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Severe Headaches Can Be Serious, Doctor Warns

Many people experience headaches, but some are more serious than others, a US-based doctor says.

Taing Tek Hong, a Florida physician, told “Hello VOA” last week that serious headaches can be a sign of disorders like brain tumors. Other headaches, though, can be typical, he said.

Seventy to 80 percent of adults suffer from headaches sometime in a lifetime, and 38% of children will also have headaches, he said.

Headaches can be classified as migraine, tension-type headaches and cluster headaches, he said. Secondary headache disorders include brain tumors, intracranial hypertension or hypotension, temporal arteritis, and subarachnoid hemorrhage.

“Migraines and tension-type headaches are caused by a primary neuronal dysfunction in the brainstem, leading to excessive discharge of the trigeminal nerve, with release of substances that cause vasodilation and pain,” he said. “There is a decline in the serotonin released from the brainstem resulting in vasodilation of cranial vessels and sensitization of the trigeminal nerve.”

In cluster headaches, there is over activity of the parasympathetic nervous system in the hypothalamus and a neuronal dysfunction affecting the trigeminal vascular system with vasodilation causing pain and all the associated symptoms such as lacrimation, redness of the eye, miosis and ptosis of the eyelid, he said.

A migraine headache can be identified by its unilateral location, moderate to severe intensity, duration of four to 72 hours, a pulsating character, sensitivity to light and sound, nausea and vomiting, aggravation by routine activity, presence of aura, such as flashing lights or bright spots, zigzag lines, changes in vision, numbness or tingling in the fingers of one hand, lip, tongue, or lower face, or no associated symptoms, he said.

A migraine headache usually starts two days before through three days after the onset of menstrual bleeding, he said. Women with this condition may also have a migraine at other times during the month, which could be related to a decrease in estrogen levels that occur with menstruation, he said.

A tension headache has a bilateral location, mild to moderate intensity, a duration of 30 minutes to seven days, pressure and squeezing, but lacks other symptoms associated with a migraine, he said.

A cluster headache, relatively uncommon, has supra orbital or temporal location, severe intensity, begins without warning and reaches maximal intensity within a few minutes, he said. It then repeats, occurring for weeks to months at a time, followed by periods of remission, with a duration of 15 minute to 180 minutes, he said.

People who take headache medication for more than 15 days per month may develop refractory headaches, he said.

“Continuous exposure to these medications causes tolerance to pain suppression with diminishing medication effectiveness, leading to rebound headaches,” he said.

Most women with migraine headaches report improvement during pregnancy, he said.

“Headaches of new onset during pregnancy may be migraine or tension type headaches, but should be evaluated immediately for preeclampsia or an acute neurovascular event,” he said.

Headaches have many causes, he said. These include stress or anxiety, changes in hormones in women, bright lights, loud sounds, and strong smells, smoking, drinking alcohol, certain foods such as chocolate, cheese, salty food or processed food, food additive such as MSG or aspartame, not getting enough sleep, not getting enough food to eat and not eating on time, intense physical activities, change in the weather, or some medications (nitroglycerin, estrogens, hydralazine).

In practice, he said the diagnosis of a migraine is clinical, based upon a history and physical examination. Neuro-imaging should be considered in patients with non-acute headaches that go along with abnormal findings, atypical headaches that don’t fit the migraine profile, and patients with severe headaches where a hemorrhage is suspected.

CT scans may work for many patients. Sometimes an MRI or other examinations are needed, he said.