Heads will Ache!

Headaches are so common that not to have ever suffered from it raises doubts whether the head is indeed there. While most are innocuous and transient and pass away with time or with a painkiller, some could be indicators of worrisome underlying problems.

The head often aches when other parts of the body are under strain. It accompanies seasonal fevers, fasts, and often appears after a gruelling day under the hot sun. It is not uncommon after a sleepless night of exam preparation, international travel or watching the last of the day’s FIFA world cup matches. The heads of young women often ache before or during periods. It can be brought about by mental stress such as a rebuke by the boss,  a spat at work or a feud at home.

Migraine is a common but specific form of headache that occurs due to spasm of arteries in the head. In its typical pattern, these attacks start with mild ache starting in one half of the head, often associated with visual auras such as light flashes or sparling lights. Over hours it progresses to intense throbbing pain in the head, often associated with nausea, vomiting and restlessness. Painkillers don’t work at this stage. Falling asleep often terminates the attck but some patients have it going for a day or two.

Migraine sufferers often learn to recognize what triggers their attacks (menstrual periods, fasts, bright sunlight, lack of sleep, red wine or cheese, physical or emotional stress etc) as well as the early phase of an episode, as a painkiller pill popped in at this time helps abort a full blown throbbing attack. And avoiding the triggers help reduce the episodes. If they are disablingly frequent and intense, mild medicines such as propranolol or sibelium are very helpful.  Yoga and positive life style changes, if pursued regularly, often provide much relief.

Unlike most stress related headaches that come on by the end of the day, early morning headaches have a different connotation. When they occur in hypertensive patients they suggest that the BP is poorly controlled. In a diabetic, they indicate that the blood sugar levels are dropping too low at night (nocturnal hypoglycemia). Although rare, patients with increased pressure within their heads from causes such as tumors also complain of morning headaches, often accompanieds by vomiting.

The age also matters.  Headache in a school child is often due to eye sight disorder such as short sightedness, or stuffy choked ears or a blocked nose. Pain from sinusitis is usually located towards the front and gets worse with head movements.

In the middle or older ages, cervical spondylosis is a common cause, especially if the ache tends to radiate down to the neck and back and worsens with movements of the neck.

Analysing, diagnosing and treating headaches can be a challenge to doctors as well. A detailed clinical evaluation often holds the key that an expensive MRI scan cannot provide. And a gentle massage of the aching head by the spouse often achieves what the stongest painkillers fail at!

As published in HT City ( Hindustan Times) dated 20 june , 2010.