Author: Dr. Simranjeet Singh
Consultant Neurosurgeon 
ARHI Hospital

Headaches are probably the most common of medical problems, which almost every person faces at one time or the other. Though a majority of these headaches are self limiting and may not require medical attention, sometimes, and for some people they may become serious enough to warrant expert opinion. And, on some rare occasions, what may seem to be a trivial headache, may be hiding a major medical condition underneath. 

An occasional headache, lasting few minutes, occurring may be just once or twice a month, not associated with any other worrisome feature, may be self limiting or be amenable to management with over the counter medications. 

But a sudden onset new headache, or a change in the character of a chronic headache, or a headache which is severe/unbearable, or associated with vomiting / visual disturbances / fainting / loss of consciousness/ seizure or any other such alarming features definitely warrants urgent medical attention and probably a thorough evaluation.

Headache is a common complaint with which a patient may present to the neurosurgical OPD ( Out Patient Department ). The most important concern for the patient as well as the doctor is to ascertain the cause of the headache, to classify the headache type and to formulate a treatment plan which would best suit the patient. 

Headaches can be either primary or secondary. Primary headaches are the most common type and here the disease or the disorder is the headache itself. Secondary headaches are headaches which are caused by some other underlying disease/ disorder eg an infection in the brain, or a tumour in the brain, or an injury/insult. The cause of secondary headache can also  be outside the brain/skull, eg dental caries / paranasal sinus infection (sinusitis) / ear infection / cervical spondylosis / oral ulcer etc. 

The role of radiological evaluation ( CT / MRI ) in  a patient presenting with headache disorder is mainly to rule out secondary headache. For a patient with suspected primary headache, a negative CT / MRI helps to confirm the diagnosis by ruling out the presence of any significant underlying disease pathology. 

Primary headaches can again be of multiple types, eg tension type headache, migraine type headache, cluster headache, and some less common types being medication overuse headache, pregnancy headache, exercise headache, hemicrania continua, new onset daily headache etc. 

Tension type headache is probably the most common of all headache disorders and is also probably the type which can be cured completely, sometimes even without any medication. Tension type is usually characterised by a throbbing type headache, which may be associated pain/stiffness in the neck/jaw, is usually worse by evening, and may be associated with sleep disturbances and other signs of anxiety disorder/depression. Recognition of this headache type, and working to relieve the underlying anxiety/depression can easily cure it. Counselling sessions, learning stress management techniques, lifestyle modifications, and some medications when needed can all help provide relief. 

Migraine type headache is characterized by headache that is usually moderate to severe in intensity, may be limited to one to side of the head, may last hours to days, occurs one to two times per week, may be associated with nausea/vomiting, with photophobia/phonophobia, and may be associated with some visual symptoms also. Migraine type headache is usually more commonly seen in young women, and may even run in families. Medication can prevent recurrent relapses and provide relief. 

Cluster Headache is characterised by occurrence of headache episodes in clusters/bouts, where the patient may have days with maybe 8 – 10 bouts of headache in a day, and then be headache free for a few weeks or even months. This type of headache is characterized by redness and watering of the eyes, usually limited to one side only. Again, recognition of the headache type, and proper medication can relieve it. 

As we discussed, headaches though often taken to be trivial and sometimes even neglected, may be a cause of significant pain and suffering to the person who is affected by them and sometimes may even be hiding a significant underlying  disease pathology. So seeking expert medical advise, especially when the headache is severe/ non relenting/ worsening / affecting the quality of life / is associated with any of the danger signs is definitely warranted.