SD is a 14-year old student. She experiences troubling headache affecting the front part of the head mostly. This has been on for over six months. She and her mum are worried. Enquiry by the doctor revealed that she has difficulty with reading objects on the board in class. An eye test reveals that she has refractive error (a problem with the lens in the eyes). She feels fine with the use of prescription glasses.
Headache is a very common complaint with diverse causes. The brain itself lacks pain fibers, however, surrounding structures within or outside the skull contain nerve fibers that are sensitive to pain.
Headache is a complaint experienced because one has a medical condition or a disease. Therefore, to experience satisfactory relief, the cause must be identified. It could last a short while as found in acute infections like malarial fever and common cold. It could also be recurrent or chronic in duration, meaning that it affects the individual for weeks to months with occasional mild relief.
Common causes of recurrent/chronic headaches
Migraine: Usually one sided and pounding in nature. The individual occasionally experiences difficulty with tolerating bright light and sound. It is commoner in ladies.
Cluster headache: Commoner in males, it is associated with stuffiness of the nose, redness, and tearing from the eyes. Affected individuals may experience drooping of the eyelid.
Tension headache: Usually associated with stress and generally feels like a band-like sensation around the head. Generally, it is relieved by rest and adequate hydration. Medications may be needed for relief sometimes.
Medication misuse: This is usually related to chronic overuse of pain relievers. It is generally due to a rebound of headache symptoms when the pain reliever has been skipped.
Some other causes include:
- Refractive error (problem with the lens of the eyes)
- Poorly controlled sleep apnoea
- Chronic sinusitis / Otitis media (infection of spaces surrounding the nose and infection of the middle ear)
- Trigeminal neuralgia. Trigeminal nerve supplies facial structures.
- Tooth decay.
- Bleeding into the brain.
- Emergency states of extreme elevation of blood pressure.
- Cancer involving the brain or surrounding tissues.
The following complaints are alarming and are suggestive of a more serious cause of the headache. Individuals who experience them must see a doctor immediately.
– Persisting headaches, severe enough to wake one up from sleep or prevent sleep.
– Associated vomiting, intolerance of light, and neck stiffness.
– Associated limb weakness, movement imbalance, or abnormal sensation in the arms or legs.
Given the various causes of headaches, the treatment of the headache is based on the cause and that’s why a thorough evaluation by a doctor is quite important. Modalities of treatment of headache include any or a combination of the following:
1. Treating the cause of the headache
2. Use of pain relievers following prescription only
4. Lifestyle adjustments: Reduction of stress, avoidance of certain diets that are associated with some headaches.
5. Indiscriminate use of pain relievers should be avoided as it can mask the intensity of the headache and prevent the need to seek help.
Dr Femi Afolayan obtained his medical degree at the University of Ilorin, Nigeria. He had a stint in internal medicine residency programme at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi state and later National Hospital, Abuja before he relocated to Australia and started out in emergency medicine training as a registrar for 2 years and later a fellowship program in internal medicine about 3 years ago. He is currently a senior registrar in acute care and intensive medicine, general medicine, and geriatrics. He is also an honorary lecturer with the medical school, Deakin University, Geelong, Australia. He enjoys teaching, cooking and playing video games. He can be reached on email@example.com.