• Headache is very common
  • It is also very misunderstood
  • Pain in the head is a common cause of Emergency Department visits, and it’s costly
  • This quick guide to headache shows you how to get the right help

Headache is one of the most common reasons people present to the hospital, with more than 3 million visits to Emergency Departments yearly costing more than $400 Million.  The coming changes in the healthcare system are going to make it more important than ever that you become capable of taking care of yourself.  This includes using Internet-based technology to get help faster, cheaper, and for a better value than the current system allows.  But this also means that it will be more important for you to understand when things are truly going bad, so that you get the appropriate emergency help.  Allowing time to pass on the wrong kind of headache could lead to unnecessary brain damage and even cost you your life.

From a practical standpoint, there are two types of headaches:

1.  Pathological Headaches

2.  Everything Else

Pathological Headaches

These headaches are called pathological mostly because they are caused by something that is doing damage to your brain structures.   Most headaches are not pathological, but when a pathological headache occurs, you really better get help, because it’s a sign that there is underlying tissue damage occurring.  Many times, if we catch it early enough, we can stop the process in time and rescue your brain from further injury.  The main kinds of pathological headaches are listed with their technical names:

  1. Inflammation or infection of the brain lining (meningitis) or brain tissue (encephalitis)
  2. Brain (cerebral) aneurysm
  3. Stroke (in this case, ischemic cerebral infarction)
  4. Blood clot in a vein that drains the brain (cerebral venous thrombosis)
  5. Bleeding into the brain (cerebral/cerebellar/brainstem hemorrhage)
  6. Bleeding around the brain (subarachnoid/epidural/subdural hemorrhage)
  7. Contusion and concussion (traumatic brain injury)
  8. An unrelenting seizure (status epilepticus)
  9. Water on the brain (hydrocephalus)
  10. Extremely elevated blood pressure (hypertensive urgency or emergency)

Everything else, aka “Benign” Headaches

  1. Tension-type headache
  2. Migraine
  3. Occipital neuralgia
  4. Cluster headache and trigeminal neuralgia
  5. Medication overuse
  6. Medication or substance withdrawal (“rebound” headaches)

If you’ve ever had a headache (I know, it’s amazing, but some people have not!) then you’ll know there’s not much benign about them.  Even headaches that are not pathological still rob your time, cramp your style, and reduce your productivity.  For many, these headaches become so overwhelming that they reduce their quality of life dramatically.  No fun, no sex, no travel, no job… it can be a real drag.  And a drain on our economy, to boot.

Even though the brain tissue itself does not feel pain, the lining of the brain and its arteries are embedded with a layer of pain-sensing nerves.  This layer reports back to the pain centers of the brain, which get more pumped up the longer you have pain.  It’s kind of like exercising a muscle – the more you use it, the bigger it grows.

So getting control over “benign” headaches is really important, because with time they can turn into a major source of strain on the brain, the pocketbook, and your enjoyment of life in general.

Brain Rescue:  How do I get help?

Obviously, if a pathological headache comes on, call 911 and get to your nearest Emergency Department quickly.  Don’t try to sit it out, hoping it will go away.  Pathological headaches are usually:

  • Explosive, or at least severe and unrelenting
  • Worse with the passage of time
  • Associated with other neurological symptoms, like weakness, collapse, confusion or disorientation, and behavior changes.

Otherwise, if you’re dealing with a non-pathological headache, educate yourself so that you can help your doctor help you.  Understand the differences between types of headaches.  If you do this, you will be so much better off matching the right kind of treatment to your headache.

Why is this important?  Because the there are different cause of different headaches.  And that means that not all treatments are going to work the same.  Many agree that narcotic prescription isnot appropriate for most headaches in Emergency Departments.  The truth is that there are many other more modern medications that treat and even fix the underlying problem because of the way that they work.

Also, it is important to know that most headache experts use strategies other than medications to help relieve head pain.  Matching the right strategy to the underlying problem can take some time to figure out, and usually someone with an outsider’s objective view is better at identifying what strategies are best.

Brain Optimization: for the “benign” headache.

  1. Ensure adequate amounts of sleep, 7-8 hours nightly.
  2. Treat sleep apnea, if you have it.  If you don’t, it will eventually damage your brain.
  3. Avoid being overweight.  This places unneeded tension on the neck and spine.  And messes with your metabolism.  And causes unnecessary inflammation, all of which make headache worse.
  4. Learn to relax.  Be mindful of what stresses you – you may be swimming in a sea of stress that you’re not aware of.
  5. Take a deep breath, once in a while.
  6. Make sure you are getting enough magnesium, riboflavin, vitamin B12 and vitamin D3.  Another post for another time.
  7. Ask for help!  You’d be surprised (everyone is!) about how easy it is to figure out most headache syndromes just by talking about it.  So don’t be shy.

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