Headaches: What you need to know

DR PREM PILLAY,
Senior Neurosurgeon, Expert in Headaches

headache

Your headache symptoms can help your doctor determine its cause and the appropriate treatment. Most headaches aren’t the result of a serious illness, but some may result from a life-threatening condition requiring emergency care.

Headaches are generally classified by cause:

Primary headaches:

A primary headache is caused by overactivity of or problems with pain-sensitive structures in your head. A primary headache isn’t a symptom of an underlying disease.

Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck (or some combination of these factors) can play a role in primary headaches. Some people may also carry genes that make them more likely to develop such headaches.

The most common primary headaches are:

  • Cluster headache
  • Migraine
  • Migraine with aura
  • Tension headache
  • Trigeminal autonomic cephalalgia (TAC), such as cluster headache and paroxysmal hemicrania

A few headache patterns also are generally considered types of primary headache, but are less common. These headaches have distinct features, such as an unusual duration or pain associated with a certain activity.

Although generally considered primary, each could be a symptom of an underlying disease. They include:

  • Chronic daily headaches (for example, chronic migraine, chronic tension-type headache, or hemicranias continua)
  • Cough headaches
  • Exercise headaches
  • Sex headaches

Some primary headaches can be triggered by lifestyle factors, including:

  • Alcohol, particularly red wine
  • Certain foods, such as processed meats that contain nitrates
  • Changes in sleep or lack of sleep
  • Poor posture especially affecting the upper spine
  • Skipped meals
  • Stress

Secondary headaches

A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions — varying greatly in severity — may cause secondary headaches.

Possible causes of secondary headaches include:

  1. Acute sinusitis (sinus infection)
  2. Arterial tears (carotid or vertebral dissections)
  3. Blood clot (venous thrombosis) within the brain — separate from stroke
  4. Brain aneurysm (a bulge in an artery in your brain)
  5. Brain AVM (arteriovenous malformation) and Dural AV Fistulas— an abnormal formation of brain blood vessels
  6. Brain tumor
  7. Carbon monoxide poisoning
  8. Chiari malformation (structural problem at the base of your skull)
  9. Cranio-Cervical Instability
  10. Concussion
  11. Dehydration
  12. Dental problems
  13. Ear infection (middle ear)
  14. Encephalitis (brain inflammation)
  15. Giant cell arteritis (inflammation of the lining of the arteries)
  16. Glaucoma (acute angle closure glaucoma)
  17. Hangovers
  18. High blood pressure (hypertension)
  19. Influenza (flu) and other febrile (fever) illnesses
  20. Intracranial hematoma
  21. Medications to treat other disorders
  22. Meningitis
  23. Monosodium glutamate (MSG)
  24. Overuse of pain medication
  25. Panic attacks and panic disorder
  26. Post-concussion syndrome
  27. Pressure from tight headgear, such as a helmet or goggles
  28. Pseudotumor cerebri
  29. Stroke
  30. Spine problems especially in the upper part of the spine called the Cervical Spine
  31. Toxoplasmosis
  32. Trigeminal neuralgia (as well as other neuralgias, all involving irritation of certain nerves connecting the face and brain)

Some types of secondary headaches include:

  1. External compression headaches (a result of pressure-causing headgear)
  2. Ice cream headaches (commonly called brain freeze)
  3. Medication overuse headaches (caused by overuse of pain medication)
  4. Sinus headaches (caused by inflammation and congestion in sinus cavities)
  5. Spinal headaches (caused by low pressure or volume of cerebrospinal fluid, possibly the result of spontaneous cerebrospinal fluid leak, spinal tap or spinal anesthesia)
  6. Cervicogenic Headaches cause by Spine disorders such as Slipped or herniated discs, Spine tumors, cranio-cervical or cranio-spinal instability
  7. Thunderclap headaches (a group of disorders that involves sudden, severe headaches with multiple causes including brain bleeding / stroke)

Dr Prem Pillay an Expert on Headaches recommends that if they are severe and /or persistent that you have a consult which may include a Neurological examination and imaging including MRI of the Brain. Serious problems such as Brain Tumor or a ruptured Brain Aneurysm or Arterio Venous Malformation are not common but if not detected early have serious life changing consequences. Headaches can be treated with medications, physical therapy, posture improvement, injections and root cause treatments including no surgery day treatments including radiosurgery, radiofrequency, discoplasty using superior to laser technology, endovascular therapy and in some cases microsurgery when needed.

With many years of experience in treating Headaches and access to the latest technological advancements, Dr Prem Pillay endevours to offer patients the highest standard of care. From accurate diagnosis to tailored treatment plans, our approach aims for the best possible outcomes for individuals affected by this challenging condition.

If you or a loved one has been diagnosed with a Headache problem, we welcome you to seek consultation with our specialized team. Together, we can develop a comprehensive evidence based and personalized treatment strategy that addresses your unique needs and provides the best chance for a positive outcome.