Headaches is a common problem. I wrote this blog to give some tips when to worry, e.g., how to know when to go to your doctor. The interesting bit I discovered when researching the topic was there is something called a sex headache- and it is not what you think!
There are several types of headaches that can cause a person to have regular headaches. A headache is defined as longer lasting when it lasts more than 4 hours. Headaches are classified as primary when there is no underlying medical problem causing it. Primary headaches are caused by overactivity or problems with the pain structures in the head (pain structures include nerves, arteries, muscles etc)
Causes of longer lasting headache (longer than 4 hours) include:
• Chronic migraine
• Chronic tension-type headache
• Hemicrania continua
• New daily persistent headache
• Medication overuse headache
Causes of shorter headaches (shorter than 4 hours) include:
• Chronic cluster headache
• Chronic paroxysmal hemicrania
• Hypnic headache
• Primary stabbing headache
Sometimes headaches are caused by a certain activity, such as coughing, exercise or sex.
According to the Mayo clinic there are two types of sex headaches- and no, it does not include the type of headache you get if you do not want to have sex but:
1. A dull ache in the head and neck that intensifies as sexual excitement increases
2. A sudden, severe, throbbing headache that occurs just before or at the moment of orgasm.
It seems sex headaches can vary from a couple of minutes up to three days! Some people may have it only once, but for about half of the people with sex headaches it comes and goes over the course of six months. Sex headaches are not dangerous, but I assume that this can cause some big frustrations for those suffering from it.
When should I worry about my headaches?
So- when should you consider going to the doctor?
• It begins when the patient is older than 50 years
• Acute onset (feels like being hit by lightning)
• New headaches
• Headaches are different from the headaches in the past
• Other signs of illness e.g. weight loss, fever
• Neurological symptoms that does not fit in with typical aura symptoms (migraine)
• There is a known underlying medical illness e.g. cancer, HIV
Evaluation:
These are the things your doctor will look for when you go for a consultation. The most important thing is to exclude the serious medical conditions that can cause headaches.
• Medical and headache history
• Primary or secondary?
• Medication overuse headache?
• Examine: carotid and temporal arteries, cervical paraspinal muscles, range of motion of neck, temporomandibular joints, sinuses, and ocular fundi
• Examination is usually normal except:
1. Tension type headache- may be peri cranial muscle tenderness
2. Chronic Migraine signs such as hyperalgesia and allodynia
3. Some types may have signs of autonomic activation
• Any other abnormalities should be worked up for a secondary headache disorder
• Investigations may include:
1. Blood tests
2. Brain scans
3. Imaging of arteries or venous sinuses
4. Cervical spine imaging
5. Lumbar puncture
In a nutshell it is important to exclude serious medical problems that can cause headaches, and if possible, try to find ways of alleviating the headache without taking too many pain killers.