A World of Hurt: Red Flags

Thu, Nov 26, 2009

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This week’s post is actually going to step away from headaches, somewhat. We’ll be discussing a few red flags that tell doctors that your “headache” may not be a headache and may be something more sinister. So if you’re experiencing these, go to your doctor immediately!

Many times, the first headache or worst headache is nothing serious.

Many times, the first headache happens in childhood or adolescence, typically no big deal (other than an overwhelming majority of those that experience a headache/migraine in youth will experience multiple ones in their lifetime).

However, if you’re one of the minority where you’re in your 50s before you ever experience a headache, that’s a red flag! This could be a sign of something called temporal arteritis. Many times it clears up on its own, but with complications like vision loss or stroke, why risk it?

Along these lines, if someone with a headache also experiences double vision, vision loss, stiff neck, one-sided weakness or difficulty moving – are all pretty big warning signs.

Severe headaches that appear suddenly are assumed to be vascular in nature before anything else. So if you remember this: when neurological signs (i.e., aura) appear before head pain and diminish after the onset of head pain, this is a migraine. If neurological signs start with head pain or get worse at the start of head pain, that is a HUGE concern since that could be a vascular problem like a stroke. Also, don’t confuse a vascular headache/migraine with a vascular problem.

Another possibility of a later-aged headache can be mass lesion, like a hematoma, a tumor, or an aneurysm. So again, it’s not something to just forget about. This is where a history of a physical exam comes into play for a doctor when determining a cause of a headache. Also, an increase in frequency or severity can be a sign of a problem. But do keep in mind that many normal headaches decrease in frequency around the age of thirty and start to increase again after the age of 60. You may have noticed that temporal arteritis starts to appear around 55 and normal headaches begin to creep in around 60.

The most important information during your physical exam you can give to your doctor is to tell them about the change in pattern of your headache. (This goes for doctors, too. It’s the number one reason for malpractice in an older patient.)

So let me briefly differentiate temporal arteritis from the other headaches we’ve discussed so far. This is experienced as a burning, boring, jabbing head pain. You’ll get that throbbing headache around the temples that is tender to the touch (most commonly, that tenderness is felt on the scalp) and you may feel ill in general. You may also experience the other symptoms we discussed earlier, like weakness or vision problems. It’s suspected that the cause of this is immune related and is commonly seen with other inflammatory diseases. A biopsy may be needed to confirm the diagnosis if blood tests are inconclusive. Once confirmed, corticosteroids should be given to reduce inflammation and secondary damage to the arteries. Aspirin may also be used to help treat this, and the treatment can last for over a year to prevent TA from being experienced again. Unfortunately, this is a condition that’s a little unclear on how to prevent it from occurring, but the array of odd symptoms should be clues that it’s not something to mess around with and to get early treatment.

As we begin to wind down with the World of Hurt series, we’ll be talking about more of the dangerous head pains and a few other special cases of headaches.

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