DEAR DOCTOR, A neighbour of mine lost a cousin recently. He said that the cousin complained of a headache and went to bed, but was found dead hours later. This is not the first time I’ve heard of someone dying suddenly after complaining of a headache. What happens here? How can you tell the difference between a normal headache and a serious one? CLIVE DEAR CLIVE, It is really sad that a family lost their person so shockingly. What was his age? Was this the first episode of headache or did he have frequent or intermittent headaches for some time? The most common cause for sudden headache which turns fatal is bleeding in the brain. In young adults, it can be due to rupture of a blood vessel which may have some abnormality since birth. In elderly people, sudden rupture of a major blood vessel of brain can be fatal. It usually occurs due to very high blood pressure. Use of blood thinner drugs, bleeding disorders, can also cause sudden bleeding, subsequent sudden headache and death. Drugs, disorders causing platelet deficiency may manifest as sudden bleeding in any part of brain, which can cause headache and death. A clot in any blood vessel of the brain is more likely to cause paralysis, but if brain stem is involved, death can occur. This happens because a clot causes sudden cessation of blood supply resulting in death of brain tissue concerned. The brain stem contains control centres for breathing and heart function, affection of which results in death. Tumour in any part of the brain can be fatal, if it spreads and compresses vital centres of the brain. But its spread is usually not very rapid. Moreover, headache caused by it is chronic, increasing slowly in intensity and frequency. There would be one or more associated symptoms like visual and or hearing disturbances, vomiting without nausea, paralysis of one or more body parts, and et cetera, depending on the part of brain affected. Similarly, infections of the brain substance or coverings of the brain can cause headache and death, but there would be associated features like high fever, stiff neck, nausea, vomiting, to name a few. Headaches caused by Covid-19 have been documented, which have mostly recovered, but it has caused death due to clotting of cerebral blood vessels. A headache should be considered serious if it is very sudden and severe. Severe, sharp pain in any part of the head for the first time, should be worrisome. Intense headache with nose bleed, stiff neck, high fever, nausea and or vomiting, fainting or imbalance in walking, any one or more of these features should raise alarm, that there may be a sinister underlying problem which needs urgent treatment. Full blood count, imaging of the brain (CT scan and MRI), lumber puncture (where fluid is drawn from the spine), are some of the basic investigations which reveal any pathological process of brain. Timely treatment of underlying cause usually cures the headache as well. A healthy lifestyle can prevent most of the types of headache and subsequent complications, including death. Dr. Rachna Pande,Specialist internal medicine rachna212002@yahoo.co.uk
