Headaches or Migraine

Headaches or Migraine

Article by John Miller

Types of Headache

What is the Cause of Your Headache or Migraine?

As a headache or migraine sufferer, you’ll know how disruptive and inconvenient a severe headache or migraine attack can be. Not only does a relentless headache or pulsing migraine impact you, but also your immediate family and friends. With over 300 potential cause of your headache, an accurate diagnosis is essential to guide the proper investigations, treatment and management of your headache disorder.

Head pain can have many causes, not just a migraine. Correctly identifying the cause will lead to better treatment. I will explain some of the differentiating diagnostic criteria later in this article, but let’s prioritise the small group of headache sufferers who have a significant reason to seek prompt medical attention and further investigations of their headache source.

When Should You Be Concerned about a Headache?

In a small percentage of patients, there is, unfortunately, a sinister cause of your head pain, which require investigation. We call these Red Flags because they can be vital signs of more sinister underlying conditions such as brain tumours, aneurysm, stroke, meningitis and other systemic illnesses. If you experience any of the following symptoms, please seek the urgent advice of your healthcare professional.

You MUST thoroughly investigate any Red Flags!

Please check with your doctor to investigate further if your headaches have any of the following characteristics. Your headache is:

  • History your worst ever headache or a different headache to your usual.
  • Exertion triggers your headache (e.g. exercise, cough, sneeze or sex).
  • Age is higher than 50 years.
  • Despite treatment, your headache persists.
  • Acute onset.
  • Central nervous system findings. e.g. motor weakness, memory loss, slurred speech.
  • HIV or other immune system compromise
  • fEver or other systemic symptoms, e.g. weight loss, rash.

If you have any of the above HEADACHE Red Flags symptoms, we strongly recommend that you consult your doctor immediately.

Less Urgent & Severe Headache Types

Fortunately, the vast majority of headaches do not require urgent medical investigation and should respond positively to treatment depending upon an accurate diagnosis.

What is Causing Your Headache or Migraine?

Historically the diagnosis of headaches and migraine was based on whether or not your head pain involved pulsatile “throbbing” or not. Any headache that was “throbbing” would affect the head’s blood vessels was a “migraine”. Any headache that was “not throbbing” was labelled a “tension-type headache”, despite there being no evidence of increased tension in the muscles of the scalp or forehead.

Headache & Migraine Research

Researchers have luckily improved our knowledge of headache sources. Things have changed and will continue to evolve as researchers and healthcare experts grow their diagnostic criteria and categorisation. As we currently stand, there are over 300 causes of headaches and migraine. That’s a lot more than the two first options! The numerous potential reasons can make it very confusing to diagnose and treat.

Of the over 300 causes of headache and migraine, most problems are migraine, tension-type headache or neck headache. These are the most common headache causes, and interestingly, they can also co-exist.

Specific information

Neck & Jaw Headache

At PhysioWorks, we have a particular interest in assessing, diagnosing, and treating migraine and headache disorders. In particular, we focus on the diagnosis and treatment of a neck headache and jaw headache. Your headache physiotherapist will be able to assist your headache or migraine diagnosis and point you to the appropriate health practitioner if required.

Specific information

Article by John Miller

When Should You Be Concerned about a Headache?

headache

Unfortunately, in a small percentage of patients, there is a sinister cause of your head pain, which require investigation. We call these Red Flags because they can be vital signs of more sinister underlying conditions such as brain tumours, aneurysm, stroke, meningitis and other systemic illnesses. If you experience any of the following symptoms, please seek the urgent advice of your healthcare professional.

You MUST thoroughly investigate any Red Flags!

headache red flags

Please check with your doctor to investigate further if your headaches have any of the following characteristics. Your headache is:

  • History your worst ever headache or a different headache to your usual.
  • Exertion triggers your headache (e.g. exercise, cough, sneeze or sex).
  • Age is higher than 50 years.
  • Despite treatment, your headache persists.
  • Acute onset.
  • Central nervous system findings. e.g. motor weakness, memory loss, slurred speech.
  • HIV or another immune system compromise
  • fEver or other systemic symptoms, e.g. weight loss, rash.

