Chronic headaches can be managed successfully

According to Dr Kok Chin Yong, consultant neurologist and internal medicine physician, tension headaches and migraines can become chronic. Each year, 2 percent of patients with migraine go on to develop chronic migraine. Kok defined chronic headaches as ones that last 15 days or more in a month, for more than 3 months. Kok cautioned that chronic headaches should not be taken lightly—while it may not always be a marker of something serious, one should seek medical attention if the headache is accompanied by other symptoms such as numbness, weakness, difficulty speaking and walking, visual disturbance, fever and weight loss.

Half of individuals with chronic headaches also suffer from a condition known as a medication overuse headache, which is often underdiagnosed but can be treated by managing the usage of painkillers to reduce its severity.

“Migraines can be debilitating and affect one’s life and work. It can worsen with physical activity, affecting focus and concentration that in return reduces one’s efficiency at their workplace. Episodic migraines can be prevented from turning into chronic migraines by taking good preventative medications and making lifestyle changes,” Kok said.

Lifestyle changes include regular exercise, managing stress levels and getting sufficient sleep, which is about 7–8 hours. Kok advised patients to avoid consumption of alcohol to aid sleep and to avoid caffeine later than 3 pm as it may affect sleep quality. In the current society, high screen time is a reality of the times, but it can also trigger migraines, especially in young adults as they are sensitive to light and flickering images, which coincidentally may worsen migraines.

Kok said: “The key to prevent migraines is regularity. Patients with migraines need to have a regular eating and sleeping time, as a lack of it can trigger migraine attacks. If someone has high frequency of migraine attacks, one has to be aware that there are good and effective preventative medications. Some come in the form of pills and some in the form of injections. The latter is very easily administered and can reduce the frequency and severity of migraine attacks.”

Headaches may be a possible indicator of more serious health issues
Dr Gerard Arvind Martin, consultant neurosurgeon, noted that individuals with gradually or progressively worsening headaches may be diagnosed with life-threatening neurosurgical diseases that, if left untreated, are potentially fatal. Some headaches can be indicators of abnormalities such as tumours, which can result in headaches that affect the entire head or a portion of the head.

“We have seen this to be especially true for those whose headaches are caused by tumours or vascular conditions such as aneurysms. A tumour may announce itself by affecting that specific area it is pressing against or developing in, therefore causing those symptoms related to that part of the brain. A tumour may grow, either quickly or slowly over time, and push aside the brain, causing brain swelling to occur, and headache ensues,” Gerard said.

Gerard noted that patients should also be on the lookout for impairments in other brain functions, such as decision-making, thinking, and memory. In addition to headaches, brain tumours may also be accompanied by convulsions that occur before, during, or after the start of headaches. He said: “When a patient comes to a hospital with some or all of these symptoms, a preliminary CT scan is done, with an MRI in due course depending on the initial CT finding and proposed treatment route.”

However, it is not all doom and gloom, and patients should refrain from jumping to conclusions. While it is scary and natural to believe that all headaches are caused by something bad happening within the head, the truth is that headaches can also be caused by other areas of the head, including the eyes, ears, neck, sinuses, and teeth. Consequently, it is prudent to rule out anything occurring in these regions during the initial consultation.

The best advice to everyone with headaches is to act upon their symptoms in a timely manner and seek treatment to be able to mitigate their conditions to continue to lead fuller lives, concluded Gerard.

Ed: The NHS defines migraines as “a moderate or severe headache felt as a throbbing pain on one side of the head.” [Available at https://www.nhs.uk/conditions/migraine/ Accessed on 15 June 2022]