What’s Up Doc?: Difficulties of diagnosing and managing headache

By Dr. Noorali Bharwani on October 29, 2019.

Headache is not an uncommon symptom. Headache can be on one or both sides of the head and can radiate across the head.

The type of pain one experiences can vary quite a bit. A headache may appear as a sharp pain, a throbbing sensation or a dull ache. Headaches can develop gradually or suddenly, and may last from less than an hour to several days.

There are many causes of headache. It can be a sign of stress or emotional distress. It can be due to migraine or high blood pressure, anxiety or depression. In some cases, there may be evidence of a tumour. A tumour can be benign like meningioma or malignant.

If a person has severe or persistent headache then further investigation is warranted. Urgent medical attention is required if you have weakness, dizziness, sudden loss of balance. Other symptoms requiring urgent attention are numbness or tingling, or you cannot move your body. Majority of the headaches are due to migraine or tension. A headache can be a symptom of a serious condition, such as a stroke, meningitis or encephalitis.

Investigating headache

Radiological investigation of headache is done by having a CT scan or MRI. One test usually supplements the other.

The biggest difference is MRIs (magnetic resonance imaging) use radio waves and CT (computed tomography) scans use X-rays. There is some radiation exposure with CT scan. While both are relatively low risk, there are differences that may make each one a better option depending on the circumstances. Usually CT scan is done first and if that does not answer the question then MRI is done next.

Most of the time you do not need these tests. Often these tests are not helpful.

Doctors see many patients for headaches. And most of them have migraines or headaches caused by tension. Both kinds of headaches can be very painful. But a CT scan or an MRI rarely shows why the headache occurs. And they do not help you ease the pain, says Choosing Wisely (2016 Consumer Reports developed in cooperation with the American College of Radiology).

From the individual’s medical history and physical examination, a doctor can diagnose most headaches during an office visit. If your medical history and exam are normal, radiological tests usually will not show a serious problem. The results of your test may also be unclear. This can lead to more tests and even treatment that you do not need.

In some cases, a doctor may order a CT scan or an MRI if your physical exam finds something that is not normal.

You may also need a CT scan or an MRI if you have unusual headaches. Go to a hospital emergency room or call 911.

When should you have CT scan and/or MRI test for headache?:

1. If you’re experiencing the worst headache of your life, a sudden, severe headache

2. If you have headaches that are sudden or feel like something is bursting inside your head

3. If your headaches are different from other headaches you’ve had, especially if you are age 50 or older

4. If your headaches happen after you have been physically active

5. If you have headaches with other serious symptoms, such as a loss of control, a seizure or fit, or a change in speech or alertness

6. If it occurs more often than usual

7. If they are more severe than usual

8. If it worsens or don’t improve with appropriate use of over-the-counter drugs

9. If it keeps you from working, sleeping or participating in normal activities

10. If it causes you distress, and you would like to find treatment options that enable you to control them better

Dr. Bharwani is a general surgeon, freelance writer, photographer and author of A Doctor’s Journey and Doctor B’s Eight Steps to Wellness. His latest book is available at Shoppers Drug Mart and Coles Book Store (Medicine Hat Mall), and http://www.nbharwani.com. You can discuss this article and other articles on his website: nbharwani.com and sign up for RSS feed, Twitter or get on the email list.

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