The Doctor Is In

Q: I get headaches pretty frequently—at least once a week, sometimes twice. They seem to come no matter what my diet or level of activity is. When are headaches just headaches and when should I see a doctor?

“Not tonight honey … I have a headache!”

This commonly used phrase shows us just how common headaches are. In fact, there are more than 300 types of headaches.

Most of us experience minor headaches from time to time, and these are not worrisome at all. These minor headaches can go along with colds, flu and even dehydration.

Common types of headaches include tension headaches, which are often described as a band around the head with a feeling of tension in the neck and shoulder muscles.  These are often relieved with over-the-counter pain relievers or even a good massage.

Other common headaches are migraines, cluster headaches and sinus headaches. Although all of these types can be debilitating and very uncomfortable, they are not life threatening.

Migraines are usually one-sided severe throbbing headaches often associated with nausea, as well as light and sound sensitivity. Some patients with migraines have visual auras where they can see flashing lights or other changes in their vision, or even numbness and tingling in their body.

Sometimes caffeine can help. Otherwise, there are prescription medications that can abort the headache when taken early. There are also preventive medication options to help those with frequent migraines. For some, avoiding certain triggers, like alcohol, aged cheese and stress, can reduce the onset of these headaches.

Cluster headaches are intense stabbing pain, often described as a piercing pain behind an eye and can accompany nasal congestion and tearing. They can come in clusters (hence the name) and go away for long periods of time. These are much more common in men and can be treated with pure inhaled oxygen, as well as other medications.

So when is it time to seek medical attention immediately? There are a few red flags that are important to remember.

These include an unusually severe headache or “the worst headache of my life.” This can sometimes be a headache from a subarachnoid hemorrhage, a bleed in the brain from an aneurysm, which could be fatal.

Other warning signs are new headaches that occur after the age of 50, a major change in the pattern of your headaches or headaches that get steadily worse.

If you have a headache that is associated with fever, neck stiffness or other neurological signs such as confusion, slurred speech, weakness or seizures, this could be the sign of a serious infection such as meningitis that needs prompt medical attention.

Please also see a doctor right away if you have a headache that occurs after any head trauma as this could indicate a concussion or a bleed on or near the brain. Severe headaches that come on abruptly, especially waking you up, are possible brain tumors.

In addition, older people with severe, new headaches could have a condition called temporal arteritis—an inflammatory condition which if not diagnosed could lead to blindness. Or, if the headache comes with a painful red eye, glaucoma is a possibility and needs to be diagnosed quickly.

Finally, headaches in patients with impaired immune systems or cancer are also very concerning and need to be seen by a medical professional as soon as possible.

So, if you have a minor headache, remember what Arnold Schwarzenegger said in “Kindergarten Cop”: “It’s not a tumor!” But with any other signs or symptoms, including the red flags I described, please seek medical attention as soon as possible.