seek advice.
FEVERS. Quite often you can get a very unpleasant headache with a feverish illness such as the 'flu, tonsillitis, chest infections etc.. There may be muscle tenderness and even some slight sensitivity to the light causing worries about meningitis etc.. If the symptoms are mild and the patient well otherwise then it is worth trying some PARACETAMOL first but if there is any doubt about what the diagnosis is or if the patient is getting worse then please telephone for advice.
NEURALGIA. This is due to an irritated nerve which produces a pain sensation in response to, for example, light touch. It doesn't usually give rise to an emergency situation - but if the symptoms are difficult to control then first seek advice by speaking to the duty doctor on the 'phone.
GLAUCOMA and other acute eye problems sometimes present with the onset of a severe frontal headache and usually also with a red eye or eyes and deteriorating eyesight. Often the pain may not localise very obviously to the eye itself. If in doubt ring for advice or go to casualty.

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