A World of Hurt: Hypertension, Tumors, and Spinal Taps (Oh My)

Thu, Dec 10, 2009

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So in the finale of the World of Hurt series for head pain, we’ll be talking briefly about several types of conditions that cause headaches that you should be aware of, but are rare.

The first on our agenda this week is one called the hypertension headache (not just anyone with high blood pressure). We’re talking about someone that’s at least grade III hypertensive. Someone that has a blood pressure at about 200/120 mm Hg will feel a dull, throbbing, diffuse headache. This headache is usually felt in the occipital areas of the head, as well as the vertex (the back of the head and the top of the head). Most identifiable is that the headache here is worse in the morning and better when out of bed/standing up.

When you’re laying down, essentially gravity isn’t as much of a factor for slowing blood to your brain. So in this case, the pressure isn’t hindered and it’s just too high. It’s usually caused by renal artery stenosis – when the artery going to the kidney is blocked (because of high blood pressure injuring the artery, starting atherosclerosis). The arterial blockage to the kidneys is a medical emergency and is the actual problem in this case that requires an immediate hospital visit. The treatment for this in the long-term is to get that blood pressure under control with immediate therapy. If the diastolic blood pressure is actually below 110 mm Hg, the headache may actually be due to another reason (what that is can vary).

Intracranial masses are another thing that produce a particular type of headache. These particular headaches can vary in the location of the headache, but it is one that waxes and wans, but never goes away. This is because there’s an increase in the intracranial pressure (the mass is taking up space so there’s less room for the fluid) and the severity changes with body position. Lying down is the worst. Neurological signs are one of the big giveaways for this. But keep in mind that it’s not the only cause. Aneurysms, hematomas, and a few others look like it as well. Neurological signs are rarely okay to have. A new onset of seizures, or an increase in vomiting, loss of vision (progressively and typically one-sided), loss of coordination or sensation – the list goes on and your doctor can identify this. If there’s no trauma involved, then odds are that it’s some sort of mass and the treatment is surgery.

There is one type of headache that appears to be a tumor, but isn’t. It’s called pseudotumor cerebri. It’s believed to be caused by an excess of lipids/fats. These are an increase in lipids because of an excess of estrogen, so women taking birth control pills tend to be at a higher risk. Women that have high estrogen levels may want to consider getting a diet that includes phytoestrogens, since they tend to block estrogen receptors from the full effects of estrogen. There are a few tests your doctor can do to look for this as a cause for your pain, but what’s most peculiar is that spinal taps will relieve the pain almost immediately. What makes this odd is that a tap hurts. So the short term treatment is getting a shunt put in to relieve the build up of fluid pressure in the skull and spine, but in order to reverse this condition completely is to get a diet that includes phytoestrogens and a goal to decrease weight overall.

Well, this will be the final World of Hurt series for a while. We’ve covered a lot, and I do encourage you, if you came into this series just now or halfway through, to look at previous ones. We’ve come from migraines, tension headaches, and cluster headaches to the special, more dangerous causes for headaches, subarachnoid hemorrhages, and what we covered today.

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