August 21, 2014

Ask the Doctors

My husband, age 54, is having increasingly disabling headaches three to four times a week. He complains that his vision changes during these episodes. He has had headaches from time to time since his early 20s, especially when experiencing stressful circumstances. Over-the-counter pain relievers are not helping, and in fact seem to make the headaches worse at times. He says this is just stress; are there other causes we should be concerned about?

Yes, you should most definitely seek professional help regarding this obvious change in pattern of headaches. Stressful circumstances may certainly be associated with tension-type headaches, which are made worse by neck-and-shoulder muscle spasm. From your description, however, there has been a very significant change in the headache pattern. This signals an urgent need for further investigation of the problem.

Migraine headaches may be associated with visual changes, including blurred vision. These attacks may be preceded by what is known as an aura, which may include blurred vision, a change in speech, or some difficulty with movement—which is reversible and of short duration. Associated symptoms may be nausea and even vomiting, discomfort when looking at the light, and increased sensitivity to sounds and smells (odors or fragrances). The typical migraine headache has a phase during which the pain is throbbing or pounding in nature. Migraine headaches often start in younger age groups but may occur in middle age as well. There may be specific identifiable triggers for migraine headaches: lack of sleep, certain foods, cold weather, stress, extreme exercise, to name but a few.

Inflammation of one of the large arteries at the side of the head may be associated. This condition is known as temporal arteritis (or giant-cell arteritis). Accompanying symptoms may include scalp tenderness or pain, nausea, visual disturbance, and even loss of vision. Hearing may be affected, and there may also be joint pains and fever. Health professionals can confirm the diagnosis by taking a biopsy of the artery and studying it under the microscope. This condition requires urgent and aggressive treatment, not only to alleviate the pain but also to prevent loss of vision.

Viral and bacterial infections can cause inflammation of the brain (encephalitis) or of the tissues lining the brain (meningitis). These may be associated with headache, neck stiffness, fever, nausea, vomiting, and light sensitivity (meaning that light appears uncomfortably bright and intrusive). These conditions can be dangerous, and bacterial meningitis—especially meningococcal meningitis—can be rapidly fatal if not diagnosed and urgently treated.

Bleeding into/under the netlike tissue that covers the brain (subarachnoid bleeding) can also cause neck stiffness and severe headache. The pain can shoot down into the back on bending the head forward. There may also be a loss of consciousness. This condition may be related to an abnormality in the blood vessels of the brain called an aneurysm, which then leaks and can cause brain damage and death.

Severe and uncontrolled high blood pressure can also result in headaches. The blood pressure needs to be tested and treated if shown to be the cause of the problem. It should be noted that in patients who have chronic high blood pressure, the absence of headache is not an indication of blood pressure control. If one has high blood pressure and is on treatment (lifestyle and/or medication), it’s helpful to have your own blood pressure monitor so you can check the readings and be sure all is well.

Brain tumors can also cause headaches.

As the list of causes increases, the reader may become more concerned. I strongly encourage those who experience such changes in headache symptoms as described in today’s question to urgently seek professional advice. Don’t delay, because your life may depend on timely intervention. 

Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or e-mail them to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matters of your health.