Headache - common causes of

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This is a common symptom which is only too often diagnosed by sloppy thinkers as Paracetamol deficiency! With headache one should always think of the cause and the best clues come from careful history taking rather than tests.

ACUTE

Meningitis - this is one of the rarest causes of headaches, but understandably it is the one most people worry about. In acute meningitis, almost always there is a high temperature and nearly always the patient is not with it. They cannot think clearly, they are totally occupied by the pain, there may be lowering of the level of consciousness, or even acute confusion. They are irritable and dislike bright light, loud noises. Any movement of the head is painful and clinically this results in a stiff neck. In advance cases, there may be bleeding of the small vessels - in the skin this causes a rash that does not fade when you press on it. The treatment is high dose injected antibiotics given as soon as is possible. Indeed one should not wait for hospital admission nor tests before initiating therapy as a matter of urgency.

Eye disease - a visit to an optician is always a good idea.

Glaucoma, (raised pressure in the eye) - can present with loss of vision.

Ear disease - infection or pressure can cause headache.

Shingles - before the rash appears the diagnosis can be awkward.

Dental problems - undetected abscesses, impacted wisdom teeth, temporo-mandibular joint dysfunction (feel for the jaw joint in front of the ear - does it hurt when you press on this joint and open and close the jaw?).

Sinusitis - may be acute or chronic. Often this causes headache which is worse lying down - this is because it increases the pressure in the head. Chronic sinusitis is often caused by allergy to dairy products.

CHRONIC HEADACHE - all of the above, plus:

Lack of sleep.

Excessive caffeine - if the problem is caffeine, then when you stop drinking caffeine suddenly this can cause the mother of all headaches within a few hours. It can be surprising how little caffeine is necessary to do this.

Allergy - migraine is the classic food induced headache but allergy can cause almost any headache.

Toxic headache - many of my patients with CFS and/or poisoning - complain of headache, the characteristics of which sound like raised intracranial pressure. It is fairly constant, waxes and wanes a little, feels like a pressure and is worsened by movement. It feels like a nasty hangover from alcohol - which of course is another sort of toxic headache! Sometimes it can be so severe as to be mistaken for meningitis. My guess is that it is due to some sort of inflammation in the brain which results in mild oedema or swelling of the brain. But the brain cannot swell within the bony skull - so there is pressure in the ultrasensitive coverings of the brain ie the meninges. It is this that causes the headache. But why should there be oedema? Usually because of inflammation. Where there is a toxin there is often immune activation against that toxin. This type of headache may be made initially worse by a detox regime (as toxins are mobilised) but in the longer term got rid of by detoxing. See Detoxification - an overview

Problems with the cervical spine (eg following neck whiplash injury from car accidents) - often causes occipital headaches (back of head). X ray or MRI scan may be needed to make sure it is safe for a physio to manipulate the neck.

Head injury - sometimes a headache will persist for weeks after.

Raised intra-cranial pressure - this is a rare cause of headache (usually worse in the mornings) but should be picked up at an eye examination where the back of the eye is viewed. If the headache gets progressively worse despite one's best efforts to find a cause, then further investigation is required.

Blood pressure is not supposed to cause headache unless the pressure is very high. However many of my blood pressure patients instinctively know when their pressure is up.

Hypothyroidism sometimes presents with headaches.

A brain tumour is the cause of chronic headache that everybody worries about, but again is uncommon. It is often accompanied by neurological symptoms, which may be subtle at first, such as change in personality, depression, lack of motivation and so on. MRI scans are now inexpensive and freely available to anybody and one can self refer to organisations such as Lifescan (contact via their Contact us page on the website or by phone on 0845 217 9947).

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