Headaches: the different types, symptoms, and when to see a doctor

Headaches: the different types, symptoms, and when to see a doctor

Headache is the most common symptom that patients present with when they visit the Neurology Clinic. The cause may be due to changes in modern society's way of life where everyone is rushing, stressed, and having trouble sleeping. However, headaches may not only be caused by stress or lack of sleep but may also be a symptom of dangerous diseases, disability or even death.

Headaches can occur in people of all genders and ages, mostly in the working age group, middle-aged people, and even the elderly. The likelihood of each age group having different types of diseases also varies. For example, people of working age may encounter non-dangerous diseases, while the elderly may encounter more dangerous diseases.

Generally, we tend to divide headaches into two groups:

1. Primary Headache, which refers to headaches without any underlying disease in the brain, head or neck. This group usually consists of non-serious headaches that come and go intermittently, such as migraines, tension-type headaches, cluster headaches, etc.

1.1 Migraine: A type of headache that occurs frequently in people from a young age to middle age. It often causes throbbing pain on one side of the head, spreading to the eye or temple. The pain is usually accompanied by nausea or vomiting, sensitivity to light or sound, and can last from 4 hours to 3 days. Migraines are believed to be caused by the expansion of blood vessels near the brain's covering tissue after being stimulated by certain triggers, including hormonal changes in women, certain foods such as coffee, chocolate, cheese, alcohol, bodily and emotional stress, environmental factors such as hot weather, loud noises, strong smells, etc.

1.2 Tension-type Headache: The most common type of headache, often causing a feeling of tightness or pressure around the head, neck or shoulders, as if something is squeezing around the head. The cause is usually related to inadequate rest and stress.

1.3 Cluster Headache

Cluster headaches are commonly found in people between the ages of 20 and 50. They have distinct characteristics such as one-sided headaches that occur around or behind the eye, feeling like something sharp is poking into the eye, and intense pain that makes one feel restless. The duration of these headaches can last from 15 minutes to 3 hours, and they can occur multiple times a day. Typically, they persist for weeks to months, and then they disappear, only to reoccur around the same time the following year.

Cluster headaches are often accompanied by autonomic nervous system symptoms such as droopy eyelids, swollen or red eyes, runny nose, and watery eyes or nose. These symptoms occur on the same side as the headache.

The cause of cluster headaches is believed to be related to the hypothalamus, the part of the brain that controls the body's internal clock. When this area of the brain does not function properly, it can cause changes in the trigeminal nerve, which is responsible for facial sensations, as well as the autonomic nervous system and the blood vessels on one side of the head.

Office Syndrome is the most common cause of headaches today. This condition is caused by working for extended periods and involves using computers, mobile phones, tablets, chatting, watching movies, and listening to music. This results in symptoms ranging from mild tension headaches to severe ones such as numbness in the hands, back pain, and leg cramps.

People who use computers and smartphones usually do not sit upright but instead slouch and cross their legs for hours on end. Some even continue using these devices after returning home, resulting in insufficient sleep and little rest, causing their muscles to become stiff for a long time.

Many people who experience headaches for several months become anxious and worry about having a brain tumor. They visit doctors to have their brain computer-checked, but the results are usually normal, and the headaches do not go away even after taking painkillers like paracetamol.

The treatment for headaches is not difficult. Taking a 5-minute break to rest your eyes every hour of work or standing up from your chair to stretch your muscles can prevent these headaches. It may seem easy, but in reality, it is often overlooked because work can be demanding and urgent.

2. Group with neurological diseases (Secondary Headache)

For example, tumors in the brain, inflamed brain covering, swollen brain blood vessels, inflamed blood vessels, bleeding in the brain, degeneration of neck bones, meningitis, sinusitis, etc.

For dangerous cluster headaches, they can be identified by the fact that the pain is relatively rapid and severe, such as within 1 minute, starting from no pain at all and turning into intense pain as if the head is about to explode. This is considered dangerous, as there may be bleeding in the brain.

For people who have never had a headache before, but suddenly experience one after the age of 50, it is considered dangerous because non-dangerous headache groups, such as migraines, tension headaches, and cluster headaches, usually have symptoms before the age of 50.

For people who have experienced headaches before, if they recur in the same pattern as before, and suddenly change in a negative way, such as becoming more severe, changing location, lasting longer, or sometimes waking up due to pain, this is considered dangerous.

