Headaches - when to seek expert advice

This week Dr Stephanie Hughes talks us through headaches- what causes them, what helps, and when you should seek professional advice

Headache is very common problem – around 1.5 million people in the UK report having a headache every day, and 3% of A&E attendances are for this symptom. There is a huge number of possible causes of headache (the nattily-named 3rd edition of the International Headache Society’s 2013 Classification of Headache is over 800 pages long – enough to give you a headache just thinking about it!) and diagnosing headaches is a true test of a doctor’s clinical skill. Happily, most headaches are due to benign (not dangerous) conditions, which can range from muscle tension, migraines and even having sex! However, getting the diagnosis exactly right is very important – headaches are very unpleasant for sufferers and can, sometimes, be a symptom of something serious (such as - very rarely - a brain tumour). Many patients with headaches assume that they need a “scan” of their head to identify the cause of their symptoms; however, in actual fact there is no substitute for a thorough history and examination, so you should expect your doctor to do some really good listening and looking.

Common myths around headaches include believing that headaches are caused by high blood pressure – in fact, this is very rarely the case (your blood pressure would have to be extremely high to have this effect). Likewise, patients often assume that they need an eye test if they have headaches – problems focusing (“refractive errors”) on their own are rarely a cause of headaches (although getting these sorted out can help reduce the severity of a pre-existing headache). Finally, patients often feel that taking steadily stronger painkillers is a good strategy for treating an ongoing headache – actually, medication overuse is one of the commonest causes of worsening headache! Sitting down and talking through your headache symptoms in detail with your doctor is the best way to sort out the problem once and for all, and to develop a treatment plan that can prevent and/or treat the problem effectively.

Most people get headaches at some point, and it is important to remember that the vast majority are not suffering from a serious medical condition. However, please make sure that you see a doctor if you have any of the following: a sudden onset “blinding” headache that comes from nowhere; associated problems with fever, weight loss, fatigue, rash or feeling generally unwell; a headache that gets worse when you cough, bend down or strain on the loo; problems with confusion, memory loss, or fits; visual problems, including seeing “haloes” around lights; pain in the jaw on eating and/or pain on combing your hair – these can all be indicative of a serious issue which needs treating straight away. However, please remember that most headaches are inconvenient rather than dangerous, so don’t worry – keeping a symptom diary (especially relating to painkillers and other medications) for a week or so is very useful, and will help your doctor to help you. Your headache needn’t be a headache to sort out!

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