Headache

Headache is one of the most common neurological symptoms encountered in the daily practice of Neurologist.  It is very important to know this symptom because headache is sometimes caused by life-threatening neurological disorders such as Stroke (especially Bleeding in the brain), Tumour / Cancer and Infection in the brain (Meningo-encephalitis).  

What are the common causes of headache?

a. Vascular Headache

This condition refers to headache which is caused by abnormal blood vessels in the brain and increased activity of brain cells.

The most common type of Vascular Headache is Migraine, which is the commonest cause of headache in our daily life. Migraine affects almost all age groups - children, teenagers, adults and elderly people. The headache of Migraine is usually one-sided, and when it is severe the headache may affect both sides of the head simultaneously. It is often described as throbbing or pulsating – the headache occurs intermittently and coincides with the heartbeat.  

In Migraine, visual symptoms may be present such as seeing “flashes of bright light”.  In some patients, bright light and loud noise aggravates the headache.

Cluster headache is a rare type of Vascular Headache, which is characterized by one-sided headache especially around the eye.  It is associated with watery eye, redness of the eye and stuffy / runny nose.

b. Neurological emergency

This refers to life-threatening neurological disorders as mention above - Stroke (especially Bleeding in the brain), Tumour / Cancer and Infection in the brain (Meningo-encephalitis).  Bleeding in the brain is most commonly seen in patients who have severely elevated blood pressure causing the blood vessels in the brain to burst. Some patients may have abnormal blood vessels which may burst even without having high blood pressure, such as Aneurysm.

Headache that starts after a fall and head injury can be caused by bleeding in the brain.

c. Sinus Infection and Eye strain

Sinuses are air-filled spaces in the skulls, which are located at the forehead, behind the eyes and cheek. Sinus Infection (Sinusitis) results in headache which is felt at the forehead, back of the eye and cheek.

Eye strain refers to pain around the eyes which is caused by long period of staring at the computer and abnormal lens (which require wearing spectacle).   

d. Tension Headache

This is actually one of the most common causes of headache in our daily live. Tension Headache is due to emotional disorders such as Anxiety (excessive worrying and thinking) and Depression (feeling down or sad).  Work-related stress also contributes to Tension Headache. The headache is usually felt at the back of the head, and associated with neck pain (due to contraction of the muscles at the back of the neck).

When should a patient with headache consult the Neurologist?
Ideally, all patients who have headache should consult the Neurologist, as headache can be a neurological emergency.  

Patients are advised to urgently consult the Neurologist if:

• The headache occurs for the first time in life
• The headache lasts longer than 24 hours
• The headache is severe and started suddenly
• The headache starts after Head Injury
• There are other symptoms such as slurring of speech, weakness or numbness of limbs, blurring of vision, confusion and fever.

What will the Neurologist do for patients with headache?
The Neurologist will perform physical examination, CT / MRI brain scan and other relevant tests.

Dr Chew Nee Kong
Consultant Neurologist.

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