Headache Article by Doctor Kenneth Prudhoe Club de Mar Medical CentrePalma de Mallorca

White Paper

"DOCTOR AT SEA" a monthly Column in The Islander Magazine

Headache

This is such a common symptom that we can all identify with the experience and generally know how to deal with it.

Everyday benign headache can stem from lack of sleep, dehydration in alcohol hang-over, mild fever associated with a self-limiting flu-like illness, or maybe from wear and tear problems in the neck. We can usually make our own diagnosis and take the necessary action in terms of a siesta or an early night, plenty of fluid, or, in any one of these scenarios, a painkiller like paracetamol.

Tension headache is another form of everyday benign headache which can often drive people to see a doctor and it is usually described as "pressure on top of the head" or a "tight band around the head" and also "feeling tired all the time". Doctors learn to recognise the presentation of tension headache quickly but it needs more probing to clarify why the condition has arisen and also needs some sensitivity to avoid giving the impression that the symptom is an imaginary phantom of no importance. It commonly arises in stress situations possibly compounded by a poor sleep pattern which can in turn stem from a significant depression or heightened anxiety and the treatment ultimately is not a painkiller for the presenting symptom but treatment for depression or for anxiety management to get to the root of it all.

Migraine is another fairly common form of headache which is thought to be caused by blood vessel spasm in the cerebral circulation. A typical severe migraine attack starts with visual disturbance in terms of a shimmering spot of light or zig-zag lines which herald the onset of the localised headache perhaps in one temple after about half an hour and is associated with nausea and vomiting as well as an aversion to light. This can last for several hours and longer for some unfortunate people whose condition is difficult to control. Occasionally the vessel spasm can produce symptoms resembling a stroke so the person has speech difficulty or weakness or numbness affecting the face or an arm and this is particularly frightening on the first occasion. Mild migraine limited to visual disturbance and headache can be treated with paracetamol before the headache develops but more complicated or more frequent symptoms need medical advice and possibly daily preventive medication.

There are many serious causes of headache which fortunately are much less common.

Spontaneous bleeding on the surface of the brain from a vessel deformity (aneurysm) can lead to a sudden severe pain on the back of the head "like a hard slap in the neck" and leads to immediate collapse. Neurosurgical treatment to relieve the bleeding and to tie off any remaining aneurysms may save an individual but this condition (sub-arachnoid haemorrhage) carries high mortality and can affect any age group.

Bleeding inside the brain is one cause of stroke and can produce headache although does not usually lead to rapid unconsciousness but rather loss of function down one side of the body or the face and maybe speech disturbance. Strokes due to bleeding may be due to very high blood pressure and patients often think high blood pressure causes headache - this is a very uncommon link although not a reason for ignoring blood pressure checks whether or not there are concerns about headache but simple headache hardly ever means high blood pressure.

Meningitis is caused by infection of the meninges which are membranes around the brain and the swelling associated with this leads to headache usually at the back of the neck which in turn leads to pain on bending the neck forwards. The swelling inside the tight skull produces pressure on the brain leading to severe vomiting and loss of consciousness and if the infection escapes into the blood stream the septicaemia is associated with the appearance of small non-blanching blood spots under the skin. This is an emergency situation needing immediate antibiotic injection and rapid admission to hospital.

Head injury can obviously cause headache either at the site of the injury or from concussion, as per the article in December, but in the absence of injury there are certain unremitting headaches which can arise from other serious causes such as brain tumour. A brain tumour is a growing lump inside the brain and there is limited space to accommodate it so it produces an unremitting boring pain which is unrelieved by sleep and which can actually disturb sleep. As the tumour size increases, various brain functions become compromised and symptoms of stroke, as outlined above, can develop and eventually loss of consciousness and death.

The serious causes of headache have characteristic features as sketched out above and fortunately they are very uncommon and the common causes of headache are generally amenable to treatment. It is obviously important to be able to have some idea how to tell the difference and this ground is covered in Medical Care Onboard Ship Courses for those who have responsibility at sea and who need some informed confidence when dealing with guests or fellow crew members whose headache may be, as they say in Yorkshire, "nowt nor summat" (nothing or something).

Dr Ken Prudhoe, MCA Approved Doctor, can be contacted at Club de Mar Medical Centre, Palma de Mallorca. Tel: (+ 34) 639 949 125.