By Dr. Willie Ong

Q. I’ve been having headache for the past 5 days. It’s all over my head. It’s tolerable but irritating. I have high blood pressure and I’m taking amlodipine 5 mg daily for 5 years already. My BP is controlled at 120/85. Should I worry about my headache? (Alvin)

A. Everyone gets a headache from time to time. Most headaches, especially those of short duration and mild intensity, are nothing to worry about. However, there are certain rare types that could be more serious. Let’s find out how to distinguish the harmless types from the deadly ones.

Harmless Causes

Alvin’s headache doesn’t appear to be serious. The hot weather and climate changes, like going in and out of air-conditioned rooms then out in the streets are likely causes headaches. Lack of sleep and stress can also produce headaches.

Alvin also mentioned that he has high blood pressure, which if uncontrolled (greater than 140 over 90) can sometimes cause nape pains. The medication, amlodipine can also cause headache in the first few days of intake. However, since he’s been taking the drug for 5 years and his blood pressure control is excellent, we can’t blame the drug for his headache.

Tension Headaches

What about stress? If your head feels like someone put a strong rubber band around it, then it could be tension headache. As the name implies, it’s emotionally-related. Too much work or family stresses can cause this. Try this, ask your wife to gently massage your head, if it goes away, then it’s a tell-tale sign for tension headache. Again nothing to worry about. Just remember to say “Thank you.”

Eye-related & Sinusitis Headaches

Does your headache occur after prolonged reading? If it does, this points to an eye problem like an error of refraction, astigmatism or presbyopia. Visit your ophthalmologist or optometrist and get a pair of glasses.

Pain from sinusitis is usually obvious. There’s stuffy nose and the pain is located in the sinus areas (you have 2 sinuses beside your nose and two more sinuses just above the eyebrows). Go to your doctor, preferably an ENT specialist.

Migraine Headaches

Migraine headaches are more troublesome and different in character. The headache has a pounding or throbbing quality. And it usually occurs on one side of the head only and often felt right behind one eye. Migraines are more painful. You feel nauseated and prefer lying down in a quiet dark room. Some people even see jagged lights and color a few minutes before the headache, which doctors refer to as an “aura.” There’s a tablet you can take to abort an attack. But you need to see a doctor beforehand, preferably a neurologist.

When Should You Worry

Our readers should also be aware of the danger signals which, if present, would tell you that you need to see your doctor.

Vomiting with headache is a worrisome sign, especially if the headache is severe. It could be a stroke or something else. Fever accompanied by severe headache could point to typhoid fever or meningitis (an infection in the brain). But it doesn’t necessarily mean that if you vomit or have fever, then you’ve got these conditions. Doctors just want to be careful and care for you the best they possibly can.

Something we definitely should worry about are the signs and symptoms of a stroke: (1) any sudden weakness in the arm or leg, (2) numbness of a part of the face, (3) sudden slurring of speech, (4) trouble with walking or loss of balance, (5) blurry or double vision, (6) drowsiness or confusion and (7) severe headache.

Strokes usually occur in older people, especially those with high blood pressure, heart disease, and diabetes. If these symptoms occur suddenly, forget the out-patient check-up and rush the patient to a hospital. You’ll know a stroke when you see it.

Lastly, some people worry that they have a brain tumor. Headache is rarely the first sign of a tumor. And most tumors don’t have headaches. But if we really really want to be sure and you have lots of money to spare, then we can order a CT-scan to rule out the serious causes of headaches.

Final Thoughts

Majority of headaches are harmless and will just go away. If your headache is disrupting your work, then by all means see a doctor. But for most headaches, it’s still good advice to “Take a paracetamol then call me in the morning if it’s still there.”

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