Headaches
Approximately 40 percent of all Americans
have a significant headache at some time requiring medicine for
treatment, with 10 percent of the population seeing a physician
occasionally for headaches. Migraine headache alone affects 23
million Americans. Headache pain can originate from areas inside
the head as well as outside.
or example, a number of nerves that originate
from the brain (cranial nerves) are a common source of head pain.
Only 1 percent of all headaches are symptoms of a significant
underlying illness. The emergency physician must distinguish serious
and life-threatening presentations from those that are less serious.
This is best accomplished by performing a medical history and
physical examination along with testing as needed.
The most common type of headache seen in
the emergency department is migraine headaches. Approximately
12 percent of the population is affected by migraines with approximately
70 percent of these having a positive family history for similar
headaches. Social histories of migraine patients may include drinking
alcohol and smoking habits as well as contact with other toxins.
Mood and anxiety disorders can be associated with migraines, with
depression more common than anxiety. Migraine headaches occur
three or four times more commonly in women than in men and usually
begin in adolescence or young adulthood.
Migraine headaches can be provoked or intensified
by changes in the body's internal physiology and by environmental
factors. Changes in body rhythm such as too little sleep, too
much sleep, or fasting may provoke an attack. Physical activity
makes the pain worse; minor head trauma may also precipitate a
headache. Often relaxation following stress such as after a very
hectic day, on vacations, or weekends will result in a headache.
Hot, humid weather or changes in weather may trigger an attack.
Foods are also known to precipitate an
attack in 15 to 20 percent of migraine sufferers. Red wines and
alcoholic beverages are notorious for causing headaches. Consuming
foods containing nitrites in processed meats and foods, as well
as foods containing the additive monosodium glutamate (MSG) may
result in headaches. Medications such as contraceptive estrogens
("the Pill") may cause an increase in frequency or severity
of headaches. If this occurs, the medication should be discontinued.
EMERGENCY PRESENTATION OF HEADACHE PATIENTS
Basically, three categories of headache
patients will present to the emergency department.
1. The chronic headache patient who has
been thoroughly evaluated presents for pain control with no change
in the headache pattern.
2. The person who has never been evaluated
presents with the first severe headache.
3. The patient with prior history of evaluated
headaches who now presents with a change in the quality and intensity
or character of the headache.
The emergency physician should be especially
concerned if any of the following are present:
1. The first or worst headache of the patient's
life, especially if the onset is acute and associated neurological
symptoms are present.
2. A headache that gets progressively worse
over days or weeks.
3. A headache without an illness but associated
with fever, nausea, and vomiting.
4. A headache associated with a stiff neck,
poor neurological findings, increased intracranial (within the
skull) pressure, and changes in consciousness.
5. No obvious identifiable cause of the
headache.
CAUSES OF HEADACHES OTHER THAN MIGRAINE
HEADACHES
- Subarachnoid Hemorrhage (Bleeding on the Brain): The
result of bleeding from a ruptured aneurysm or in a younger
person, from a deformity in a blood vessel.
- Hypertensive Headaches:
These throbbing headaches are associated with high blood pressure,
and do not generally occur until the diastolic pressure exceeds
130 mm Hg.
- Meningitis Headaches: Headaches
due to meningitis (an infection in the central nervous system)
usually involves the entire head with associated fever and neck
pain.
- Mass Lesions: Headaches caused
by anything that creates a mass within the head, such as fluid,
blood, or a tumor.
- Brain Abscess:
The findings in cases of headaches due to brain abscess will
be similar to those for other space-occupying lesions, but the
patient will also have a history of fever.
- Sinusitis: Acute infections of
the sinuses may be associated with severe headaches.
- Toxic Metabolic Headaches:
Toxic metabolic headaches can result from exposure to a variety
of substances, such as paint or gasoline fumes. The treatment
of these headaches is directly dependent on discovering the
substance that has provoked the pain.
- Post-concussive Headache: Post-concussive
headaches may follow head injury within hours to days. These
headaches usually run their course in a short period of time,
but non-steroidal anti-inflammatory drugs (NSAIDs) may be beneficial.
The prognosis is excellent.
- Acute Glaucoma: Any abnormality
in vision or the eyes can cause headaches. Acute glaucoma is
particularly notorious for producing severe headaches.
For the most part, headaches can be treated as an outpatient
by a family doctor. On occasion, a patient may seek medical attention
in the emergency department for severe or unrelenting pain. If
even concerned that a headache is out of character from previous
headaches and is severe, then a patient should not hesitate but
visit the closest emergency department immediately.
If you have any questions regarding headaches,
please call St. Elizabeth Hospital's emergency department (225-647-5000),
or consult your primary care doctor.
St. Elizabeth is the premiere emergent care facility in Ascension
Parish. It is open 24 hours a day with highly trained doctors
and nurses who are committed to the health and safety of the residents
of Ascension Parish.
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