By the time we reached a hospital with better facilities, his brain pressure had increased, and
he fell into a state of unconsciousness. His heart was almost at a standstill. Despite
undergoing surgery to remove the tumor, he passed away, leaving behind many unfulfilled
dreams.
It was later revealed that his headache, which he had been dismissing for a long time, was
actually caused by cervical vertebrae pain. He had been putting off the MRI for days, and in
the end, it was too late.
It’s heartbreaking to see some people self-diagnose their headaches as something simple, like
a migraine or sinusitis, and ignore the warning signs. Sadly, many of these seemingly
harmless headaches turn out to be something much worse.
Headaches are something that happens to almost everyone at some point in life, and they’re
usually nothing to worry about. Only a very small percentage of headaches are due to serious
conditions. However, misidentifying the cause of a headache can cost a person their life.
Three patients came to the outpatient department with headaches that had lasted for 5 years, 5
months, and 5 days. As doctors, who should we prioritize? The 5-day patient is the one who
deserves immediate attention if the pain is sudden and severe without any obvious cause.
Next would be the patient with 5 months of pain, and finally, the patient with 5 years of pain,
though this person may be suffering significantly and affecting their quality of life. But the
likelihood of a serious underlying condition in the 5-year patient is very low.
Headaches can generally be classified into two categories: Primary headaches (which occur
as a primary condition) and Secondary headaches (which are symptoms of other underlying
conditions).
Primary Headaches (with percentage distribution):
1. Tension-type headaches (50%)
2. Migraine (40-45%)
3. Trigeminal Autonomic Cephalalgia (TCA)
Rare Primary Headaches:
1. Idiopathic Stabbing (2%)
2. Exertional Headache (1%) - Caused by physical exertion.

Secondary Headaches (only the major causes are mentioned here):
1. Infections (63%)
2. Head Injuries (4%)
3. Vascular Disorders (1%)
4. Subarachnoid Hemorrhage (less than 1%) - Bleeding in the brain’s covering layer.
5. Brain Tumors (0.1%)
6. Benign Intracranial Hypertension
Tension-type Headache:
This is the most common type of headache. It occurs in people experiencing both mental and
physical stress, including those suffering from depression. The name "tension-type headache"
refers to the tension in the muscles of the head, neck, and shoulders. The pain typically feels
like a tight band around the head, especially around the eyes, neck, and top of the head. The
pain starts gradually and can intensify, lasting for days or even up to 10-15 days a month.
While it generally doesn't cause significant disruption to daily life, it can become a chronic
annoyance.
Unlike migraines, which may be accompanied by nausea, light sensitivity, or sound
sensitivity, tension headaches don't usually present such additional symptoms. Prolonged
computer use, long drives, eye strain due to vision problems, or environmental factors like
weather changes can trigger this type of headache. Some people may experience pain when
pressing on their head. Additionally, people who grind their teeth at night (known as
bruxism) may also experience tension-type headaches.
The key to managing these headaches is identifying the causes and addressing them. Mental
stress and anxiety can often be relieved with relaxation techniques or by identifying the
underlying issues. If simple remedies like heat pads or ice packs don't help, medications may
be necessary. For headaches that occur multiple times a month and interfere with daily life,
regular medication might be required. It's crucial to consult a doctor and undergo the
necessary tests if headaches persist.
It’s important to note that medications should not be used without proper guidance, especially
for those who require painkillers regularly. Overuse of stronger painkillers without doctor's
advice, especially those stronger than paracetamol, can cause harm. For people with bruxism,
botulinum toxin (Botox) injections may help relieve headache symptoms.
Migraines:
Migraine is a type of headache that is more commonly known than tension-type headaches,
though it is less frequent. It is most often seen in adolescents and young adults, while it is less
likely to start in middle age. Migraines usually cause severe, stabbing pain that can affect
either one side of the head or the entire head. Unlike other headaches, migraines often come
with some distinct symptoms:
? Sensitivity to light and sound (discomfort when exposed to them)
? Worsening pain when the body moves
? A visual disturbance where lights may flicker or parts of the vision may go dark
? Dizziness, a feeling of lightheadedness, and nausea/vomiting

? Occasionally, temporary weakness or loss of sensation in part of the body
Migraines tend to occur at intervals and can last anywhere from hours to days. Some
individuals may experience a migraine only once, with no recurrence for a long period. For
such individuals, treatment is usually required only when the pain occurs. However, for those
who experience intense and frequent migraines, regular medication may be needed for a
period of time. Many medications are available today, and the appropriate one is chosen
based on the patient's lifestyle, personality, and physical condition.
