LEWISBURG – The pulsating, gnawing pain in the head must not be a migraine. Headaches come in a variety of forms and not all are treated equally.
Neurologists from the area gave a breakdown of the differences between headaches, ranging from just annoying and uncomfortable to downright debilitating.
Dr. Jessica Ahlum is a neurologist at Evangelical Community Hospital. Dr Stuart Olinsky is with UPMC in North Central Pa. Neurology. Dr. Abigail Chua, headache specialist at Geisinger, is certified in both neurology and headache medicine.
“Many things can cause headaches, like poor sleep, too much caffeine, and dehydration. In addition, some people have neurological or medical conditions that predispose them to having headaches, ”Chua said.
Many people often assume that severe headaches and migraines are one and the same thing. Not so, said Ahlum.
“Migraines are classified into a group of specific symptoms,” she said, including sensitivity to light and sound, changes in smell, and some neurological symptoms such as numbness and tingling. Patients with migraines also initially experience an aura or awareness that the migraine is onset. An aura can consist of the symptoms mentioned and / or nausea or dizziness about an hour before the onset of migraine pain. A migraine headache is often included on one side of the head and face. “General headaches are not associated with it,” said Ahlum.
“If you have frequent migraines, it’s important to speak to your doctor to rule out any underlying problems,” said Olinksy.
Common forms of headache, other than migraines, are tension headaches, occipital neuralgia, and cluster headaches. Neurologists can determine the type of headache a patient is having based on the symptoms that surround the pain.
The most common type of headache is the tension headache. The pain is like a tight rubber band around the forehead to the back of the head.
“When most people think of a headache, that dull pressure and discomfort in the head, they describe a tension headache,” said Olinksy. “These headaches are very common and usually have no additional symptoms. They can be painful, but are rarely a sign of a more serious illness. “
Ahlum said that tension headaches are often due to a muscle spasm in the neck or head. The pain is often moderate and can be managed with over-the-counter pain relievers.
Cluster headaches are known for their location. The pain triggers autonomic symptoms such as red eyes, eyelid swelling, dilated pupils, and nasal congestion. These extremely painful headaches appear in “clusters” over a day and last no longer than an hour.
“A cluster headache usually wakes you up in the middle of the night with severe pain in or around one eye on one side of the head,” Olinsky said. usually followed by periods of remission when the headache stops. During remission, there will be no headache for months and sometimes even years. Cluster headaches are rare and not life-threatening. “
The only known treatment for cluster headache relief is inhalation of oxygen. “The classic way to find out if it’s a cluster headache is to give extra oxygen,” said Ahlum, noting whether the headache stopped.
Occipital neuralgia occurs when nerves in the back of the head are irritated, Ahlum said. “That can cause a sharp, stabbing pain in the back of the head,” says Ahlum and is often accompanied by pain in the neck and behind the ears. An injury to the neck or head can cause this headache, which is where the nerve becomes pinched.
Arthritis in the upper spine can also cause a headache, Ahlum said. In severe cases, she refers patients with this problem to pain management for further treatment.
Ahlum said when a patient with a chronic headache is referred to them, she meets with them to discuss their symptoms. It can divide headache into one or two groups: migraine-like or non-migraine-like.
Ahlum says she likes to rule out serious concerns right away by getting an MRI of the brain to see if there’s a stroke or a tumor. She also looks into the fundus to see if any growth is putting pressure on the brain. Another worrying factor is weakness or hyperreflexia (loss of movement).
“There are no guaranteed signs that a headache is caused by an underlying medical condition. However, headaches that are brand new in a person under 5 or over 50 should be evaluated by a doctor to make sure there are no signs of worrying, ”Chua said.
It’s common for patients to fear the worst with frequent, intense headaches, Olinksy said. “When headaches are a burden in your daily life, it is time to make an appointment. This could mean they are more common, more severe than usual, or when pain relievers or other over-the-counter medications don’t help, ”Olinsky said.
A stroke can cause sensory changes, numbness or tingling, and facial weakness, Ahlum said. “In the treatment of headaches, it is very rarely a stroke.”
In most cases, the problem is not life threatening, only life impact, as chronic headaches, if left untreated, can interfere with daily activities.
Women are more likely to experience headaches than men, Olinksy said.
“Migraines and tension headaches are more common in women than in men. When it comes to migraines, many women can be triggered by changes in sleep patterns, certain foods or drinks, or strong smells or light patterns. Migraines can also be triggered during a woman’s period due to the variation in estrogen levels during a menstrual cycle. “
Regardless of the cause of your headache, keep in mind how you treat yourself.
“If your headache doesn’t get better with over-the-counter drugs, or you’re taking a lot of medication,” said Ahlum, then it’s time to see a neurologist.
Often times, patients choose to self-medicate and can over-medicate, Ahlum said. Managing headaches incorrectly by taking too many medications for long periods can actually lead to rebound headaches, she said.
“It’s best to see a neurologist for pain management,” said Ahlum, and limit the use of pain relievers for headaches to two to three times a week. “Any more over-the-counter medication taken is too much.”
Neurologists can help you find the best prescription drug for your type of headache. Ahlum said patients often ask if they should take opioids for their headaches. “We have so many other drugs to offer and these (opioids) are often overused,” she said.
Common causes of typical headaches are stress and dehydration, she said. Other causes can include excessive use of caffeine and MSG in certain foods. Headache can also be part of another existing medical condition.