Let’s talk about headaches…
Headaches are something almost all of us will experience at some point in our lives. Naturally they are a cause for concern for many of us as we fear they may be related to to a problem with the brain or may be due to another serious underlying cause. Thankfully the vast majority do not tend to be due to something serious or sinister and are what are known as primary headaches, that is those which do not have a serious underlying cause.
When should you see a GP
It is always important to consider seeking medical advice from your GP when presenting with new onset headaches so that they can be assessed properly. Particularly if they persist and/or are interfering with your daily life. There are so many different things that can cause pain in the head and many of these are easily remedied and modifiable. Think about when they first started and how frequently they occur. Are they related to any particular activity or worse at any time of day? Do you have any associated symptoms such as visual disturbance or nausea with them? Have you significantly changed your lifestyle recently or started any new medication or supplements that may be linked to them? If you are wondering if there is a GP near me that can help, look no further. Here at London Doctors Clinic we are happy to see you anytime.
If you have any concerns it is always best to consult a GP to talk about these and be assessed and examined in detail and most of the time, there won’t be any reason to worry. It has been reported that 90% of headaches that present to primary care are of a primary cause, i.e. no serious underlying cause has been found. Examples of these include tension headaches, migraines and cluster headaches.
These are not due to the sufferer being under severe tension/stress (though stress can play a part) but are so-called to describe the nature of the pain causing them. Often described as a tight band causing pressure around the head. These do not usually disturb activity or sleep and people often soldier on through them, though the symptoms can still be profound and last for several days. They can also develop into a long-term problem know as chronic tension type headache where the symptoms persist for some time. But thankfully there are ways to manage them.
Simple painkillers and anti-inflammatory medications are a start. For the chronic types, acupuncture has been shown to be an effective preventative measure but there are many other treatment options that your doctor can discuss with you.
Another type of primary headache these often overlap with tension headaches as the sufferer can often have a combination of both and tend to be disruptive to one’s daily activities sometimes with aura. That is other associated symptoms occurring just before or during the early stages of a migraine, such as visual disturbance, pins and needles, difficulty with speech/language and muscle weakness. These symptoms would of course worry anyone, so when first presenting with a possible migraine it is always best to see your GP to exclude another cause. If the aura is present they tend to be short lived and are followed by the classic migraine symptoms. These include pain that affects one side of the head, is pulsating and is often associated with visual disturbances, nausea and vomiting.
The good news is that migraines can be effectively managed with a combination of medications and lifestyle measures. As it is thought that they are likely to be a result of temporary disturbance to the blood vessels in the brain, specific medication can be used to treat them as well as other painkillers and anti-nausea medication. Lifestyle measures are also extremely important as will be discussed later.
In women headaches can be strongly associated with hormonal change. Monthly hormone cycles can bring about regular symptoms and these are also called menstrual migraines. These are not always due to periods themselves. In fact, those women on combined oral contraceptives should consider whether the medication itself is a possible cause as it is has been shown to be. Were the headaches present before starting the pill?
Again, lifestyle measures are such an important management tool and medication, including those used to treat regular migraines as well as hormonal methods, can be tried.
These are another type of primary headache but tend to be the most painful, affecting one region of the head often with pain localised in or behind one of the sufferer’s eyes. They tend to be more common in middle aged men and more common in those men who smoke, but can affect anyone. Sufferers often report extreme agitation and discomfort as the pain is so severe and disabling. It is often accompanied with the classic associated symptoms of a red/watery eye, blocked or runny nostril on one side and changes in the pupil and/or eyelid on the same side.
Again, these symptoms should be assessed and reviewed by your GP. If cluster headaches are the likely diagnosis then a specialist review is best so that treatment options, many of which are effective, can be considered.
As touched upon earlier, it is important to ensure appropriate lifestyle modification and measures are taken as these are so often related to primary headaches.
- Ensuring you are always well hydrated and monitoring alcohol and caffeine intake is vital.
- Regular exercise and minimising stress where possible.
- Eating a balanced diet and getting a good night’s sleep are also essential.
Indeed, when headaches occur it is also worth avoiding the regular use of particular medication, anything including codeine or similar drugs, as these can cause another type of headache called a medication overuse headache. As well as this sometimes exercise, or sexual activity, can themselves trigger headaches. It is particularly useful to keep a headache diary to note exactly when the headaches occur. What time of day/during what activity/any dietary or lifestyle trigger? This can be invaluable to the clinician when trying to diagnose their possible cause.
The main reason people worry about headaches is because they feel something serious may be causing them. Patients I have encountered will often ask, normally within the first few minutes of being seen, do I have a brain tumour or another form of cancer? Can I please get a scan? Thankfully, the number of headaches presenting to GPs due to brain tumours or other serious conditions make up an extremely small proportion of those that are seen. Many secondary causes of headaches are themselves easily treatable and managed.
Some of these include:
- Flu/sinusitis and other infections – infections can cause localised inflammation and activate pain receptors in the head which is often why the common cold or flu gives sufferers that feeling of a heavy head which with sinusitis is often worse with movement
- Chemical/drug/substance withdrawal – the classic hangover gives sufferers a severe headache and indeed other substance withdrawal such as caffeine in those who are used to its effects can cause severe headaches
- Referred pain – Sometimes pain from other areas such as the neck muscles and teeth can cause pain in the face and head by activating nearby pain receptors
- High blood pressure – particularly if poorly controlled can cause severe headaches
The most important thing is to know when to seek medical advice urgently regarding headaches and this is best discussed by seeing a doctor straight away to talk about such concerns. As mentioned, London Doctors Clinic is always happy to help when looking for a GP near you.
Some red flags to be aware of:
- Pain associated with a rash/neck stiffness/sensitivity to light/fever and the feeling of being very unwell – meningitis needs excluding in this case
- Headaches presenting following a head injury – even in the weeks following a head injury as in some cases internal damage can occur
- Headaches that present in the first time for those aged 50+ as these are unusual and can be cause for example by inflammation of one of the blood vessels in the head (a condition called temporal arteritis)
- Any headaches that cause confusion/weakness/speech/swallowing – most people are aware of the FAST stroke assessment tool, but strokes can present in different ways
- A new headache that is simply the worst headache the sufferer has had – often described as a thunderclap headache, this could be due to an internal bleed known as a subarachnoid haemorrhage
For all the cases mentioned above urgent medical advice should be sought and again there is no harm speaking to a GP for advice even on how to manage the above symptoms as they can decide whether you should present straight to A&E and or be seen face to face first for a review.
To find a Private GP near you follow the link and we will be happy to see you for a same day appointment or future appointment. A specialist referral can also be organised to neurologists, where appropriate, to assess and investigate these headaches in more depth. At London Doctors Clinic we can also refer you directly for a brain scan (MRI) if we feel this is suitable.
Written by Dr Bilal Ahmed Chaudhri, General Practitioner
Published: October 2018
Review: October 2021