Headaches | Sunday Observer


5 June, 2021

Headache is defined as a pain arising from the head and the upper neck. There are multiple causes for headaches.
This is one of the commonest health problems we come across as doctors. As pain consultants headaches are referred to us specially by GP’s and neurologists in the U.K.
Sadly the referral system is unsatisfactory in Sri Lanka. As a result the patients miss out from the options available today them due to the poor referral system. This has to improve in Sri Lanka.

Common causes of headaches are

· having a cold or a flu
· stress
· drinking too much alcohol
· bad posture
· sight problems
· not eating regular meals
· not drinking enough fluids (dehydration)
· taking too many painkillers
· having your period or during menopause
· Migraine and cluster headaches

More serious causes of headaches are

Trauma - Bleeding in to the brain (haematomas)
Tumours in the brain - Also termed space occupying lesions (SOL)These can be malignant or non malignant.
Infections - Meningitis, Encephalitis due to Viral infections (Covid 19 etc) and Bacterial infections (TB etc) , Malaria.
Cervical facet joint arthropathy - Headache can be the presenting symptom.

Medical help should be sort by visiting a local GP.
· symptoms do not improve after 3 weeks
· symptoms get suddenly worse
· temperature is very high
· feeling short of breath or develop chest pain
· long-term medical condition – for example, diabetes, or a heart, lung or kidney condition
· weakened immune system – for example, because you’re having chemotherapy
The general practitioner could asses the headache and make a referral to an appropriate consultant. As a pain consultant I would prefer a patient with a headache to see a neurologist and have a diagnosis. More importantly to exclude any serious conditions which may contribute to the headache.

One should worry if

- Headaches that first develop after the age of 50
- A major change in the pattern of your headaches
- An unusually severe headache
- Head pain that increases with coughing or movement
- Headaches that get steadily worse
- Changes in personality or mental function
- Headaches that are accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness, or seizures
- Headaches that are accompanied by a painful red eye
- Headaches that are accompanied by pain and tenderness near the temples
- Headaches after a blow to the head
- Headaches that prevent normal daily activities
- Headaches that come on abruptly, especially if they wake you up
- Headaches in patients with cancer or impaired immune systems

The treatment available in a pain clinic for headaches
If there is no serious underlying cause for the headache confirmed by a neurologist following treatments can be used
Medication - Simple analgesics
Complimentery therapy - Acupuncture

Interventions -
1. Greater occipital nerve block
2. Botox injections to the scalp in the area of the headache. 50-100 units of Botulinum toxin is used.
3. Cervical Facet joint Injections
The above procedures have given good results in my experience.

The writer Dr. Namal Senasinghe is a consultant in pain medicine in the United Kingdom and The London Pain Clinic, No 31, Horton Place, Colombo 07, Sri Lanka. Unfortunately his travelling between the two countries is hindered by the 14 day hotel Quarantine in both countries the U.K. and Sri Lanka.