A nagging discomfort or a pending neurological devastation.

Qaiser Toqeer MPH MD

A Diplomat of the American Board of Psychiatry and Neurology, Inc., a Member of the American Board of Medical Specialties.

Novant Health Inc.
Dept. of Neurology

Headache is a very common disorder that we face on a regular basis some suffer more than others. Can headache be a sign of something major concern? There are several neurological disorders that can have headache as a symptom therefore it should not be taken lightly. Especially in someone who does not suffer from headaches on regular basis. We typically divide headaches into two major categories. Primary and secondary headaches which can then further be divided into many other subtypes. Primary headache disorders are those that are typically not due to anything serious and resolve spontaneously. There are 3 main types of primary headaches: Migraine, Tension and Cluster. Tension headache is far more common than anything. Next is migraine which affects approximately 1 in 4 households where someone suffers with migraine headaches (American Headache and Migraine Association 2017). Migraine is far more common in females than males. It carries variable disability and can lead to significant incapacitation. Signs of migraine typically include severe one sided headaches and pain is typically described as throbbing or pulsating. Additionally, symptoms include nausea, vomiting, light sensitivity and sound sensitivity. Patients usually complain of worsening pain with physical activity. Duration of migraine attack can be for from few hours to days. Typically headache starts mild and progressively worsens over time to severe enough that functioning in normal life becomes extremely difficult.

There are several triggers to migraine attacks and avoidance of triggers is usually the mainstay of treatment. Triggers to migraine headaches include sleep deprivation, certain foods, dehydration, caffeine overuse, inconsistent mealtimes, and exercise etc. There are several other triggers to migraine attack which are patient specific and finding those triggers can lead to better management of headaches. For young females migraine attacks are common during the menstrual cycle which is typically thought to be hormonal related phenomenon. Moreover, sleep deprivation is one of the most common reasons for headaches. Sleep deprivation can come from stimulation in bedroom such as TV, or video games in room or caffeinated drinks prior to bedtime. It is recommended to not have any caffeinated beverages at least 8 hours prior to the bedtime (source). If headaches are still not controlled then medications are recommended to prevent migraine attacks. Most of these medications cannot alleviate migraine attacks all together however can decrease the intensity and frequency of attacks.

Secondary headaches are considered to be due to something serious neurologically. There are several neurological disorders that may lead to headache and typically have some other associated symptoms. Some of these disorders are treatable if caught early. Therefore recognizing red flag symptoms when someone is suffering from headaches can be lifesaving. Red flag symptoms point towards neurological disorder and include new sudden onset severe headache (Also known as thunderclap headache), worsening of headaches with lying flat, bending forward, or with cough, headaches associated with fever, altered mentation, blurring or loss of vision, weight loss, and severe neck pain. Common reasons for secondary headaches include bleeding in the brain, tumors, infections, stroke, primary eye disorder and certain inflammatory conditions. Many of these neurological disorders can be treated if caught early enough. Considerable delay in seeking medical attention in the presence of red flag symptoms can lead to severe permanent damage or even death.

Although commonly headaches are typically considered to be just nagging discomfort however presence of red flag symptoms should be taken seriously. Urgent medical attention should be sought if any of the red flag symptoms are present. Furthermore, careful recording of symptoms can help your neurologist come up with diagnosis quicker.

In summary, 1.2 million Americans seek medical attention in the emergency room due to acute migraine attack (MRF 2017). Migraine can be prevented by avoiding triggers of which poor sleep hygiene is considered to be one of the common reasons. Medication overuse headaches specifically pain medications can lead to rebound headaches therefore such medications should not be taken on regular basis.

Secondary headaches are due to neurological condition which if not caught early enough may lead to permanent damage to brain or even death. Red flags symptoms are those that suggest secondary headaches and should be taken seriously. If any of the above red flag symptoms are present then urgent medical attention should be sought.


“About Migraine.” American Headache & Migraine Association. N.p., n.d. Web. 14 May 2017.
“Migraine Facts.” Migraine Research Foundation. N.p., n.d. Web. 14 May 2017.

Dedicated to my mother Nadra Toqeer who suffers from Migraine and encouraged me for this work.

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