Headaches come in many varieties. Perhaps the most common are simply muscle-tension headaches, in which muscles of the neck and scalp contract and cause garden-variety misery.
This time of year, some headaches are precipitated by allergies, as nasal congestion and sinus fullness cause irritation and pain. Similarly, sinus infections cause many headaches and are typically associated with green/yellow nasal drainage, facial pain and pressure, cough and fever.
There are cluster headaches, which are usually around one eye and cause runny nose and eye drainage. Some headaches are caused by inflammation of an artery in the temple, a condition called temporal arteritis. This can cause some serious side effects — including blindness if left untreated, as the blood vessels to the eye become narrowed.
Headaches involving an eye and associated with blurred vision may actually come from glaucoma, a condition that is also associated with blindness if left untreated.
Many headache sufferers endure migraine headaches. These headaches may produce nausea and vomiting, as well as sensitivity to light and sound. They can also produce symptoms that look very much like stroke.
Given the wide variety of headaches, it can be confusing to know when to seek medical care. In short, there are a few things that can help distinguish worrisome headaches from less concerning (but still uncomfortable) causes.
Headaches that begin very suddenly should raise an alarm. In medicine we use the term “thunderclap,” meaning that the headache started like a loud, unexpected clap of thunder. Likewise, a headache that one has never had before, or that is described as “the worst headache of my life,” is troubling.
These sorts of headaches may come from leaking aneurysms (dilated arteries that begin to slowly leak or burst). This description, of being like thunder or like “a hammer to my head,” and beginning with sudden intensity, is enough to prompt at least a CT scan, and often a lumbar puncture (spinal tap) to look for blood in the spinal fluid.
Headaches associated with injury to the head, especially with confusion, vomiting, or loss of consciousness are worthy of physician evaluation and CT scan. This is especially true when the victim is taking a blood thinner.
Headaches with fever should also be taken very seriously as they may suggest spinal meningitis or encephalitis, necessitating a physician evaluation and possibly spinal tap and antibiotics.
Many people suffer for decades, or lifetimes, from headaches. But when the pattern is different, when the symptoms are worse or associated with the characteristics above, then one should seek out immediate care from a physician.
Headaches have caused human misery from time immemorial. However, advances in modern medicine make them remarkably (if not perfectly) treatable.
If you have a new or worsening headache, please see a physician as soon as you can.