How serious is your headache?

There’s no need to rush to the doctor for an occasional headache. “If you are having daily or near-daily headaches, then an evaluation by your doctor can determine the type of headache, and whether diagnostic investigations are required to rule out a serious cause,” says Dr. Jonathan Gladstone, director of the Gladstone Headache Clinic in Toronto and president of the Canadian Headache Society. Less frequent, intermittent headaches (a few days each week or month) are also worth seeing your physician about if they continue month after month.

Headache Emergency There are situations when you should seek immediate, emergency attention. Sudden-onset headache with excruciating pain, referred to as a thunderclap headache, needs immediate attention at the emergency room. “This is where the intensity instantaneously escalates to a 10,” says Gladstone. Doctors need to see if there is a potentially dangerous cause such as bleeding in the brain.

A severe headache accompanied by fever and neck stiffness also warrants a trip to the doctor to rule out meningitis. Also, seek help if a severe headache occurs in association with other neurologic symptoms such as a loss of balance and coordination, or speech difficulties.

Keep a Headache Calendar for your Doctor Gladstone encourages patients to keep a headache calendar before visiting the doctor. Record each episode’s onset, length and intensity (scale of 1 to 10). Also outline any medications used and note their efficacy. Track any triggers, such as menstrual cycle, stress, sleeping patterns, weather, food eaten or skipped meals.

Less frequent sufferers will likely not require any diagnostic investigation; instead the physician will review your overall health and ask you specific questions about your headaches. The most common diagnosis is a tension-type headache or migraine. In fact, nearly three million Canadians suffer from migraines.

“Ordering a CT scan in these scenarios rarely identifies a cause for the headache and exposes the individual to unnecessary radiation,” says Gladstone. “An MRI rarely identifies a cause; however, it sometimes identifies incidental findings that can lead to unnecessary stress and anxiety, such as a benign cyst.”

For ongoing, frequent headache sufferers, a physician will order a history and perform a physical exam. Or, in some cases, a CT or MRI scan of the brain is required to help exclude a hidden cause. Depending on the nature of the symptoms, a formal eye exam, blood work or sinus imaging may be required. “When the primary care physician is uncertain of the diagnosis, a referral to a neurologist is often beneficial,” says Dr. Gladstone.

In a study published in the journal Neurosurgery in 2014, neurosurgeons raised concerns over restrictive guidelines that recommend no neuro-imaging (such as CT scans) for stable and not-new headache cases; they pointed to the risk of missing or delaying a brain tumour diagnosis. Ultimately, the decision to have further tests needs to be weighed in the context of your medical history and discussed thoroughly with your doctor.

The good news: A combination of lifestyle strategies — including staying hydrated, not skipping meals, keeping a regular bedtime and wake-up time, exercising regularly and implementing stress-reducing relaxation techniques — along with over-the-counter and prescription medication can help manage and review the pain of most types of headaches.