Dear Doctor: I've always had headaches, from the time I was a teenager. But now I get them more often -- about one headache per week. Is this a warning sign of something?
Dear Reader: Headache is among the most common -- and ancient -- of physical complaints. You would be hard-pressed to find someone who hasn't suffered from a headache at some point in time.
Mentions of headache in written texts date back to 1200 B.C., and treatments over the centuries have included the use of leeches, garlic, oil in the ear, tying a dead mole to one's head (no, we're not making this up), magnets, electricity, psychotherapy and that universal refuge, the soothing bath.
Most headaches are periodic bouts of pain centered in the head and/or neck. It's not the brain tissue itself that's sending pain signals -- it's the surrounding tissues, blood vessels and nerves that serve the area. Many headaches respond to medication and lifestyle changes. Some, however, like migraines, may persist despite treatment. Some headaches can be warning signs of larger problems such as blood clot, stroke or tumor. Thankfully, those are rare.
Although there are many different types of headache, most fall into four major categories:
-- Tension headaches are the most common, marked by dull pressure, like a band tightening around your forehead.
-- Sinus headaches, which cause a deep, throbbing pain, occur when the cavities around the cheeks, nose and forehead become inflamed.
-- Cluster headaches, marked by severe pain in and around one eye, get their name because they often occur in clusters, but they are less common.
-- Migraines, which can last for hours or even days, cause debilitating pain, often on one side of the head. They can be accompanied by flashes of light, photosensitivity, a blind spot in the field of vision, tingling sensations on the skin and nausea.
Headaches can also be the result of factors such as eye strain, allergy, hunger or fasting, fever, fatigue, dental problems, lack of fluids and hangover, to name just a few. The truth is, the subject of headache is vast and extremely complex. And despite many strides forward (remember that dead-mole-on-the-head cure?), science still has more questions than answers.
What signals that a headache may be something to worry about?
-- A major change to the pattern of your headaches, such as going from a few per month to one per day.
-- The sudden onset of persistent headaches, particularly after age 50.
-- A headache that is the most severe you have ever had.
-- The onset of a headache after a traumatic event to the head.
-- Any headache that alters cognitive function, is accompanied by fever and a stiff neck, or includes symptoms like slurred speech, blurred vision, weakness, numbness or seizures.
These can be signs of underlying conditions such as head injury, infection, tumor, high blood pressure, fluid buildup in the skull, decrease in blood flow or bleeding in the brain.
This all sounds alarming, so let us assure you again that these conditions are rare. However, if any of the above happen to you, please be safe and seek immediate care.
(Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.)
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