Understanding Your Symptoms: Headache
Almost everyone has experienced a headache at some point. Most are temporary and go away without treatment or with an over the counter pain medication like acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). The most common causes of headache are tension (stress) or neck muscle spasm but there is a very long list of illnesses that can also cause headache. Certain characteristics of the headache can give doctors a clue as to whether the headache is likely to resolve on its own or whether it is a symptom of a much more serious problem like concussion, low blood sugar, infection, stroke, bleeding within the skull or even tumor. Therefore it is important to take note of how the headache started (suddenly or gradually), how long it has persisted, what the pain feels like (throbbing, sharp, like a vise around the head, etc), where the pain is most intense (forehead, face, back of head, all over), what, if anything, seems to make the headache worse (light, certain postural positions, time of day) and whether or not there are other symptoms or illnesses accompanying the headache (fever, stiff neck, rash, nausea, vomiting, localized weakness, difficulty speaking, history of head trauma, diabetes, high blood pressure, cancer, etc.). Another important clue is whether or not the headaches tend to recur and if so, how often and for how long.
Features of a particular headache that signal greater concern (and require medical attention) are: a headache of very sudden onset that seems to come on with an explosive nature; one that would be described as the worst headache of a person's life; headaches which grow more severe over a 24 hour period; headaches which are accompanied by fever, stiff neck, nausea, and vomiting; headaches after head trauma; headaches occurring with speech impairment, problems moving an arm or leg because of weakness, vision or balance problems, memory loss or mental confusion; a new, persistent (lasts greater than 24-48 hours) headache in a patient with cancer; a new headache in a person over 50 who has not had headaches in the past particularly when the headache is associated with pain when chewing and with new vision problems.
Headaches that are more benign (not associated with any serious illness or permanent damage) can usually be controlled by drinking fluids (water is best), taking an over-the-counter pain reliever, and rest (preferably in a cool, quiet, dimly lit room). Other simple measures that also offer some relief are placing a cool cloth towel over the forehead or at the base of the neck and avoiding bright lights and excessive noise.
Certain types of recurring headaches called migraines or cluster headaches can be particularly difficult to relieve and may require prescription medication. Migraine headaches occur in about 28 million people (check stat and source) and are often described as throbbing, one-sided headaches at least at the start. Many patients also report that they get a warning symptom or aura such as a very brief visual disturbance (like a brief flash of light) that signals a bad headache is likely to follow. When their headaches occur, they are often accompanied by nausea and/or vomiting. Cluster headaches are one-sided headaches, commonly accompanied by eye tearing or redness and nose stuffiness, that come on regularly and frequently (several times a week) for a period of time and then resolve for a while before another cycle of headaches begins again. In both these cases of recurrent headaches (and any other frequent headache situations), keeping a "headache" diary", recording the day, time, and characteristics of each headache episode including how long it lasts, to present to your physician can be very helpful in devising a successful treatment plan.