HEALTH WATCH
Don't ignore that headache
Dr. U.S. SRINIVASAN
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A headache could be the sign of a serious underlying disorder.
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Treatable if detected early: See a doctor if you have frequent headaches. Photo: Shaju John
HEADACHE is one of the most common complaints. It occurs in around six to 20 per cent of the general population and among all age groups. The commonest form is either migraine or tension headache. Physicians also attribute chronic sinusitis to be a cause for headache.
After some time a person suffering from headache resorts to self-medication. But sometimes a headache can be the manifestation of a more serious problem, which if ignored can lead to a situation where the person either is paralysed or lapses into coma.
One kind of headache is known as cluster headache also called suicide headache. Patients suffer headache mainly at night since sleep is a trigger. The pain is of severe intensity and lasts anywhere from 15 to 180 minutes. It recurs with remarkable regularity each day for periods that lasts for six to 12 weeks — hence the term cluster. A no- pain period lasting months or even years may follow this.
Symptoms
This commonly affects men and is usually localised to the eye and temple but can involve the maxilla and can be associated with nasal congestion. Nasal discharge may be clear and colourless in these cases. Some automatic symptoms are increased tears, facial sweating, drooping of the upper eyelid and decrease in size of pupils. These patients engage in self-hurting behaviour and almost 50 per cent would attempt suicide.
Recently Positron Emission Tomographic (PET) studies have shown that posterior inferior hypothalamic grey matter is activated during episodes of cluster headache and is considered to be the generator of the pain. It can be treated with a single anticipatory dose of ergotamine or sumitriptan at bedtime. Inhalation of 100 per cent oxygen for 10-15 minutes at the onset may abort the attack but is not always practical.
Drugs like verapamil, divalproex, topiramate,lithium carbonate, methysergide and prednisone are used prophylactically in prevention. In severe cases, which do not respond to these drugs, deep brain stimulation has been found to have moderate success.
Due to tumour
Brain tumour headache can occur at any age and can affect both sexes. It is usually one-sided and sometimes can be global. It is of variable intensity, is non-throbbing and commonly occurs early in the morning with increasing severity. It lasts anywhere from a few minutes to a few hours and occurs over a period of weeks to months.
It is aggravated by physical activity and changes in position of the head. Resting diminishes its frequency. When associated with early morning vomiting, transient obscuration of vision, leg weakness with drop attacks, fits or loss of consciousness, there is a high likelihood of brain tumour. Investigations like Computed Tomography Scan or Magnetic Resonance Imaging clearly identifies the brain tumour, which can be operated upon to ensure a cure.
Headache due to bleed into the brain due to subarachnoid haemorrhage is sudden and severe. It occurs over the back of the head and neck, sometimes over the forehead and is usually associated with projectile vomiting and transient loss of consciousness. The patient may completely recover from the loss of consciousness and have a dull headache following it.
Warning sign
If the person is able to remember clearly the time, the date of onset of headache it is more likely to be due to bleed in the brain. This is also known as Warning Headache since if ignored the patient may develop a massive bleed into the brain and lapse into coma.
The subarachnoid haemorrhage occurs due to rupture of abnormally dilated blood vessel (aneurysm) or can occur due to uncontrolled hypertension. A CT scan of the brain followed by angiogram of the brain is used to detect this.
Brainfever headache is almost similar to the subarachnoid haemorrhage but is usually associated with high-grade fever, neck stiffness and is of short duration. Those who have discharge of pus from the ear that is not surgically treated, chronic pyogenic sinusitis, congenital heart disease, tuberculosis, pyogenic infectious diseases in other areas of the body, immunocompromised individuals or those on immunosuppressant drugs, or those who have had organ transplants or who are HIV positive are likely to have brain fever or brain abcess.
Headache due to viral infection of the brain is usually associated with fits and is rapid and of short duration. If ignored, the patient lapses into coma.
The causes are picked up by investigations like CT scan, MRI and analysis of the cerebrospinal fluid.
Temporal arteritis headache occurs in the elderly above 50 years and can affect both men and women. It is a throbbing, one-sided headache present for weeks or months associated with intermittent blurring of vision, fever, loss of weight and multiple joint pains.
If ignored it can lead to total blindness in one or both eyes and sometimes cause a stroke. Blood tests like erythrocyte sedimentation rate, `C' reactive protein and biopsy of the temporal artery confirm this problem.
Most of these headaches are treatable if detected early and if proper treatment is instituted before the person develops paralysis or lapses into a coma.
All the drugs mentioned in this article should be taken only on the advice of a medical practitioner.
The writer is Chief Neurosurgeon, MIOT Hospitals, Chennai. E-mail him at ussrini@vsnl.net
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