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When to be concerned about headache: ten percent of headaches require urgent care. Here's how to recognize the symptoms of a serious headache.

For most of us, an occasional headache is nothing more than a minor inconvenience. But for some, headaches can strike repeatedly. At their most benign, these headaches are the result of lifestyle and behavioral factors, and addressing these factors can significantly improve quality of life. In other cases, a headache may indicate more serious health problems. Knowing when and how to get help for headache pain will help you get the care you need.

"About 90 percent of headaches are primary headaches--such as tension, sinus, cluster, and migraine headaches," says David Borsook, MD, PhD, co-director of the Center for Pain and the Brain, which has a branch at MGH. "These headaches may be painful, but they aren't related to any underlying disorder and they are usually not dangerous. Secondary headaches, on the other hand, are head pain associated with a serious underlying condition, such as head trauma or a tumor, and require prompt treatment."

Secondary headaches tend to occur more frequently in older adults. Prompt medical assessment with neuroimaging and other tests are recommended to help identify their cause, and chances are good that treatment can eliminate or reduce pain.


The following types of headache should be taken seriously:

* "Thunderclap" headaches: Characterized by a sudden and severe onset, these headaches may indicate hemorrhagic stroke, bleeding from a cerebral vein following a head injury, or a surge of high blood pressure caused by a problem such as acute inflammation of the kidney. When accompanied by a stiff neck, thunderclap headaches might signal infectious meningitis or a ruptured brain aneurysm.

* Progressive headaches: Headaches that grow steadily worse, or that worsen when lying down, or are accompanied by weakness, numbness, or visual symptoms, should cause concern. Underlying causes may range from inflamed scalp arteries that can be complicated by stroke or cause blindness, to brain tumors or head injury.

* Cough headaches: Headaches associated with sneezing or coughing may be harmless, but they may also indicate a brain tumor or obstruction of ventricles in the brain that channel cerebrospinal fluid. See your doctor.


"Primary headaches--by far the most common types of headaches--may be more difficult to address and are often given cursory treatment because they're not seen as life-threatening and patients eventually get better," says Dr. Borsook. "Yet if they were more widely treated, it might be possible to ease symptoms among as many as 20 percent of older adults who have more than two of these headaches per month and suffer significant disruption and diminished enjoyment of life because of them."

A study published in the May 2015 issue of the Journal of General Internal Medicine revealed that treatment of primary headaches in the U.S. often involved overuse of low-value, high-cost services such as advanced imaging and treatment with barbiturates and opiates rather than recommended treatments, such as counseling on stress reduction or avoiding dietary triggers.

"Appropriate treatment for primary headaches involves determining headache triggers and making lifestyle changes, and it often results in improvement," says Dr. Borsook. "However, if your headache recurs four or more times in a month despite treatment, consider seeing a headache specialist."


Primary headaches include: migraines, which affect approximately three in 10 people at some time in their lives, are characterized by moderate to severe throbbing pain, often on one side of the head, that gets worse with physical activity and may be accompanied by other symptoms, such as vomiting or extreme sensitivity to light, noise or odors; tension headaches, which comprise about 70 percent of headaches, are felt as a band-like sensation around the head and neck, and do not get worse with physical exertion; and cervical headaches, which are characterized by pain in the back of the head, sometimes accompanied by weakness in the arms and/or numbness and tingling in the scalp, neck or arms.

Other, less common, primary headaches include cluster headaches, which occur in a series of short-lived, severe bouts; exertional headaches, provoked by exercise; and sinus headaches, triggered by blocked sinuses. MMM


Secondary headaches are serious headaches that could be disabling or life-threatening. Contact your medical care provider promptly for headaches that are:

* Sudden and severe

* Associated with a blow to the head or other traumatic injury

* Become more severe over time

* Accompanied by symptoms such as fever, neck stiffness, nausea, loss of balance, rash, confusion, difficulty speaking, weakness, dizziness, numbness, or visual disturbances

* Headaches that occur four or more times in a month or are a major cause of discomfort and disruption do not necessarily suggest a secondary headache, but require assessment as well.
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Publication:Mind, Mood & Memory
Date:Sep 1, 2015
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