Common Triggers for Migraines:
There are several triggers that can bring on a migraine. Recognizing these triggers can help
prevent or reduce the frequency of migraines. Key triggers include:
? Hunger, lack of sleep, or excessive sleep
? Strong lights or loud sounds
? Mental or physical stress
? Alcohol, excessive physical exertion, certain foods, weather changes, and travel to
high-altitude areas
? Hormonal fluctuations, especially during menstruation
Trigeminal Autonomic Cephalalgia (TAC)
Trigeminal autonomic cephalalgia (TAC) includes intense headaches that typically affect the
eye area, the side of the face, and the neck, and sometimes even the back of the head. These
headaches are usually experienced on one side of the head and are accompanied by a variety
of other symptoms on the same side, including:
? Tearing of the eye and runny nose
? Nasal congestion or nasal drip
? Redness in the eye
? Sweating or swelling on the affected side of the face
? Drooping of the eyelid or pupillary constriction
These features make TAC headaches distinct from other types of headaches. There are three
main types of headaches within this category:
1. Cluster Headaches (0.1%):
Cluster headaches are the most common form of TAC. They occur in clusters, which is why
the name suggests a recurring pattern. These headaches usually happen at the same time
every day, ranging from 8 times a day to once every few days. Each headache episode can
last from 30 minutes to 3 hours, and a person may experience up to 8 cluster episodes in a
single day. Unlike migraines, these headaches can start during sleep, and alcohol or strong
smells can often trigger them. Cluster headaches predominantly affect men. While people

By the time we reached a hospital with better facilities, his brain pressure had increased, and
he fell into a state of unconsciousness. His heart was almost at a standstill. Despite
undergoing surgery to remove the tumor, he passed away, leaving behind many unfulfilled
dreams.
It was later revealed that his headache, which he had been dismissing for a long time, was
actually caused by cervical vertebrae pain. He had been putting off the MRI for days, and in
the end, it was too late.
It’s heartbreaking to see some people self-diagnose their headaches as something simple, like
a migraine or sinusitis, and ignore the warning signs. Sadly, many of these seemingly
harmless headaches turn out to be something much worse.
Headaches are something that happens to almost everyone at some point in life, and they’re
usually nothing to worry about. Only a very small percentage of headaches are due to serious
conditions. However, misidentifying the cause of a headache can cost a person their life.
Three patients came to the outpatient department with headaches that had lasted for 5 years, 5
months, and 5 days. As doctors, who should we prioritize? The 5-day patient is the one who
deserves immediate attention if the pain is sudden and severe without any obvious cause.
Next would be the patient with 5 months of pain, and finally, the patient with 5 years of pain,
though this person may be suffering significantly and affecting their quality of life. But the
likelihood of a serious underlying condition in the 5-year patient is very low.
Headaches can generally be classified into two categories: Primary headaches (which occur
as a primary condition) and Secondary headaches (which are symptoms of other underlying
conditions).
Primary Headaches (with percentage distribution):
1. Tension-type headaches (50%)
2. Migraine (40-45%)
3. Trigeminal Autonomic Cephalalgia (TCA)
Rare Primary Headaches:
1. Idiopathic Stabbing (2%)
2. Exertional Headache (1%) - Caused by physical exertion.

Secondary Headaches (only the major causes are mentioned here):
1. Infections (63%)
2. Head Injuries (4%)
3. Vascular Disorders (1%)
4. Subarachnoid Hemorrhage (less than 1%) - Bleeding in the brain’s covering layer.
5. Brain Tumors (0.1%)
6. Benign Intracranial Hypertension
Tension-type Headache:
This is the most common type of headache. It occurs in people experiencing both mental and
physical stress, including those suffering from depression. The name "tension-type headache"
refers to the tension in the muscles of the head, neck, and shoulders. The pain typically feels
like a tight band around the head, especially around the eyes, neck, and top of the head. The
pain starts gradually and can intensify, lasting for days or even up to 10-15 days a month.
