Migraines are a common cause of headache. The range of symptoms are variable but often present with a typical pattern of occurring in the same location each time and often associated with nausea, vomiting, sensitivity to light and noise, and can be preceded by an ‘aura’ of sparkles or wavy lines in the vision prior to the onset of symptoms. Some migraines can even cause symptoms that resemble a stroke (complex migraines).
It is important though that a migraine is diagnosed as such and that at some point headache sufferers receive an evaluation by a neurologist and also have neuro imaging (CT scan or MRI scan of the brain) to exclude other causes of headaches. Even in a person with a history of migraines, a change in the severity, location, or associated symptoms could signal a different problem and not a migraine. Any change in the usual pattern of a headache should be investigated.
Migraines are typically treated with non-narcotic medications and most patients will have significant relief of symptoms after treatment in the emergency room. Narcotic medications can make migraines worse and we typically avoid these as part of our treatment of migraines.
Most strokes do not cause headache. Nearly 90% of strokes are painless and present only with weakness or with a range of symptoms including difficulty speaking, seeing, walking, or coordination. Some strokes may only cause loss of sensation. However, 10-15% of strokes are caused by the rupture of a blood vessel within the brain. Strokes causes by ruptured aneurysms at the base of the brain (a subarachnoid hemorrhage) are usually extremely painful and sudden in onset. While many patients may have associated weakness or other neurologic symptoms, many patients only have severe headache without any other symptoms. Headaches that start suddenly and are immediately severe (the so-called ‘thunderclap’ headache) should be presumed to be a stroke from a ruptured blood vessels and investigated immediately.
Meningitis is a potentially serious cause of headache. The meninges (pronounced ‘men-en-jees’) are a connective tissue lining around the brain. The meninges have sensitive nerves that trigger symptoms of pain when they are irritated. Symptoms of meningitis include headache, fever, neck pain, and light sensitivity.
Bacteria, viruses, and rarely fungus can all be causes of infectious meningitis. Bacterial meningitis is a life-threatening disease that can be rapidly fatal without treatment. Viral meningitis causes severe symptoms but is seldom fatal. One particular cause of meningitis, meningococcal meningitis, is a very rapidly fatal and contagious form of meningitis. The disease is so deadly that up to 40% of patients can die. Even with treatment, the mortality rate is as high as 10-15%. Fortunately there is a vaccine to prevent meningococcal meningitis and it has already cut death rates in half. The vaccine is given to children between the ages of 11-18 and often upon entry to college.
If you or someone you know has fever, headache, and a stiff or painful neck, then this is an emergency that should be investigated immediately.
One of the most dreaded diagnoses associated with headaches is a brain tumor. Fortunately, brain tumors are uncommonly found to be the cause of headache as many tumors cause symptoms other than headache and are usually found in the absence of headache. However, depending on the location of the tumor, it is possible for a brain tumor to grow to a large size before causing any obvious symptoms and eventually cause complications that result in headache.
The diagnosis of a brain tumor is usually made by a CT scan of the brain and a careful neurologic examination.
Head injuries can cause headache. Serious injuries such as skull fractures and bleeding in or around the brain can occur. More commonly, head trauma results in a concussion. Concussions are caused by a direct blow to the head or from rapid acceleration/deceleration forces.
Evaluation for head trauma includes a careful neurologic examination and usually a CT scan. Treatment will depend upon the findings and severity of symptoms.
There are many more causes of headache. Many headaches are benign. Tension headaches are very common and are often causes by stress or muscle strains/spasm. What the cause of your headache, our Emergency Medicine Residency-Trained Physicians will treat your pain and insure the correct diagnosis.