I HAVE A HEADACHE. IS IT SERIOUS?

It can be experienced as pain in the front, the top, side, back of the head, and the neck and may be described as is sharp, dull, constant, intermittent, or pounding. Despite this great variation in the characteristics of headaches, the diagnoses are mostly based entirely on the verbal description of the headache by the patient. Which means that the pattern of headaches with all its variations could be classified into a category and easily dealt with by pharmacist-assisted self-care or by your family doctor. It is only rarely necessary for a referral.

The most frequently seen headaches are migraine, cluster headaches and tension headaches. The intensity and type of headache experienced by people with migraine or cluster headaches are typical and not difficult to diagnose based on your description of it and a physical examination. Your doctor will prescribe very specific medications to abort an acute onset of the headache, or if it occurs frequently, to prescribe medication to prevent the attacks.

So, when is it necessary to go and consult with a doctor?

Causes of Mild Headaches

Not all headaches indicate underlying severe illness, and events that trigger mild headaches vary widely among people who get headaches. Each person seems to have his or her common headache triggers that can include stress, hormonal fluctuations (before, during, or after menstruation), muscle tension in the back and neck, exhaustion, hunger and dehydration, and alcohol, caffeine, and sugar withdrawal.  Do not suddenly stop drinking coffee or other caffeine containing drinks – chances are that you will develop a monster of a headache within hours due to caffeine withdrawal.

Headaches are commonly associated with viral or bacterial infections as commonly experienced this time of the year and can be the presenting complaint for influenza or COVID-19, of a common cold or sinusitis. Typically, you may experience fever, cold-like symptoms, sensitivity to light or sound, and nausea and/or vomiting.

If the doctor prescribed any new medication for you to take regularly it can also be the reason for a new onset headache as a side-effect of those medications. Examples are prescription medicines used for heart conditions and high blood pressure, hormone replacement therapy, oral contraceptives and medicines used for male impotence.

Treatment of Mild Headaches

Most headaches are self-limiting and self-treated, often with guidance from your pharmacist, with over-the-counter pain medications like paracetamol or aspirin alone or in combination with anti-inflammatory medications like ibuprofen. Be aware of side-effects that may be associated when taking over the counter (OTC) medications like drowsiness or irritation of the stomach. Do not continue with medication once the headache has disappeared.

Can Headache be Caused by Painkillers?

The easy access in South Africa to pain killer medication, often more than just one chemical compound in one tablet, may lead to the belief that OTC medicines are always safe. The important reality however is that even OTC medicines must be used with caution and for a limited time period. In all patients presenting with frequent daily headaches, the possibility of medicine overuse headaches should be considered. Often, people continue for a long period of time with over-the-counter painkillers and anti-inflammatory medicines that was used for either headache or other pains like muscle strain when technically the medications could have been discontinued. Thus, the medications are used for a longer time period and sometimes dosages that is not advisable. This overuse of these pain killers intended for short-term use to relief pain can start a cycle of having nearly daily headaches for which pain medication is used to the point where daily headaches are experienced and the taking of more painkillers are required for the headache. So, these headaches are actually caused by the pain killers and are referred to as medication overuse headache.

The treatment of medication-overuse headache is complicated and a team effort between the pharmacist, the family doctor and sometimes a clinical psychologist is needed to assist the patient with this problem to overcome it. The treatment plan involves educating the person about the relationship between frequent intake of acute headache medication and medication-overuse headache, a plan to reduce intake of acute pain killers so as to break the cycle causing the headaches. The important lesson is to discuss with your pharmacist about OTC medication duration of use and possible side-effects.

Be on the lookout for

Certain new onset headaches can however also be an indication that something is seriously wrong and needs to be investigated. Less than 20% of headaches is caused by a serious condition   that should be evaluated by a doctor as soon as possible. Watch out for the following indicators that should generate a doctor’s appointment:

• A high fever and headache with a stiff neck
• Any sudden onset headache accompanied by difficulty to talk, numbness/weakness in face or arms and legs, or disturbance of your vision.
• If the pain is the “worst pain in my life,” especially when over the age of 50 years.
• Very sudden or abrupt onset of headache – the so-called “thunderbolt headaches” with peak intensity occurring within several minutes.
• New headaches if you were treated for cancer previously.
• The onset of worsening headache after a minor head injury in a motor vehicle accident or a sports injury.

When to Act

Any headache that does not go away and increase in intensity need to be evaluated by your doctor. Also remember that if your headache is the “first and worst” or “new and different” from what you had before, don’t hesitate to make an appointment.

Dr Martin de Villiers is the Medical Director at Medwell SA – The Home Health Care Specialists.  For more information, visit www.medwell.co.za