Headache: When Does it Need A Medical Intervention?

One of the most common ailments affecting mankind is a headache. It is so common that only a few persons would not have experienced a headache at some time or other in their lives, says Consultant Neurologist Dr.V.Natarajan.

Fortunately, most often the headaches are harmless, especially those which are recurrent. However, at times the headache, those occurring especially in people who do not usually get headaches and sometimes even in patients who have had headaches earlier may be due to a serious underlying cause which needs specific treatment.

The following situations would indicate medical intervention:

  • Sudden severe headache
  • Headache associated with fits.
  • Headache accompanied by confusion or loss of consciousness.
  • Headache following a blow on the head.
  • Headache associated with fever.
  • Persistent headache in children.
  • Headache which interferes with normal life.
  • These are headaches which might suggest:
  • Bleeding within the cranial cavity (Head).
  • Tumours within the cranium.
  • Accumulation of fluid within the brain.
  • Infections of the coverings of the brain or within the brain.

As these headaches have an underlying cause which needs to be attended to urgently, medical advice should be sought immediately.

Fortunately, the majority of headaches are not due to such causes and are harmless but recurrent. However, these headaches can be severe and can last for 3 to 4 days of disrupting work and social attendance.

Recurrent Headaches:

Recurrent headaches are common and occur in 10 to 15% of the population at any given period. These headaches most often fall under the following diagnostic categories: Vascular, Muscle contraction, traction, inflammatory.


The most common type of vascular headache is migraine. Migraine headaches are usually characterised by severe pain on one or both sides of the head, nausea with vomiting and at times increased sensitivity to light and sound. There are two types of migraine- classical and common. Both types can occur as often as several times a week or as rarely as one every few years and both types can occur at any time including on waking up from sleep. The exact mechanism as to how this headache occurs is still uncertain.

How is the diagnosis done?

Most kinds of headaches can be diagnosed from the type of pain, supplemented by physical examination by the doctor even though there are 300 types of headaches.

Tests are often not necessary if the headaches follow a standard pattern, particularly if the person feels better after reassurance and simple treatment, but anyone who does not improve or has unusual features in the attacks may have to undergo a few tests.

C.T.and M.R.I scans of the brain are useful in the assessment of headaches which are considered to be due to bleeding or increased pressure within the head and in brain tumours.

However, it should be stressed that the vast majority of scans prove to be normal and also there are some serious causes of headaches which might need specific treatment and yet do not show up on a scan.


Treatment is directed at the underlying cause in those few who have sinister headaches.

In the vast majority who have recurrent headaches with no serious disorders drug therapy, biofeedback training and lifestyle modifications are advised.

Lifestyle changes:

Eating and Drinking:

The minority of people who are sensitive to cheese, chocolates, nuts, alcoholic drinks are aware of the need to avoid these and people who have not already identified these links need not change their diet.


It is not possible to avoid stress at work, though simple adjustments to the way work is organized may be helpful. In many cases, the headache is made worse by worrying about its cause and medical reassurance is often all that is required.

Quite often, affected people will benefit from appropriate drug treatment taken whenever the headache occurs on a regular basis to prevent it.

Even though at present it is not possible to cure migraine it is certainly possible to reduce or control the same with medication so that the person can carry on his or her normal activities without disruption.

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