Headache

HEADACHE

Definition

  • Pain or discomfort of the scalp or forehead areas
  • The face and ears are excluded

Common Causes

  • During the course of a year, the majority of adults suffer headaches.
  • Muscle Tension Headaches: The majority of headaches are caused by muscle tension. The discomfort is usually diffuse and may radiate down into the neck and shoulders. The discomfort is aggravated by emotional stress.
  • Migraine Headaches: Also referred to as vascular headaches. The headache is moderate to severe in intensity, described as throbbing or pulsing in nature, and usually unilateral. Associated symptoms include nausea and vomiting. Some individuals will have visual warning symptoms (aura) that a migraine is coming.
  • Sinusitis: Headaches occur with sinusitis. The headache is usually located in the forehead area and the individual has associated sinus symptoms (nasal discharge, congestion).
  • Fever: A mild to moderate headache frequently accompanies the fever that occurs with common viral infections such as the flu and the common cold. A severe headache that persists after the fever has come down to normal is a red flag that something more serious may be causing the headache.
  • Caffeine Withdrawal: This occurs in individuals who drink large amounts of caffeine (e.g. coffee, tea, colas) and suddenly stop. Some caffeine drinkers will note a headache upon arising that goes away after their first cup of coffee.

Some Serious Causes of Headache

  • Stroke ("Brain Attack")
  • Meningitis, encephalitis
  • Temporal arteritis
  • Brain tumor
  • Carbon monoxide exposure

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WHEN TO CALL YOUR DOCTOR

Call 911 (you may need an ambulance) if:

  • Difficult to awaken or acting confused
  • New onset of weakness of the face, arm or leg on one side of the body
  • New onset of numbness of the face, arm or leg on one side of the body
  • New onset of slurred speech, garbled speech, or inability to speak

Call your doctor now (night or day) if:

  • You feel weak or very sick
  • Pain is severe and it is the worst headache of your life
  • Pain is severe and you have not had severe headaches before
  • Stiff neck (can't touch chin to chest)
  • Blurred or double vision
  • Unsteady walking
  • Fever of 103 F (39.4 C) or higher
  • Fever of 100.5 F (38.1 C) or higher and you:  
    • Are over 60 years of age
    • Have diabetes mellitus or a weakened immune system (e.g. HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy)
    • Are bedridden (e.g. nursing home patient, stroke, chronic illness, recovering from surgery)
  • Possible exposure to carbon monoxide

Call your doctor within 24 hours (between 9 am and 4 pm) if:

  • You think you need to be seen
  • Sinus pain or pressure of forehead with nasal symptoms (discharge, congestion)
  • Age greater than 50
  • Weakened immune system (e.g. HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy)
  • Fever lasts longer than 3 days (72 hours)

Call your doctor during weekday office hours if:

  • You have other questions or concerns
  • Headache present longer than 24 hours  
  • Headaches are a recurrent problem

Self care at home if:

  • Similar to prevously diagnosed migraine headaches and you don't think you need to be seen
  • Mild headache and you don't think you need to be seen
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HOME CARE ADVICE

  • Pain Medication: For pain relief, take acetaminophen every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
    • Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
    • Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  • Migraine Medication: If your doctor has prescribed specific medication for your migraine, take it as directed as soon as the migraine starts.
  • Rest: Lie down in a dark quiet place and try to relax. Close your eyes and imagine your entire body relaxing.
  • Local Cold: Apply a cold wet washcloth or cold pack to the forehead for 20 minutes.
  • Stretching: Stretch and massage any tight neck muscles.
  • Call Your Doctor If:
    • Headache last longer than 24 hours
    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of patients presenting to the emergency department with acute headache. Ann Emerg Med. 2002;39(1):108-22.
  2. Attia J, Hatala R, Cook DJ, et al. Does This Adult Patient Have Acute Meningitis? JAMA. 1999;282:175-181.
  3. Edlow JA Diagnosis of subarachnoid hemorrhage in the emergency department. Emerg Med Clin North Am. 2003;21(1):73-87.
  4. Friedman DI. The eye and headache. Ophthalmol Clin North Am. 2004;17(3):357-69, vi.
  5. Gus M, Fuchs FD, Pimentel M, Rosa D, Melo AG, Moreira LB. Behavior of ambulatory blood pressure surrounding episodes of headache in mildly hypertensive patients. Arch Intern Med. 2001 Jan 22;161(2):252-5.
  6. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders. Cephalalgia. 2004;4:1-160.
  7. Lipton RB, Stewart WF, Liberman JN. Self-awareness of migraine: interpreting the labels that headache sufferers apply to their headaches. Neurology. 2002;58(9 Suppl 6):S21-6.
  8. Muiesan ML, Padovani A, Salvetti M, Monteduro C, Poisa P, Bonzi B, Paini A, Cottini E, Agosti C, Castellano M, Rizzoni D, Vignolo A, Agabiti-Rosei E. Headache: Prevalence and relationship with office or ambulatory blood pressure in a general population sample (the Vobarno Study). Blood Press. 2006;15(1):14-9.
  9. Purdy R, Kirby S. Headaches and brain tumors. Neurol Clin. 2004 Feb; 22(1); 39.
  10. Saper JR. Medicolegal issues: Headache. Neur Clinics. 1999;17(2):197-214.
  11. Sheftell FD. Role and impact of over-the-counter medications in the management of headache. Neurol Clin. 1997;15(1):187-98.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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