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Headaches

Headaches

Headaches are a very common medical problem and a common cause of disability among men and women. Headaches interfere with the ability to work and do daily tasks. Some people have frequent headaches. Other people hardly ever have them.

Causes

Although headaches can be painful and distressing, they are rarely due to a serious condition.
Primary Headache Disorders: Most headaches are not caused by another identifiable disorder. Such headaches are called primary headache disorders. They include
•    Tension-type
•    Migraine
•    Cluster headaches

Tension-type headaches are the most common type of headache.
Secondary Headache Disorders: Less commonly, headaches result from another disorder. Such headaches are called secondary headache disorders. Usually, disorders that cause headaches are not serious. These disorders often affect the eyes, nose, throat, sinuses, teeth, jaws, ears, or neck and are minor or temporary. For example, a dental infection, sinus infection (sinusitis), or a problem with the joint of the jaw (temporomandibular disorder) may cause a headache.

Rarely, headaches are caused by a serious disorder, including the following:
•    Brain infections, such as abscess, meningitis, and encephalitis
•    Other infections, such as tuberculosis, if they affect the brain
•    Brain tumors
•    Accumulation of blood in the tissues that cover the brain (subdural hematoma), often due to a head injury
•    Bleeding in the brain (intracerebral hemorrhage)
•    Bleeding in the tissues that cover the brain (subarachnoid hemorrhage), often due to rupture of a bulge in an artery (cerebral aneurysm) or of an abnormal connection between arteries and veins (arteriovenous malformation)
•    Intracranial hypertension
•    Very high blood pressure (rarely)
•    Breathing disorders, such as emphysema and sleep apnea
•    Giant cell (temporal) arteritis

Some of these disorders, such as brain tumors, hemorrhages, hematomas, and intracranial venous hypertension, increase pressure within the skull. In their early stages, many infections, including Lyme disease and Rocky Mountain spotted fever, can cause headaches, as can influenza if severe. These infections can be serious.

Headaches commonly result from withdrawal of caffeine, withdrawal of pain relievers (analgesics) after long-term use, and use of certain drugs that widen blood vessels.
    
Diagnosis

Usually, doctors can determine the type or cause of headaches on the basis of the person's medical history, the characteristics of the headache, and the results of a physical examination. Doctors ask about the characteristics of the headache: frequency, duration, location, severity, and any symptoms that accompany it. Doctors also ask what triggers the headache, what makes it worse, and what relieves it.

The following characteristics may indicate that a serious disorder is the cause of headaches, and people who experience any of them should promptly seek medical attention.
•    Headaches that are increasing in frequency or severity
•    Daily headaches
•    A very sudden, severe headache (thunderclap headache)
•    Any change in the pattern or nature of headaches
•    Headaches that begin after age 50
•    Headaches accompanied by symptoms such as fever, a stiff neck, changes in sensation or vision, weakness, loss of coordination, fainting, or very high blood pressure
•    Headaches that cause seizures or confusion

For example, a severe headache with a fever and a stiff neck suggests meningitis—a life-threatening infection of the layers of tissues covering the brain and spinal cord (meninges). A headache that occurs very suddenly and that is more severe than any others the person has experienced may suggest a subarachnoid hemorrhage—bleeding within the meninges, which is often due to a ruptured aneurysm.
Testing: When doctors suspect a serious disorder, diagnostic tests are usually done. If a tumor, a hemorrhage, or increased pressure within the skull is suspected, computed tomography (CT) or magnetic resonance imaging (MRI) is done immediately.

If meningitis is suspected, a spinal tap (lumbar puncture) is done immediately. A spinal tap may also be done if doctors suspect a subarachnoid hemorrhage or encephalitis. If doctors think that a mass (such as a tumor or abscess) may be present, CT or MRI is done before the spinal tap to determine whether a spinal tap can be done safely. A spinal tap decreases pressure below the brain. If a mass is present, the brain may shift downward and be pressed through one of the small natural openings in the tissues that separate the brain into compartments—a life-threatening disorder called herniation.

Occasionally, blood tests are done to check for a disorder such as Lyme disease. The erythrocyte sedimentation rate (ESR—the rate at which red blood cells settle to the bottom of a test tube containing a blood sample) may be determined to check for giant cell arteritis, which causes inflammation. A high ESR suggests inflammation.

 

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