headache & facial pain

There are many different types of headaches, the most common being migraine, tension, and cluster.

Migraine headaches can be severe and debilitating, with side effects such as upset stomach, blurred vision, and sensitivity to light and noise. Migraines are more common in women than men and typically begin to appear in early adulthood. They may be caused by heredity, chemical imbalances in the brain, or triggers such as stress, hormones, weather, and certain types of food.

Tension headaches are tight and aching, and may last for several hours. They can be triggered by intense emotional periods, poor posture, and clenching of the facial and neck muscles.

Cluster headaches have a quick onset, with intense pain arising on one side of the head and associated symptoms of a bloodshot eye, runny nose, and sweating. These headaches have a shorter duration than migraines but are just as painful, if not more so.

What are some “red flags” in the diagnosis of headache?

In the history, symptoms suggesting a possible serious cause of headache include onset of headache over age 50, headache that progressively worsens, the “worst” headache ever experienced, change in headache symptoms, and increase in headache with exertion, coughing, or sneezing. Other symptoms include numbness and tingling in the extremities, weakness in an extremity, slurred speech, loss of coordination, confusion, loss of smell, ringing in the ears. On the physical examination, signs that can be of concern would include weakness or sensory loss in an extremity, high blood pressure, elevated temperature, unequal pupils or reflexes.

What treatments are used for headaches?

Treatment for headaches includes medication as well as relaxation, biofeedback, physical therapy, and trigger point blocks.

What is the prognosis?

Not all headaches require medical attention. But some types of headache are signals of more serious disorders and call for prompt medical care. These include: sudden, severe headache or sudden headache associated with a stiff neck; headaches associated with fever, convulsions, or accompanied by confusion or loss of consciousness; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person who was previously headache free; and recurring headache in children. Migraine headaches may last a day or more and can strike as often as several times a week or as rarely as once every few years.