Sinister Headache
PKGhatak,MD
Any abnormal condition in the head and neck area may cause a headache. The cause of this type of headache is easily identifiable and effectively treated. There are, however, more serious forms of headaches. We will consider a few of them here.
The brain tissue itself is insensitive to pain, but its coverings (meninges) at the base of the skull are very sensitive. Arteries and veins of certain parts of the brain are also sensitive to pain. Bacterial meningitis is probably the most life threatening and very rapidly progressing infection.
An 18 year old youngster gets up in the morning with a mild frontal headache and malaise which he attributes to drinks he had the night before. Later in the day, he has chills and fever; the headache becomes intense and throbbing in character. He develops nausea and vomiting. In an hour he becomes dizzy; pink colored skin rashes begin to appear over his wrists and ankles. Unless he is taken to a hospital at that moment it may be too late to save him. This is an example of meningococcal meningitis.
Besides this bacterium, other bacteria may also cause meningitis but the progression of meningitis in those cases may not be that explosive and skin rashes do not develop.
A variety of common and not so common viruses can cause meningitis. In general, sore throat, runny nose, and cough begin first; a day or two later headaches become most troublesome and persist even after taking potent headache pills. A low-grade fever continues and a stiff neck develops. Only a spinal tap and examination of the CSF (cerebrospinal fluid) will differentiate viral meningitis from bacterial meningitis. Coxsackie, Echo, Herpes simplex, E-B virus, and Adenovirus are commonly responsible for viral meningitis. From time to time TV news and newspapers scare people with reports of West Nile virus encephalitis, Western Equine encephalitis, St. Louis encephalitis, Japanese B encephalitis, and other forms of encephalitis. Viral Encephalitis is an infection of the brain tissue and is often associated with meningitis. Depending on the type of virus, the illness may go on for days or a week before a correct diagnosis is made. A headache, fever, and neck rigidity are common symptoms; lethargy, mental confusion, and altered consciousness characterize encephalitis. Various neurological signs and seizures are common, however, most of the neurological defects will resolve with treatment over a period of time.
The most intense and worst type of headache is seen in subarachnoid hemorrhage. A ruptured intracranial aneurysm is often the cause. Typically, the person has an episode of a short sudden severe headache, which may subside in time. Then the most painful, intense headache starts, followed by loss of consciousness within a short period of time. There may or may not be warning signs of the presence of a berry- a size aneurysm at the base of the brain; pain following a rupture may be the only presentation. An immediate surgical procedure is required to save the life.
A stroke, as a result of bleeding inside the brain tissue, may produce a severe headache because accumulated blood stretches the meninges and blood vessels; often headache may proceed to bleed for hours or a few days, but associated paralysis is the predominant presenting symptom. A headache from stroke, as a result of thrombosis of artery or blood clot emboli, may or may not be present.
A person having high Blood Pressure often complains of a dull headache over the back of the head or forehead, often the headache has a throbbing character, at times a headache is associated with dizziness. A headache subsides with the control of BP.
People fear a headache may be a sign of brain tumors but often headache is not a presenting symptom. When a headache is present, it is deep seated, dull aching and becomes worse with coughing and straining at stool.
A persistent and constant throbbing headache over one side of the temple, or in rare cases on both sides, may result from Temporal arteritis, also called Giant Cell Arteritis. The pain is located on the face, jaw, or side of the neck. The scalp becomes very painful to touch. At times, it is associated with visual impairment or the onset of sudden blindness. Urgent treatment is required when vision is affected.
A fall or injury to the head will cause pain and headache but if vomiting, confusion, and altered consciousness are absent and no neurological signs are present, then brain injury is unlikely. A subdural hematoma may result from a fall in old people; it could even develop several weeks later. A persistent headache may be the only symptom, later incontinence of the bladder, unsteadiness on the feet, walking difficulties, and drowsiness may develop.
Infection from nasal sinuses or inner ears may spread inside the skull to the brain tissue and may end up in an abscess formation. Persistent fever is associated with a headache and various neurological signs are present depending on the location of the abscess. Nausea, vomiting, drowsiness, mental confusion, and lethargy are common.
The 5th cranial nerve carries sensation from the face, forehead, and anterior part of the scalp. Herpes zoster infection (commonly called shingles) at the ganglion of this nerve can cause a severe headache and pain in the affected area. At times a headache precedes the appearance of the typical vesicles on the skin. The vesicles appear in bunches like grapes. Without the presence of skin lesions, the diagnosis can be difficult. Early initiation of treatment with antiviral drugs may shorten the duration and severity of the illness. Neuralgia of the scalp and forehead from other causes often makes life miserable for the patients and may be difficult to treat effectively.
Post-spinal tap headache is another painful condition. It is localized on the back of the head, often dull and pulsatile in character. It is worse when the person gets up from the bed and assumes an upright posture and the headache is relieved on lying down. When there is a significant loss of CSF from the puncture site, the problem is a complex one, and a surgical repair of the torn dura is required to seal the leak.
Migraine, Cluster headache, and Histamine cephalgia are also important in this group, but most people are aware of them, and they will not be highlighted here.
edited 2020.
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