While it generally doesn't cause significant disruption to daily life, it can become a chronic
annoyance.
Unlike migraines, which may be accompanied by nausea, light sensitivity, or sound
sensitivity, tension headaches don't usually present such additional symptoms. Prolonged
computer use, long drives, eye strain due to vision problems, or environmental factors like
weather changes can trigger this type of headache. Some people may experience pain when
pressing on their head. Additionally, people who grind their teeth at night (known as
bruxism) may also experience tension-type headaches.
The key to managing these headaches is identifying the causes and addressing them. Mental
stress and anxiety can often be relieved with relaxation techniques or by identifying the
underlying issues. If simple remedies like heat pads or ice packs don't help, medications may
be necessary. For headaches that occur multiple times a month and interfere with daily life,
regular medication might be required. It's crucial to consult a doctor and undergo the
necessary tests if headaches persist.
It’s important to note that medications should not be used without proper guidance, especially
for those who require painkillers regularly. Overuse of stronger painkillers without doctor's
advice, especially those stronger than paracetamol, can cause harm. For people with bruxism,
botulinum toxin (Botox) injections may help relieve headache symptoms.
Migraines:
Migraine is a type of headache that is more commonly known than tension-type headaches,
though it is less frequent. It is most often seen in adolescents and young adults, while it is less
likely to start in middle age. Migraines usually cause severe, stabbing pain that can affect
either one side of the head or the entire head. Unlike other headaches, migraines often come
with some distinct symptoms:
? Sensitivity to light and sound (discomfort when exposed to them)
? Worsening pain when the body moves
? A visual disturbance where lights may flicker or parts of the vision may go dark
? Dizziness, a feeling of lightheadedness, and nausea/vomiting

? Occasionally, temporary weakness or loss of sensation in part of the body
Migraines tend to occur at intervals and can last anywhere from hours to days. Some
individuals may experience a migraine only once, with no recurrence for a long period. For
such individuals, treatment is usually required only when the pain occurs. However, for those
who experience intense and frequent migraines, regular medication may be needed for a
period of time. Many medications are available today, and the appropriate one is chosen
based on the patient's lifestyle, personality, and physical condition.
Common Triggers for Migraines:
There are several triggers that can bring on a migraine. Recognizing these triggers can help
prevent or reduce the frequency of migraines. Key triggers include:
? Hunger, lack of sleep, or excessive sleep
? Strong lights or loud sounds
? Mental or physical stress
? Alcohol, excessive physical exertion, certain foods, weather changes, and travel to
high-altitude areas
? Hormonal fluctuations, especially during menstruation
Trigeminal Autonomic Cephalalgia (TAC)
Trigeminal autonomic cephalalgia (TAC) includes intense headaches that typically affect the
eye area, the side of the face, and the neck, and sometimes even the back of the head. These
headaches are usually experienced on one side of the head and are accompanied by a variety
of other symptoms on the same side, including:
? Tearing of the eye and runny nose
? Nasal congestion or nasal drip
? Redness in the eye
? Sweating or swelling on the affected side of the face
? Drooping of the eyelid or pupillary constriction
These features make TAC headaches distinct from other types of headaches. There are three
main types of headaches within this category:
1. Cluster Headaches (0.1%):
Cluster headaches are the most common form of TAC. They occur in clusters, which is why
the name suggests a recurring pattern. These headaches usually happen at the same time
every day, ranging from 8 times a day to once every few days. Each headache episode can
last from 30 minutes to 3 hours, and a person may experience up to 8 cluster episodes in a
single day. Unlike migraines, these headaches can start during sleep, and alcohol or strong
smells can often trigger them. Cluster headaches predominantly affect men. While people

2. Paroxysmal Hemicrania:
Paroxysmal hemicrania has symptoms similar to cluster headaches, but the duration of each headache episode is shorter. While cluster headaches may last from 30 minutes to 3 hours, paroxysmal hemicrania typically lasts between 2 to 30 minutes.
