As we continue to deal with the COVID-19 Pandemic, a symptom such as a headache tends to raise eyebrows but we must not forget that long before COVID-19, headaches existed and may be a warning for other conditions that we may have neglected.

Over one hundred types of headaches have been described. Many of these are not dangerous, but some have the potential to disrupt your life.

Warning Bells

You may be able to manage some headaches on your own, and I believe you already do. Your doctor may have to prescribe medication or appropriate intervention for the ‘non-compliant’ headaches, but for some headaches, you need to quickly seek medical attention. Symptoms of such headaches include:

‘The worst headache of my life’
Headaches so severe, they affect the activities of daily life
Headaches that get steadily worse or are coupled with a painful red eye
Headaches that come up abruptly and may even wake you up from sleep
Headaches that follow a blow to the head
A major change in the pattern of your headaches
Headaches accompanied by pain and tenderness over the temples
Headaches accompanied by fever, neck stiffness, confusion, decreased alertness or memory impairment, visual problems, slurred speech, weakness, numbness or seizures.

Preparation before meeting with your doctor

For most headaches, the information you provide to your doctor is supreme. Blood work is not helpful in the majority of headaches, and advanced tests such as brain scans (CT scans and MRIs) and brain waves (EEGs) may not be helpful. Only your healthcare provider, with your help, can determine when tests are necessary.

It is important to have answers to at least a few of the following questions before you meet with your doctor:

When did your headaches begin?
Does anything seem related to their onset?
How often and when do they occur?
How long do they last?
What do they feel like?
Does anything trigger or worsen the headaches?
Does anything ease the pain?
Is there a history of headaches in your family?
How is your family and work life?
How have your headaches influenced your life?
Are the headaches associated with fever, weakness, chills or loss of appetite?

Types of headaches

We will look briefly at the types and causes of headaches, and hopefully, when we get our next bout of headache, we will know exactly what to do.

Tension-type headache: This is the commonest of all headaches. It often produces a dull, squeezing pain on both sides of the head. It may be triggered by fatigue, emotional stress, or problems involving the muscles of the neck or jaw.
Migraine: A migraine is often severe. It starts on one side of the head and spreads. The pain is described as throbbing or pulsating. Nausea and or vomiting may be common. Patients tend to avoid bright light and sometimes loud sounds. It may be preceded by some signs.
Cluster headache: This is uncommon, but very severe. It often affects males between 20 and 40 years of age, especially smokers.
Headache caused by hypertension: I always say only the ‘lucky’ ones get a headache when their blood pressure increases. Hypertension is generally silent, but when severe, it may be associated with a headache.
Headache caused by sudden strenuous exertion: Sudden strenuous exertion, including exercise or sex, may precipitate a headache. The emphasis is on ‘sudden’ and ‘strenuous’.
Headache caused by medication side effects: Some drugs may cause headaches. Imagine that the drug you use to manage your migraine also causes headaches! Talk to your doctor, if you suspect a drug could be the culprit. Don’t play doctor, and stop making your own diagnoses.
Rebound headache: An abuse or overuse of certain painkillers may cause headaches, especially whenever their effect begins to wear off. Talk to a professional to help you break this cycle. If you do not have such a problem, please avoid self-medication, to prevent this…
‘Ice cream headache’: Some people experience this sudden, sharp head pain when they eat or drink anything cold. Why stress yourself? Just skip it if you can, and indulge in other things.
Malaria: In our setting, this is one of the commonest causes of headaches. We may have other symptoms such as fever, chills and loss of appetite. A blood test may be helpful.
Infections: There are several, but we will list only a few:
Typhoid – this may mimic malaria, but headache is often the predominant complaint, and fever is low-grade, or rises slowly.
Sinusitis – the pain is usually over the forehead, around the nose and eyes, over the cheeks, or in the upper teeth.
Ear infection – headache may be associated with ear and throat pain.
Viral infections including the common cold, influenza and COVID-19 as well as a side effect of COVID-19 vaccine.
Toothache: the headache is often from dental caries (kaka). Ever heard the song, ‘Eka (debt), kaka (toothache) eni ayem ka (stomach pain), which of the three is the most painful?’ Trust me, you don’t want any of them. They can keep you awake and cursing all night.
Poor vision: This leads to the straining of the eye muscles all day. It often occurs at the end of the day, and improves with sleep. You may need corrective lenses. Get tested.
Miscellaneous: The list goes on, but we can’t end without mentioning these:
Abusing hard drugs such as marijuana, heroin, etc.
Hangover – just what excessive alcohol prescribes for you on the morning after.
Hunger – this is the body’s way of warning us that it is running low on fuel and we need to replenish the stores. Diabetics on medication should never ignore this warning, since it may be an early prompting of the ever so dangerous hypoglycaemic attack.
Dehydration – ‘….as water to a thirsty land’. Water never ceases to appear in our chat. Just imagine stopping a recurring headache with a cool refreshing large glass of water. That may be all the doctor will prescribe.
Fatigue – This is fresh in your memory, so we will leave it at that.

Relief from some headaches

Some headaches require specific treatment, but for many others, all we need is:

Regular mild to moderate exercise
Relaxation techniques
Time management skills
Adequate sleep
Drinking of adequate water
Eating appropriately.

I hope you do not need to scratch your head as often when you or someone else experiences the next bout of headache.

Always remember, ‘The health and wealth of Ghana starts with YOU!’

AS ALWAYS LAUGH OFTEN, ENSURE HYGIENE, WALK AND PRAY EVERYDAY AND REMEMBER IT’S A PRICELESS GIFT TO KNOW YOUR NUMBERS (blood sugar, blood pressure, blood cholesterol, BMI)

Dr. Kojo Cobba Essel

Health Essentials Ltd/ St Andrews Clinic/Mobissel

Dr. Essel is a medical doctor, holds an MBA and is ISSA certified in exercise therapy, fitness nutrition and corrective exercise.

Thought for the week –“STIGMATIZATION has no place in fighting this pandemic. It will cause people to hide and not disclose their status, seek medical care late and reduce all the benefits of protocols. We should all be comfortable enough to tell our close contacts when we test positive for COVID-19 so that the proper measures are taken. This is extremely important if we have to win this fight.”- Dr. Kojo Cobba Essel

References:

Patient Education Center, Harvard Medical School
Clinic Data, Health Essentials Ltd