If you have any of the above HEADACHE Red Flags symptoms, we strongly recommend that you consult your doctor immediately.

Less Urgent & Severe Headache Types

Fortunately, most headaches do not require urgent medical investigation and should respond positively to treatment depending upon an accurate diagnosis.

For specific advice, please consult your doctor or headache physiotherapist.

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Article by John Miller

When Should You Be Concerned About Neck Pain?

What's Urgent?

There is one situation where there’s no need to wait several weeks before deciding if your neck pain is serious.

If you’ve had an accident with forces that may have been sufficient to fracture your spine or tear nerves, seek a medical assessment as soon as possible. In this instance, either call an ambulance or head to a hospital emergency department.

Red Flags for Neck Pain

Otherwise, the rule of thumb is to start a more thorough medical investigation only when you meet all three of these conditions.

The three general red flags for neck pain are:

  1. it’s been bothering you for more than about six weeks
  2. it’s severe and/or not improving, or getting worse
  3. there is at least one other “red flag” (see below)

Red flags are reasons to seek a professional opinion rather than to worry. Seek the advice of your physiotherapist or doctor if any of these red flags apply to you.

  • Light tapping on the spine is painful.
  • A torn artery may cause severe, throbbing or constrictive (novel pain), with a high risk of a stroke. Pain is the only symptom of some tears. Most cases are sudden, on one side, and cause neck and head pain (in the temple or back the skull), but the pain is usually strange. Any hint of other symptoms? Promptly attend a hospital emergency.
  • There are many possible signs of spinal cord trouble in the neck, with or without neck pain, mainly affecting the limbs: e.g. poor hand coordination; weakness, “heavy” feelings, and atrophy; diffuse numbness; shooting pains in the limbs (especially when bending the head forward); gait awkwardness. Sometimes patients present with both neck pain and more remote symptoms and don't realise they are related.
  • Unexplained episodes of dizziness or nausea, and vomiting may indicate a problem with the stability of the upper cervical spine.
  • Weight loss without dieting (it's a potential sign of cancer).
  • Mystery fevers or chills, especially in people with diabetes).
  • A severe headache that comes on suddenly is a “thunderclap headache”! Most are harmless, but it is always wise to investigate thoroughly.
  • Symptoms of meningitis (inflammation of the membranes covering the brain and spinal cord, caused by infection or drug side effects). The presence of a fierce headache or an inability to bend the head forward, fever, or an altered mental state.
  • The main signs that neck pain might be caused by autoimmune disease specifically include:
    • a family history of autoimmune disease,
    • gradual but progressive increase in symptoms before the age of 40,
    • marked morning stiffness,
    • pain in other joints as well as the low back,
    • rashes,
    • difficult digestion,
    • irritated eyes, and
    • discharge from the urethra (bladder).
  • Steroid use, other drug abuse, and HIV are all risk factors for a serious cause of neck pain.
  • If you feel pretty unwell in any other way, that could indicate that neck pain isn’t the only thing going on.

More info: Neck Pain

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Article by John Miller

What is a Primary and Secondary Headache?

The International Headache Society classifies headaches as Primary or Secondary.

Primary headaches are not related to any other problem and include migrainestension-type headaches and cluster headaches.

Secondary headaches. Caused by an underlying problem and can include a post-whiplash headacheneck headache, jaw headache and drug withdrawal headache. “Ice cream headache” is a secondary headache caused by extreme cold within your mouth. In other words, a secondary headache is a symptom of something else being wrong rather than the cause itself. Treatment for a secondary headache involves treating the source, e.g. loosen some stiff upper neck joints or stop eating ice cream!

Multi-Source Headache

Migraine

It is also important to point out that many headache sufferers may suffer multi-source headaches. For example, a migraine sufferer may simultaneously experience a tension-type headache and neck headache. Treatment will vary depending upon your specific symptoms and headache source.

Please consult with your healthcare practitioner for an accurate diagnosis and treatment pathway.

More info: Headaches & Migraines