3. SUNCT (Short-lasting Unilateral Neuralgiform Headache with Conjunctival Tearing):
This type of headache involves short episodes that last from 1 second to 10 minutes but can occur up to 100 times a day. These headaches can be triggered by various activities such as brushing teeth, showering, shaving, chewing, or even talking.
Secondary Headaches (Headaches Due to Other Causes)
Secondary headaches arise from underlying conditions or external factors. These headaches are often associated with more severe or specific causes, and recognizing the signs is crucial for proper diagnosis and treatment. Here are some of the major causes of secondary headaches:
1. Infections:
Viral infections like the common cold, sore throat, and dengue fever often cause headaches, but more serious infections such as meningitis or brain infections can be much more dangerous. If you experience a fever and severe headache without a clear cause, brain infections should be suspected. These can usually be diagnosed with a detailed clinical examination, and if necessary, a lumbar puncture can confirm the diagnosis.
2. Vascular Conditions:
Temporal Arteritis (also known as Giant Cell Arteritis) is a common vascular condition causing headaches. It causes pain in one side of the head, often accompanied by fatigue, fever, and vision disturbances (from blurred vision to complete blindness). This condition is most commonly seen in individuals over the age of 50. Another condition related to this is Polymyalgia Rheumatica, which causes pain in the neck, shoulders, and extremities.
3. Subarachnoid Hemorrhage:
This refers to bleeding within the brain's covering layers, often from conditions like aneurysms or arteriovenous malformations. The headache is typically sudden and extremely intense, often described as the worst headache of one's life. This is a medical emergency requiring immediate treatment.
4. Brain Tumors:
Although rare, brain tumors are a possible cause of headaches, accounting for less than 0.1% of all headache cases. These headaches tend to worsen gradually and are often worse in the mornings or when lying down. Brain tumors may present other symptoms depending on the affected area of the brain. However, brain tumors are a less common cause of headaches, and most headaches do not result from tumors.
5. Benign Intracranial Hypertension:
This condition is due to increased pressure from cerebrospinal fluid without a clear underlying cause. Symptoms include headaches, vomiting, and visual disturbances such as blurred vision or ringing in the ears. This condition is more common in overweight young women. Although CT/MRI scans may appear normal, a lumbar puncture can help measure cerebrospinal fluid pressure for diagnosis.
6. Eye and Sinus Conditions:
Chronic eye strain can lead to headaches, though it's generally not the primary cause. Acute narrow-angle glaucoma, where there is a sudden increase in eye pressure, can cause intense pain around the eye and surrounding areas. Although sinusitis is commonly associated with headaches, most mild cases do not cause severe pain. Only purulent sinusitis (a severe bacterial infection of the sinuses) can lead to significant headache pain.
What to Do When You Have a Headache?
Different doctors may offer slightly varied advice, but here are some general guidelines:
•    Mild headaches: If it's a common headache from a viral infection, it's usually okay to wait for a few days. If the headache persists for more than 5-6 days, it’s important to seek medical help.
•    Chronic headaches: If the headaches have been persistent over time, it is advisable to get a CT scan or MRI to rule out any serious conditions. Some people may skip the scan if the symptoms are consistent with migraines, but getting a scan is often helpful for both the doctor and the patient to confirm the diagnosis.
When Should You Not Ignore a Headache?
While most headaches are non-threatening, the following symptoms should raise red flags, and you should seek medical attention:
•    Persistent fever with headache
•    Head trauma leading to a headache
•    Vision problems (like blurring or double vision)
•    Weakness or paralysis (such as difficulty standing or walking)
•    Changes in behavior or memory (like confusion or forgetfulness)
•    Severe headache that comes suddenly, described as "switch-flip" pain
•    Worsening pain when lying down
•    Headache starting after age 50
•    A change in the character of a previously familiar headache
•    Headaches in individuals with serious illnesses, such as cancer
Conclusion:
Although most headaches are not serious, it’s important to be aware of warning signs that could point to a more serious underlying condition. Taking action at the right time is crucial. Always prioritize awareness over fear — quick attention to a potentially serious headache can make all the difference.
 

2. Paroxysmal Hemicrania:
Paroxysmal hemicrania has symptoms similar to cluster headaches, but the duration of each headache episode is shorter. While cluster headaches may last from 30 minutes to 3 hours, paroxysmal hemicrania typically lasts between 2 to 30 minutes.
