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The question
I get mild headaches four or five times a month. Should I be worried?
The answer
While mild headaches a few times a month are usually not life threatening, they can significantly affect function and decrease quality of life. If you have never had headaches before, or your headaches are increasing in severity or frequency, changing in character, or if you have any alarm features (described below), I would recommend seeking medical attention to rule out a more serious cause.
Headache is among the most common medical complaints, and women are more likely to suffer from headaches than men. Every headache is different and the severity of the pain can vary from person to person and from one headache type to another in the same person. To understand the difference between benign and more serious headaches, it is important to understand the different causes of headaches.
The majority of headaches are not life-threatening and caused by primary causes, meaning that there is no known underlying disease. These include:
- Migraine headache: Usually felt on one side of the head as a throbbing pain that can be associated with nausea, vomiting and increased sensitivity to light and sound. Migraines usually last a few hours, but can last up to a few days.
- Tension headache: Usually felt as a tightness, pressure or band-like sensation around the head. It can last from 30 minutes to up to one week for some people.
- Cluster headache: One-sided pain felt behind the eye or temple. This headache can be explosive and very painful. It can last from minutes to a few hours. Often it can be associated with tearing of the eye or a runny nose on the same side as the headache pain.
- Sinus headache: Usually related to sinus infection or chronic allergies. It can be associated with fever, dark green discharge and foul smelling breath.
- Rebound headache: This is a common issue that many people don't know about. Taking medication twice a week or more for headaches can increase your body's dependence upon the medication. As a result, when the medication is not taken, the headache can return or "rebound." Apart from medication withdrawal, headaches can also occur when your body is dependent upon caffeine, which is often why people experience headaches in the afternoon when their morning coffee has left their system.
While serious causes of headache are much less common, if you are experiencing any of the following alarm features in association with your headache, I would strongly recommend seeking urgent medical care as they may indicate a potentially life threatening condition:
- Older than 50 years of age with no previous history of headache
- Change in vision (double vision, loss of vision)
- Any neurologic symptoms such as change in coordination, speech or strength
- Immunocompromised state such as HIV/AIDS or on immunosuppressant medication
- Confusion/decreased level of consciousness
- Medication that can increase risk of bleeding such as blood thinners
- Headache associated with head trauma
- Severe or abrupt headache
- Fever, stiff neck
If your headache is progressing in intensity, frequency, changing in character or affecting your quality of life, I would suggest seeing your doctor to discuss your symptoms to rule out serious causes and consider possible preventative measures, investigations and interventions. Your doctor may ask you to keep a headache diary to identify the time of day you experience pain, the intensity of your symptoms and any potential triggers that may increase your headaches, such as alcohol, noise, certain foods, stress, sleep pattern change or menstruation. It is also important to review your current medications with your doctor (including over-the-counter medications) as they may be contributing to your headaches as well - a specific example being birth control pills.
If avoiding triggers and reducing stress does not work, your doctor may prescribe medication that can be used to control the pain and prevent recurrent headaches.
Send family doctor Sheila Wijayasinghe your questions at doctor@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.
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