Is It Just a Headache?

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Headache Symptoms, cont'd.

4. Your head hurts all over -- a lot -- and you also have a fever and a very stiff neck.

Possible cause: Meningitis or, less likely, encephalitis. Meningitis is an inflammation of the lining of the brain and spinal cord, while encephalitis is an inflammation of the brain itself. A virus or bacteria can cause either disease, and the bacterial infection is more deadly. If you have meningitis you may also develop a rash.
What to do first: Rush to the ER. "Minutes count, especially for bacterial meningitis," says Merle Diamond, MD, a clinical assistant professor at Rosalind Franklin University of Medicine and Science/Chicago Medical School.
Getting treated: At the ER you'll get a neurological evaluation and spinal tap, says Dr. Diamond. If the cause is bacterial you'll receive intravenous antibiotics. For a viral infection you may be given an antiviral drug; severe cases may require prescription antiseizure drugs and steroids.

5. You bumped your head and have a really bad headache.

Possible cause: As actress Natasha Richardson's March 2009 death showed, even a minor knock to the head can cause a deadly brain injury. Or you could have a concussion, a less-severe but still-serious trauma. "People are surprised when they have really bad headaches after something fairly minor, but if you black out or become confused you need to be checked immediately," says Dr. Marcus. Concussions can cause memory loss, affect balance and coordination, and bring about headaches for weeks or months. Women are more prone than men.
What to do first: Go to the ER. And no matter how much your head hurts, don't take anything with aspirin, ibuprofen, naproxen, or any other NSAID; all these drugs increase your risk of having bleeding in the brain.
Getting treated: If all you have is a concussion, the main cure is rest: Don't do anything mentally taxing or physically risky until you get word from your physician. Your headaches may continue for a while, so ask your doctor which pain-relief medications are safest. But if a CAT scan reveals bleeding in your brain, you may need surgery (to handle swelling or repair broken blood vessels), medications for seizures, and physical or speech therapy.

6. You have a sudden, intense, excruciating headache. After several minutes the pain begins to fade.

Possible cause: "Thunderclap" headaches can signal a subarachnoid hemorrhage, when a brain artery with a weakened wall (aneurysm) ruptures or is about to. These strokes are rare but can happen as early as your 20s. It's very abrupt and feels like the worst headache of your life, says Stephen D. Silberstein, MD, director of the Headache Center at Jefferson Medical College of Thomas Jefferson University. Other signs? Loss of consciousness, nausea, and a stiff neck.

If tests rule out a stroke, you may have had a cluster headache. These start with excruciating pain, often behind the eyes. You can get as many as four a day for several weeks. Then they disappear for months or forever.

What to do first: As with a head injury, don't take aspirin or any other NSAID, which will make any bleeding worse. Instead, go to the ER immediately, even if the headache stops.
Getting treated: First you need a CAT scan and maybe a spinal tap to see if you had a stroke. If so, surgery and medications may repair the rupture. Follow-up treatment might include medication as well as physical and speech therapy.

For cluster headaches the goal is preventing future cycles with steroids, calcium channel blockers, antiepileptic drugs, or triptans. "Some are easy to treat with medications while others are resistant to them," says Dr. Marcus. "If the first treatment doesn't help, there are other options to try."

7. You develop a headache when you sneeze, cough, or go for a run -- or you often wake up in the morning with head pain.

Possible cause: These are potential signs of a brain tumor, but don't panic. Exertion is a common headache trigger and you may wake up with a headache if you didn't sleep well. Tumors, on the other hand, are rare -- they cause less than 1 percent of all headaches. "And by the time a brain tumor gives you a headache, you usually have other symptoms, such as blurry vision, weakness, or trouble thinking or talking," says Dr. Silberstein.
What to do first: See your doctor pronto. You may need a neurologist.
Getting treated: The first step is usually a neurological exam, plus imaging tests such as a CAT scan or MRI. If everything's clear, the usual headache remedies -- such as NSAIDs or acetaminophen -- should work. If they do find a tumor, you may need surgery. Afterward your doctor could recommend radiation, chemotherapy, and additional treatments.

Continued on page 3:  Doctors' Best Headache Remedies


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