If there are neurological symptoms, such as sudden weakness, double vision, hearing ringing in the ears, slurring speech, stumbling, or having a stiff neck, this is considered dangerous.

For people with chronic illnesses, especially those with low immunity, they should be suspicious of dangerous headaches. For example, someone with SLE taking immunosuppressants and suddenly experiencing headaches should be suspicious that there may be a possible infection. These are ways to observe dangerous headache groups. There are various types of diseases, ranging from tumors, constricted brain blood vessels, meningitis, etc.

Position of Pain

Usually, doctors will ask where the pain is located, what its characteristics are, how the disease is progressing, and how the location of the pain can help, such as:

Eyebrows - we need to see which eyebrow hurts. If it's just the eyebrow that hurts, it may be a sinus problem, or it could be a cluster headache, or it could be a migraine.

Forehead, temples, back of the head, or neck - these are important areas that people with pain may need to observe and tell the doctor about to help with diagnosis. Many people have pain in the back of their neck, which can be caused by many diseases, such as migraines, tense muscles, or cervical spine disorders, or even brain tumors.

In addition to the location, we also use other symptoms such as the nature of the disease, what makes it better or worse, and physical examination. Some diseases may cause pain throughout the head, or pain in specific areas, but if the patient can observe, the diagnosis will be easier. If there are symptoms that indicate danger, a brain scan may be needed to confirm if there is anything abnormal in the brain.

Or in cases where the symptoms are similar to encephalitis, such as fever, headache, nausea, vomiting, and stiff neck, a lumbar puncture may be necessary to analyze the cerebrospinal fluid.

Suppose there is suspicion of bleeding. In that case, a CT scan of the brain may be selected, which will be clearer, but if we want to collect more details, such as suspected tumors due to brain or cerebral infarction, we may choose an MRI because we can also see the MRA, which is a red blood vessel.

The nature of disease progression can be divided into three simple types:

1. Throbbing or pulsating pain that follows the rhythm of the heartbeat. This type of pain may indicate diseases such as vascular disorders or migraines.
2. Sharp, stabbing pain that feels like a jolt. This type of pain may be a symptom of peripheral neuropathy.
3. Tight, squeezing pain that feels like something is pressing on the head. This type of pain can be difficult to diagnose because it can range from normal muscle tension to a lump in the brain.

The duration of the disease progression is also important, with most non-life-threatening conditions experiencing periods of remission and flare-ups. The duration of each disease can vary, for example, a migraine may last no more than three days per episode, while a cluster headache may occur several times a day but only last for a few hours.

Tension headaches can occur for up to three hours at a time, but may happen several times a day. Meanwhile, conditions in the dangerous category often have persistent pain that may improve somewhat with medication but never fully goes away. For example, a lump may gradually increase in pain over time.

If the condition involves bleeding, the pain may be sudden and severe, and may not fully subside even after taking painkillers.

Another important factor in diagnosis is how the condition responds to different treatments. For example, for a migraine sufferer, lying down to rest may alleviate the pain, while for others, vomiting may be a sign of improvement.

Basic Self-care

Basic self-care emphasizes the importance of reviewing one's own headache symptoms to determine whether they may be related to a dangerous disease. If we seek treatment promptly, there is a chance that it may disappear.

However, when receiving massages, particularly neck massages, one must be extremely cautious when experiencing muscle or bone pain in the neck. Although stretching the muscles may improve symptoms, incorrect techniques, such as twisting the neck, may cause blood vessels to tear, which can be dangerous.

When to see a doctor for a headache

• If a headache feels like an explosion and has never occurred before in one's life, it may indicate an increase in pressure in the skull that is rapidly increasing, which can be due to bleeding under the brain's lining and high blood pressure.
• If the headache is severe, accompanied by sudden weakness on one side of the body, it may indicate a stroke caused by bleeding in the brain's tissue.
• If the headache is severe, accompanied by fever, stiff neck, and an inability to bend the neck, there may be an infection in the brain's lining.
• If the headache is severe, accompanied by fever and convulsions or jerking of the body, it may indicate inflammation of the brain.

If you or a loved one experience any of the aforementioned headache symptoms, you should see a doctor as soon as possible to determine the cause and receive prompt treatment.

Dr. Pongsakorn Tanayapong

Neuropathic physician