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As the name suggest it is ‘ache’ or pain, in the region of head. In broader term headache is used to describe a pain located in the region of head, over eyes, face or at the base of the skull. The word ache is derived from an old English word ‘acan’ meaning to “suffer continued pain”.
When the headache occurs repeatedly in a person it termed as headache disorder eg: migraine, tension-type headache, and cluster headache.
• It could be an important indicator/symptom of a threatening disease like spontaneous brain hemorrhage- SAH, clotting of vessels of brain (DVT), meningitis- inflammation of outer sheath like covering of brain called meninges, sometimes brain tumor etc.
Mostly headaches are associated with benign conditions which have been experienced by nearly everyone some or the other time in their lifetime, but it is important to pay attention to headache which are associated with warning signs like unusually severe sudden onset headache, where some describe it as worst headache of life or headache with fever, neck stiffness, limb weakness etc.
• It could be a symptom of another underlying condition which needs to be treated specifically rather than just trying to suppress headache by taking pain killers eg: sinusitis.
• Also it affects a person’s quality of life. It can result in decreased productivity and loss of time and money, eg migraine, tension type headaches.
• WHO has found that headache is one of the most underestimated, under-recognized and under-treated condition with only a minority of people with headache disorders being diagnosed appropriately.
• Headache associated with fever, neck stiffness, nausea or vomiting, seizures, sensitivity to light or confusion- meningitis or encephalitis.
• Headache associated with weakness in limbs or face or slurred speech- stroke.
• Headache associated with pain and redness in eye– migraine, sinusitis, inflammation in orbit or behind it, or cluster headache.
• Headache associated with vision problems- flashing lights, blind spots or blindness- ocular migraine or migraine with aura.
• Headache occurring after injury to head- concussion or hemorrhage.
• Headache getting worse with time
• Headache causing a person to get up from sleep- high BP, brain tumors, sleep apnoea or cluster headache
• Headache associated with changes in personality.
• Headaches in cancer patients or patients having impaired immune system
If a person notices these warning signs he or she should undergo medical assessment immediately.
The doctor would start from taking proper history about the characteristic of headache:
• Where is it located?
• What’s the severity of headache?
• Any associated signs or symptoms- like fever, aura, nausea/vomiting, neck stiffness?
• Would ask if one can think of aggravating or relieving factors?
• Would ask you in detail if you have aggravating or relieving factors?
• Whats the duration or periodicity of headache?
The doctor would then do general physical examination to assess the general condition of the body checking pulse, BP, temperature etc and then would do neurological examination assessing consciousness, feeling of sensation and power in limbs etc.
After this if the doctor thinks he/she needs to assess the person more than he might order some tests- blood tests, CT scan, MRI or EEG etc.
Mostly, episodic headaches resolve within 48 hours. If a headache persists for more than two days or increases in intensity, it calls for medical assistance.
If a person has headaches for more than 15 days in a month over a period of three months, the person tends to have a chronic headache condition. He or she should consult a doctor to find out what’s wrong, even if the person is able to manage the pain with over the counter painkillers like aspirin or ibuprofen.
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