Headache is among the most common symptoms seen in primary care and represents up to 30 percent of referrals to neurology specialists.
In general, it has been estimated that 47 percent of the adult population has at least one headache per year. Data has shown that head pain is the fifth leading cause of Emergency Department visits overall in the United States and accounts for 1.2 percent of outpatient visits (according to the World Health Organization, 2012).
Migraine headache is often characterized by moderate to severe throbbing pain on one side of the head with associated nausea, vomiting and sensitivity to light and sounds. However, symptoms may vary dramatically. An individual may even have differing symptoms from one headache to another, or symptoms may change with an ongoing headache. Migraine typically gets worse with routine physical activity such as walking or climbing stairs. Migraine headache that occurs on 15 or more days per month for three consecutive months is considered chronic migraine.
Some people experience symptoms before headache pain begins; this is known as an aura. A visual aura is most common and can be described as seeing light or dark spots, flashes of light, zigzag lines or even tunnel vision. Auras can also consist of numbness or tingling in the face or extremities and may progress from the hand upward along the arm or shoulder.
Diagnosis of migraine headache is usually straightforward and does not require additional testing. However, certain headache patterns or features are more concerning and could reflect a serious underlying abnormality that requires immediate attention. Some of these “red flag” symptoms include:
• First severe headache in a person over age 50.
• Sudden onset headache that reaches maximum intensity within five minutes and is associated with cough, sneeze, straining, exercise or intercourse.
• Accelerating pattern of headache.
• Headache associated with fever.
• Headache associated with a change in level of consciousness.
• Headache in a person with known malignancy.
• Headache associated with severe eye pain.
Tension headache consists of a chronic recurrent headache of uncertain cause that lacks features of migraine or other headache syndromes. Contraction of neck and scalp muscles is thought to be a possible cause. Classically, tension headache begins after age 20 and is characterized by attacks of non-throbbing pain on both sides of the back of the head not associated with nausea, vomiting or visual aura. The pain is sometimes described as a tight band around the head.
Overuse of medications used to treat migraine or other forms of headache can lead to a chronic daily headache syndrome. This type of headache is caused by using medications such as ibuprofen, Aleve, Excedrin, BC powders, or any other pain reliever more than three days per week. Treatment for medication overuse headache is withdrawal of the offending medications, which is done abruptly except for narcotic analgesics or sedative drugs.
Two types of medications are used – medications to abort the headache attack and medications to prevent future attacks. A variety of medications have been found to be beneficial in managing headaches. However, these medications should not be used until a headache care provider has determined the type of headache and developed an appropriate treatment plan.
Headache occurs very commonly among adults. Chronic headaches can be debilitating, often severely limiting daily life functions. Seek help – no one should suffer with chronic headaches when the appropriate treatment can tremendously improve quality of life.
Lisa Dabbs is a nurse practitioner with Neurology Consultants in Tupelo.