3. SUNCT (Short-lasting Unilateral Neuralgiform Headache with Conjunctival Tearing):
This type of headache involves short episodes that last from 1 second to 10 minutes but can occur up to 100 times a day. These headaches can be triggered by various activities such as brushing teeth, showering, shaving, chewing, or even talking.
Secondary Headaches (Headaches Due to Other Causes)
Secondary headaches arise from underlying conditions or external factors. These headaches are often associated with more severe or specific causes, and recognizing the signs is crucial for proper diagnosis and treatment. Here are some of the major causes of secondary headaches:
1. Infections:
Viral infections like the common cold, sore throat, and dengue fever often cause headaches, but more serious infections such as meningitis or brain infections can be much more dangerous. If you experience a fever and severe headache without a clear cause, brain infections should be suspected. These can usually be diagnosed with a detailed clinical examination, and if necessary, a lumbar puncture can confirm the diagnosis.
2. Vascular Conditions:
Temporal Arteritis (also known as Giant Cell Arteritis) is a common vascular condition causing headaches. It causes pain in one side of the head, often accompanied by fatigue, fever, and vision disturbances (from blurred vision to complete blindness). This condition is most commonly seen in individuals over the age of 50. Another condition related to this is Polymyalgia Rheumatica, which causes pain in the neck, shoulders, and extremities.
3. Subarachnoid Hemorrhage:
This refers to bleeding within the brain's covering layers, often from conditions like aneurysms or arteriovenous malformations. The headache is typically sudden and extremely intense, often described as the worst headache of one's life. This is a medical emergency requiring immediate treatment.
4. Brain Tumors:
Although rare, brain tumors are a possible cause of headaches, accounting for less than 0.1% of all headache cases. These headaches tend to worsen gradually and are often worse in the mornings or when lying down. Brain tumors may present other symptoms depending on the affected area of the brain. However, brain tumors are a less common cause of headaches, and most headaches do not result from tumors.
5. Benign Intracranial Hypertension:
This condition is due to increased pressure from cerebrospinal fluid without a clear underlying cause. Symptoms include headaches, vomiting, and visual disturbances such as blurred vision or ringing in the ears. This condition is more common in overweight young women. Although CT/MRI scans may appear normal, a lumbar puncture can help measure cerebrospinal fluid pressure for diagnosis.
6. Eye and Sinus Conditions:
Chronic eye strain can lead to headaches, though it's generally not the primary cause. Acute narrow-angle glaucoma, where there is a sudden increase in eye pressure, can cause intense pain around the eye and surrounding areas. Although sinusitis is commonly associated with headaches, most mild cases do not cause severe pain. Only purulent sinusitis (a severe bacterial infection of the sinuses) can lead to significant headache pain.
What to Do When You Have a Headache?
Different doctors may offer slightly varied advice, but here are some general guidelines:
•    Mild headaches: If it's a common headache from a viral infection, it's usually okay to wait for a few days. If the headache persists for more than 5-6 days, it’s important to seek medical help.
•    Chronic headaches: If the headaches have been persistent over time, it is advisable to get a CT scan or MRI to rule out any serious conditions. Some people may skip the scan if the symptoms are consistent with migraines, but getting a scan is often helpful for both the doctor and the patient to confirm the diagnosis.
When Should You Not Ignore a Headache?
While most headaches are non-threatening, the following symptoms should raise red flags, and you should seek medical attention:
•    Persistent fever with headache
•    Head trauma leading to a headache
•    Vision problems (like blurring or double vision)
•    Weakness or paralysis (such as difficulty standing or walking)
•    Changes in behavior or memory (like confusion or forgetfulness)
•    Severe headache that comes suddenly, described as "switch-flip" pain
•    Worsening pain when lying down
•    Headache starting after age 50
•    A change in the character of a previously familiar headache
•    Headaches in individuals with serious illnesses, such as cancer
Conclusion:
Although most headaches are not serious, it’s important to be aware of warning signs that could point to a more serious underlying condition. Taking action at the right time is crucial. Always prioritize awareness over fear — quick attention to a potentially serious headache can make all the difference.