Headaches

Multi-million dollar sales of over-the-counter (OTC) pain relievers is proof of how many people suffer from headaches. Headache is one of our most common health complaints. Fortunately, most headaches are annoying rather than serious.

Rather than the common misconception that many headaches are caused by eyestrain, almost all headaches may considered to be due to tension, migraine or disease.

Tension headaches are the most frequent. There is no simple explanation as to the mechanism. Pain may be experienced above the eyes, in the temples, almost anywhere on the scalp. Yet the location of the pain provides little help in localization of a cause. Tension headaches may result from temporary increases in the stress in everyday life. They may result from sleeping or working in a strange position, jaw clenching, grinding of teeth during sleep, or excessive gum chewing. These headaches are usually temporary and often respond to simple OTC pain relievers.

Migraine is another common form of headache. Although the cause of migraine is poorly understood, classic migraine may run in families and affect children as well as adults. The history of a family member with pounding headaches, going off to sleep in a dark room is not unusual. Symptoms of migraine may demonstrate visual aberrations in one or both eyes. If no headache follows this experience it is considered an “ocular” migraine. While the initial ocular migraine episode is often scary, lasting effects are rare. Migraine is not a precursor of subsequent serious illness. Ocular migraine may be recurrent, with each episode similar to the previous one. At the end of the ocular migraine, typically lasting 5 minutes to two hours, senses promptly return to full normalcy. When preceding a headache, the visual display, or a funny smell, or an unusual taste is considered the “aura.” Common features of migraine headaches include recurrent, but not usually continuous pain, beating in time with one’s pulse; nausea and vomiting; exacerbation by activity; and identifiable triggers (red wine, cheese, chocolate, menses, medications). Migraine treatment ranges from avoidance of triggers, to OTC anti-inflammatory medications, to prescription analgesics, to antidepressants, to rapid-onset medications taken through inhalers or injections.

Headache caused by eye disease are not common, but is usually felt in the brow area, typically late in the day after extended reading. Headache may be caused by high blood pressure and blood pressure measurement is helpful in evaluating recurring headache. Headache caused by a brain tumor or disease is rare. It may appear quite suddenly or as an increasingly severe headache pattern over weeks to months. It may disturb sleep. The intensity of the headache may vary with body position, especially severe in a head down position. It is often associated with other symptoms such as numbness, dizziness, weakness or seizures. Such headaches tend to get significantly worse over time.

Diagnosis begins with a thorough examination by your primary care physician for any chronic or recurring headache. An eye exam may be helpful. Carefully describe your symptoms, noting when the headache occurs, associated signs and symptoms, other medical history, as well any family history.

Treatment depends on cause. If serious medical disease is found, it must be treated. Stress management may be beneficial. If your headache is not a symptom of a disease, what you tell your physician about your headaches can help him or her design a treatment program suited to your needs.