Is It Just a Headache?
Recently I was up in the middle of the night, on my computer, trying to figure out what could be causing the pounding headache I'd had for five days. Aha! Sinus infection. My doctor confirmed my self-diagnosis the next day and sent me home with nasal spray and a prescription for antibiotics.
"Brain tumor averted," I told my husband.
"I didn't want to say anything, but I was thinking brain tumor, too," he said, clearly as relieved as I was.
It's easy to fear the worst when you have a really bad headache, even though most are benign. But it can also be risky to ignore your symptoms. "A severe headache or changes in your headache pattern can signal a real health emergency," says Dawn Marcus, MD, associate professor at the University of Pittsburgh Medical Center and author of 10 Simple Solutions to Migraines. "Even if you're getting headaches that are mild but unlike any you've had before, bring it up with your doctor." We asked the experts how to tell normal symptoms from warning signs.
1. Your headaches aren't constant -- they go away after a few hours. But they keep coming back.
Possible cause: If you have a dull ache behind your eyes and it hurts just to move your head, you may have a sinus headache caused by allergies or an infection. You probably have a tension headache if it feels more like a vise tightening around your temples, the back of your head, and your neck.
What to do first: Don't try to cure yourself. Instead, see your doctor or allergist and get diagnosed. If you take a decongestant for a sinus headache but it's actually a migraine, the drug could worsen the pain.
Getting treated: For sinus aches your doctor may suggest decongestant, saline, or prescription corticosteroid nasal sprays and either antibiotics (for infection) or antihistamines (for allergies). Tension headache aids include analgesics, antidepressants, and muscle relaxants, as well as icepacks, biofeedback, and yoga.
2. There's a pulsating pain on one side of your head. Light and noise make it worse.
Possible cause: Perhaps a migraine, even if you think you don't get them. Half the people with migraines think they're something else, says a recent national migraine survey. Swollen blood vessels in the brain trigger migraines, which are hereditary. And the pain isn't always intense. "If you remember seeing your mother throw up and stay in bed all day long from a migraine, you may think that anything less severe couldn't possibly be the same thing," says Dr. Marcus. Don't discount your symptoms.
What to do first: Start with an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as aspirin, ibuprofen, or naproxen. A pill with caffeine (for example, Excedrin) can increase the anti-migraine effect. Sleeping may help, too, as it can alter serotonin levels, which is how some prescription migraine medicines help relieve the pain, Dr. Marcus explains.
Getting treated: Consider going to a headache specialist. You'll probably be asked to keep a diary to see whether certain foods (red wine, caffeine, aged cheese, for instance) or situations (skipping meals, stress, smoke, intense exercise) are prime migraine causes. Hormone changes can also be a factor. Your doctor may prescribe drugs including beta and calcium channel blockers, triptans, and ergotamines. Botox injections can help, perhaps by blocking pain pathways or chemical processes. You can also numb the throbbing area with a Lidoderm patch.
3. You seldom get headaches, but this one's a doozy and you've had it for three days.
Possible cause: It could be a new daily persistent headache, one type of a condition called chronic daily headaches. Suspect NDPH if the pain started abruptly and you're queasy and sensitive to light and noise. Recent illness could be a factor; many sufferers test positive for the Epstein-Barr virus. It could be chronic tension headache if the pain varies in intensity but is continuous, a condition often linked to depression and anxiety. Or you could have a rebound headache from extensive use of pain relievers or migraine drugs. These punishing headaches can happen 15-plus days a month, each lasting four hours or longer.
What to do first: Ask your doctor about stronger drugs or if you should stop taking what you're already using.
Getting treated: NDPH usually gets better by itself, though painkillers may help in the short term. Antiseizure drugs can relieve severe cases. Chronic tension headaches often respond to antidepressants; biofeedback can help, too. Botox injections in the back of the head and neck could relax the muscles that contribute to tension headaches. If drug overuse is the cause, other treatments, including non-drug ones, may break the cycle.