Headache disorder

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Anyone can experience a headache. It is the most common form of pain. It has been estimated that 47% of the general adult population have had a headache at least once within the past year. Headache disorders are associated with personal and societal burdens of pain, disability, damaged quality of life and financial costs.1

Some headaches occur independently and are not caused by another medical condition, while some are symptoms of another underlying health disorder. Headache causes could be acute or chronic. Some causes could be urgent like bleeding in the brain, infections like meningitis, HIV associated conditions and medical conditions like hypertension. Migraine accounts for 10% of acute headaches.

Some recurrent causes could be due to tension. Causes of chronic headaches include tumours, hormone imbalances, abnormalities in blood vessels and eye conditions like glaucoma. Excessive use of over the counter painkillers is a common cause of chronic headache.

Diagnosis

Diagnosis is made from history involving detailed description of the headache, examination and some investigations based on what the doctor finds. The most important factor in diagnosing headaches is the information provided by the patient. Headache sufferers must provide their doctor with a good description so that the correct diagnosis is made.

Doctors/nurses generally ask patients to describe their pain; pain location; any accompanying symptoms; headache frequency and duration, and what aggravates the pain. Keeping a headache journal can help your doctor to determine what is causing the problem.

Pain Relief

There are a number of ways to help relieve pain without a trip to the doctor. Self-help measures include:
– Take time to relax and be away from stressful situations.
– Maintain good posture. Avoid craning neck forward.
– Stay relaxed. Avoid frowning or jaw clenching.
– Keep headache diary: Record date, day of week and time of day; record precipitating and relieving factors.
– Avoid excessive fatigue. Get adequate sleep.
– Do not sleep later than normal on weekends.

Habits
– Eat at regular times. Do not miss meals.
– Eliminate foods and drinks thought to trigger headache e.g. alcohol and red wines.
– Limit foods associated with rebound headaches like caffeine and analgesics.

Environment

Headaches can also be triggered by specific environmental factors:
– Restrict physical exertion on hot days.
– Avoid glare or exposure to flickering lights.
– Avoid noise or strong smells.

Palliative

– Rest in a quiet comfortable dark room.
– Apply cold to forehead and temples e.g. ice pack or cool moist cloth.

Headaches could be a pointer to a very serious health problem and consulting the doctor should not be delayed if it is associated with fever, if you cannot move your neck, if it started suddenly and is severe, if you are over 50 years of age and it is occurring for the first time, if it comes with vomiting or it starts with physical exertion. Also, headaches that start after knocks on the head or come with fits or other nervous system features require attention without delay.

When to see a doctor/nurse

Not all headaches require a visit to the clinic/doctor’s office. But headaches can be a sign of a more serious condition that requires a doctor’s attention. Call on the nurse/doctor if you – or your child – have any of these symptoms:
• Sudden, severe headache that may be accompanied by a stiff neck.
• Severe headache accompanied by fever, nausea, or vomiting that is not related to another illness.
• “First” or “worst” headache, often accompanied by confusion, weakness, double vision, or loss of consciousness.
• Headache that worsens over days or weeks or has changed in pattern or behaviour.
• Recurring headache in children.
• Headache following a head injury.
• Headache and a loss of sensation or weakness in any part of the body, which could be a sign of a stroke.
• Headache associated with convulsions.
• Headache associated with shortness of breath.

• Dr Ikeakanam and Dr B Serebe can be contacted at ngopewa@iway.na or 065 24 1290.

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