Ask The Experts

Nagging headache not going away

The two most common types of primary headache disorders are tension-type headaches and migraines. While unpleasant, the majority of them are harmless and respond to simple measures.
The two most common types of primary headache disorders are tension-type headaches and migraines. While unpleasant, the majority of them are harmless and respond to simple measures.ST FILE PHOTO

Seek help early, for some headaches may need targeted investigations to reach a diagnosis

Q I've been having a nagging headache for about seven months. My head feels very heavy and

I have a slight headache most of the time. I have seen a doctor and was given painkillers.

However, they do not help.

Most headaches
are not caused
by sinister conditions
andare classified
as ‘primary’ headaches.
However, ‘secondary’
headachesare linked
to anunderlying
illness or injury,
andthese deserve
careful consideration.

I am concerned about my condition and would like some advice.

A Almost everyone will experience headaches at some time in his life. Most headaches are not caused by sinister conditions and are classified as "primary" headaches.

However, "secondary" headaches are linked to an underlying illness or injury, and these deserve careful consideration.

Other co-existing medical problems will also need to be considered in the evaluation of headaches.

If you are experiencing such headaches for the first time, seek medical attention early for further evaluation. This may include a detailed neurological assessment, followed by a brain scan - which is a magnetic resonance imaging or computed tomography scan of the brain.

You should also see a doctor for the following scenarios:

•If you had headaches before, such as migraines, but find that the intensity, quality or location of the headaches have changed.

•If you experience blurry vision, persistent nausea and vomiting. This may indicate an increased level of brain pressure.

•If you experience headaches upon waking up which get worse when you change your posture or position, cough or sneeze; or are accompanied by limb weakness or numbness, or changes in speech.

These symptoms warrant early medical evaluation for secondary intra-cranial causes such as brain tumours, inflammation and infection.

After considering the more worrisome causes of headaches, the two most common types of primary headache disorders are tension-type headaches and migraines.

Tension-type headaches or "pressure headaches" are usually felt as a band across the front and both sides of the head.

Some people experience a squeezing or pressure sensation on the head. The headache can last from a few hours to several days. Occasionally, it may become more persistent and last for months.

Such headaches are thought to be caused by tightness in the muscles at the back of the neck and over the scalp. Factors that induce muscle tension, such as poor posture, mental and physical stress, may precipitate tension- type headaches.

Some people may develop these headaches if they consume too much caffeine or alcohol.

Although uncomfortable, they are not incapacitating and usually do not disturb sleep. Most people can carry on with their daily activities without any issues.

Migraines are another common affliction. Typically, the migraine headache is one-sided and throbbing. It can last a few hours or up to three days. Occasionally, a chronic form of migraine may develop.

The pain is typically aggravated by movement. The person often has a heightened sensitivity to bright lights, sounds and odours during migraine episodes.

He often feels nauseous and may even vomit. He may also stay in bed to try and "sleep off" the headache.

About one-third of migraine sufferers develop warning symptoms or an " aura" before the migraine kicks in. This includes seeing flashing lights or zigzag lines.

Common triggers for migraines include physical and mental stress, hunger, eating certain foods, irregular sleep patterns and dehydration.

Managing the problem depends on the type and characteristics of the headache disorder.

This may include lifestyle changes, identifying headache triggers and avoiding them, medication or diagnosis-specific treatment strategies targeted at the underlying cause.

You have tried painkillers but have not found it to be effective.

This could be due to the type and dose of medication prescribed and whether you have nausea or vomiting, which may have limited the amount of medication absorbed by your body.

Another factor is how frequently the medication was taken. The development of headaches due to medication overuse or "rebound headaches" may occur, especially if the medicine was taken regularly over a few months.

In addition, the inadequate response to painkillers may alternatively signal the need to evaluate for "secondary headaches".

The patient may have to undergo several targeted investigations to ascertain the diagnosis before eventual pain relief is achieved.

While headaches are unpleasant, the majority are harmless and respond to simple measures.

It is advisable to work together with a doctor to clarify the diagnosis so that appropriate treatment strategies can be implemented.

Dr Jonathan Ong

Associate consultant in  the division of neurology at  National University Hospital  Most headaches  are not caused  by sinister conditions  and are classified  as 'primary' headaches. However, 'secondary' headaches are linked  to an underlying  illness or injury,  and these deserve  careful consideration.

A version of this article appeared in the print edition of The Straits Times on November 10, 2015, with the headline 'Nagging headache not going away'. Print Edition | Subscribe