By Michael Cohen, M.D. and Gerard E. Mitchell, Esq
The most common symptoms presented to family physicians and other primary care practitioners are complaints of headaches. Who doesn't have an occasional headache? A general practitioner with 2,000 patients will probably have 300 patients present with complaints of headaches each year. What causes headaches, and what can be done about it?
Headaches can be caused by all anatomical sites, organs and tissues of the head. Headaches can also be located in different parts of the head -- in the forehead, the back of the head (deep or superficial), originating from the eyes, ears, emanating from the throat, or sinuses.
Headaches can last all day long. Or they might only occur in the evening. Sometimes they wake you up in the morning, or your headache begins right after you wake up. Some headaches appear only on weekends. Sitting in front of a computer or watching television brings on headaches in some people. Maybe your headaches begin only when the weather is very cold or hot. Loud noises might be the culprit. Or all of the above! Finally, headaches can be associated with additional symptoms like nausea, vomiting, light sensitivity, or noise intolerance (not necessarily loud noise), and can cause anxiety and depression. Headaches can interfere with work, recreation, the most basic maintenance of daily life, and one's basic duties and tasks.
Your physician will begin by taking a good history, and about 75% of headaches can be reliably diagnosed if the physician can elicit this information from the patient. Physicians are trained to assess the cause by the characteristics of the headache. In the majority of these headaches treatment is proposed by your physician, and it may result in excluding certain foods and drinks, beginning with common irritants like chocolate, coffee or cheese. Allergies causing headaches can also be narrowed down by certain relatively easy measures like avoiding some animal products or certain garments. In some patients medication can also help if carefully thought out and carefully used. In 25% of patients with headache complaints, the patient needs further studies and evaluations to arrive at the proper diagnosis before treatment can be instituted.
Headaches can emerge from serious diseases, such brain cancer or a severe brain infection, or even intracranial bleeding. Imaging with a CT scan or MRI can lead to findings of the cause of the headache when the headache is due to a process which changes brain and skull anatomical relations and appearances.
General hematological and biochemical studies are also important. Anemia can cause headaches in a young menstruating woman, resulting from excessive menstrual bleeding. Once corrected, the pain will resolve. Viral hepatitis can raise liver enzymes and this can lead to severe headaches as well. Allowing the disease process to go through its natural cycle, or obtaining treatment as with Hepatitis C, will typically lead to resolution of the headache. Headaches can be caused by tension at work, and reducing stress levels often results in significant gains and frequently in the resolution of the pain.
Treatment of headaches has to be prescribed with the utmost care and with a clear plan to comply with the Hippocratic oath of "First do no harm," because many of the anti-headache drugs are toxic and have serious side effects. For example, several migraine headaches are treated with drugs that may cause bone marrow suppression and even death. In cluster headaches patients are occasionally treated with steroids, frequently with poor indication and serious adverse events. Beta-blockers and anti-epileptics are also prescribed with poor indications. Also, in headache treatment more and more chronically afflicted patients are referred to interventional invasive therapies. These include the use of electrical stimulators and local nerve treatments. In some patients treatment is provided by surgeons, typically a neurosurgeon, or by an ENT specialist, an ophthalmologist, or a pain specialist.
All these treatments present opportunities but they all also carry significant risk of failure. When patients experience failures in treatment, the consequences can be severe for the patient. Inappropriate surgical procedures can result in paralysis of facial muscles or neuro-ophthalmic injuries to the eyes or sinuses. Strokes may also result from local injections of drugs that may be transported to the central nervous system.
If you have been injured in the course of headache treatments you may want to consult a lawyer who is experienced and knowledgeable in the evaluation of the applicable standards of care and consequences of failed headache therapies.
