Dear Doctor,

I often get headaches and sometimes even painkillers do not help.  What could be the reason for this?  

Richard

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Dear Richard,

You have not mentioned your age. How long have you been getting these headaches? Is it getting more frequent? Is it generalised or located at a specific point, is it aggravated at some particular time of the day, does it increase by some particular movement? How does it subside? The answers to these questions can help detect the possible reason for your headache.

Amount of stress present in modern urban living is one of the main reasons for stress-related headaches. Migraine is one such headache. It occurs more in young women, affects one half of the head, the pain is intermittent, throbbing in character, intense and can last up to 24 hours. There is often associated nausea, vomiting, and coloured spots in front of eyes (one or more of these symptoms). Relief is obtained by lying down in a quiet dark room. Tension headache occurs in young adults, is diffuse in nature and occurs intermittently. Headache is associated with sleep problems. Cluster headache is common in young adults mostly men. One is awakened at night by intense headache, which is associated with a running or stuffed nose and red eyes.

Diagnosis of these headaches is established by excluding other physical causes of headache by suitable investigations. Treatment is by specific drugs for each kind of headache, but relaxation helps in a big way in preventing and treating headaches.

Eye strain as caused due to continuous working on computers/mobile phones can also lead to sense of heaviness and headache. This is prevented by avoiding continuous use of computers, for long hours. It is treated by correcting the refractive error if present. Infection and inflammation of the ears, eyes, teeth nose or any structure within the face, can manifest as headache, which is cured by treating the underlying infection.

Infections of the brain tissue or its coverings cause headache over the affected part. Viral infections are mostly self-subsiding. Bacterial infections manifest with intense headache, fever, photophobia, vomiting, one or more of these symptoms. Acute neurological problems may be present, depending on the part affected. Fungal infection causes chronic intermittent or severe pain over the affected part. There may be associated nausea, visual disturbances or even neurological disturbances. These infections are diagnosed by complete blood count, lumbar puncture and scans of the brain. Treatment is by antibiotics and anti-inflammatory drugs.

Any trauma to the brain can lead to formation of a clot or hematoma in the part involved. This can cause chronic intermittent headache, with or without vomiting. It can be diagnosed with a C.T. scan. It is either monitored regularly to see the progress or operated immediately, depending on the size and site affected and discretion of the neuro -surgeon.

Tumours of the brain, whether benign or malignant, are a sinister underlying cause of headache. The pain is located over the site of the tumour; intensity varies as per the size and growth of the tumour. It is more in the morning hours and is associated with vomiting without nausea. There may be other neurological disturbances, depending on the part affected. It is diagnosed by scans of the brain like C.T. (computerised tomography) and MRI (magnetic resonance imaging). It is treated by surgery, chemotherapy, radiotherapy, one or more of these measures.

 Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital