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Headaches should not be ignored


June 28, 2013

SPRINGFIELD – Remember those old Excedrin television commercials like "Excedrin Headache Number 24 – What's for Dinner?"

Not all headaches are to worry over or require a visit to the doctor's office. In fact, most don't. But, some can signal a more serious disorder and call for prompt medical care, and those with frequent headaches like "Number 24" may need to find out from their doctor what kind of headache it is.

June is National Migraine and Headache Awareness Month with the goal of building awareness and education around migraines and headache disorders, for which there is no cure.

According to Dr. Paul Walting of the Division of Neurology at Baystate Medical Center, some "red flags" include persistent headaches after a head injury or newly developing headaches in a person who never had problematic headaches. Headaches with other neurologic symptoms, such as changes in vision, weakness or difficulty walking, difficulty with speech, or confusion should be checked by a doctor.

"The headaches that bring most people to the doctor are migraines, which are relatively common," Walting said.

Even more common are less severe tension headaches often treated with over-the-counter medications and characterized by pain or pressure around the head, especially the temples, as well as neck pain. There are also cluster headaches, which are extremely severe, appear suddenly and "in clusters" often lasting hours over several weeks to several months. They are characterized by pain, mostly on one side of the head, watery eyes, and nasal congestion, and can be so uncomfortable as to make it difficult for the person to remain still.

The most obvious factor separating migraines from other headaches is the degree of pain. Cluster headaches may be even more painful than migraines, but tend to be less common. What also separates migraines from other headaches are unpleasant symptoms, such as nausea, vomiting, and light and sound sensitivity.

"These symptoms can be severe enough to significantly limit a person's ability to function normally, often leading to a visit with their doctor," Walting said. "Some migraine symptoms are frightening, including temporary vision change or loss, weakness, difficulty speaking, and changes in behavior. These symptoms can mimic a stroke, also sending patients to the doctor very quickly."

When it comes to headaches, there are various factors that can trigger or even worsen them, noted Dr. Walting, including diet, medications and dietary supplements, and for women – hormonal fluctuations and menstrual periods. Also, for many people, stress can play a role. Lifestyle factors such as sleep deprivation, smoking, alcohol, and drug use can influence headache patterns, as can other medical conditions such as hypertension.

According to the Baystate Medical Center headache specialist, treatments fall into two categories. Abortive treatments help to lessen or stop a headache and include over-the-counter medications such as aspirin, ibuprofen, or others, as well as prescription medications such as sumatriptan. Preventive treatments, intended to reduce the frequency of headaches, can include the use of many medications as headache preventives. There are also procedures such as trigger point injections, nerve blocks, and other interventions that may be either abortive or preventive. Lifestyle modification – including diet, exercise, weight loss and sleep pattern adjustment – also play a role in treatment.

"A 'worst headache of my life,' especially if it is very sudden in onset, is also very concerning because it may suggest bleeding in the brain. In general, if you have frequent headaches that are bad enough to prevent you from taking part in daily activities, consider speaking to your doctor about them," Walting said.



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