Headaches are such a nuisance! Thomas Jefferson would have to confine himself to bed for two to three weeks for his migraine attacks. Serena Williams, Carly Simon and Lewis Carroll all suffer or suffered from severe headaches. Statistically, 97 percent of all people have headaches, which makes one wonder how truthful the other 3 percent are, right?
There are basically four types of headaches. By far the most common are tension headaches. In our modern society, stress causes us to worry, and we respond with furrowed brows, clenched teeth and neck muscle straining. This causes the muscles around our heads to tighten and become sore.
The pain of tension headaches is described as “hatband.” There’s soreness in the forehead, both temples and the back of the head along the ridge where the neck muscles attach. Many times, these areas are tender. Treatments include over-the-counter pain medications, such as acetaminophen and ibuprofen, massage of the sore areas and temperature packs — usually heat, although some find cold packs help more. Stress relaxation techniques, such as yoga and meditation, may be preventative. In other words, “Don’t worry, be happy.”
Humans have four pairs of sinuses in their skulls. These are caverns in the bone lined with mucous-producing tissues designed to catch foreign particles that we breathe in through our nose. Viruses, pollens and other allergenic molecules trigger increased mucous production, and when the sinuses get full or infected, they can cause pain.
The areas of discomfort are specific to the sites of the sinuses, which are just above the eyebrows, below the arches on the cheeks and in the nasal bridge. The fourth sinus set is behind the nose, which will cause pain behind the eyes. Inflamed sinuses will be tender when pushed on. Nasal drainage may turn thick and green. Some people will get feverish, and most will have a cough. Sometimes the congestion will back up into the ears. Treatments for sinus headaches include decongestants, antihistamines and sometimes antibiotics. I often recommend fluticasone (Flonase), a steroid nasal spray that will get into the sinuses and decrease the allergic response.
Migraine and cluster headaches affect about 20 percent of women and 8 percent of men. The cause of these headaches is controversial, with some physicians maintaining they’re caused by spasms of the vessels in the brain and others laying the blame on neurological issues — that is, specific brain triggers. Some people have a prodrome or warning phase with vague symptoms such as food cravings, yawning or mood changes. Next might come the aura, several minutes to an hour of visual disturbances such as flashing lights or other neurologic symptoms like prickling in the skin, trouble speaking or limb weakness.
Both cluster headaches and migraines usually cause severe pain on one side of the head with a sense of it being deep inside, running from the back of the head and into the eye. However, the pain can be on both sides. Associated symptoms include sensitivity to light, sound and smells, and often nausea and vomiting. Interestingly, sometimes migraine headaches manifest with sinus headache symptoms. We no longer treat migraines with narcotics because nowadays, there are many effective preventive and therapeutic treatments — too many to go into in this article.
I said there are four main causes, but really, there are those three main ones and then a laundry list of others. For example, trauma, exhaustion, electrolyte imbalance, anemia, poisonings, carbon monoxide and hypoxia all cause headaches. But the two main ones we worry about are brain tumors and internal bleeding. Brain tumors rarely cause early symptoms, as the brain tissue itself doesn’t have pain fibers. Brain bleeds from ruptured aneurysms usually are abrupt and severe, although those from a head injury may be much slower to show effect. These two causes, tumors and bleeding, require CAT scans for the diagnosis, although that test won’t show tension or migraine changes.
Headaches have a variety of causes. Most of the time, the diagnosis is apparent from where the head hurts and other associated symptoms. If your headache is sudden and severe, go to the emergency room. If it is persistent and worsening, it’s best diagnosed through your family physician.
Dr. Philip L. Levin is a retired emergency medicine specialist in Gulfport. Learn more or contact him at www.Doctors- Dreams.com.
