What are Acute Headaches?
Acute headaches explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
Cephalalgia, commonly known as a headache, is characterized by pain that originates in the head or neck region. Complaints of headache pain are extremely common. In fact, headaches have historically been the most common pain complaint among patients seen in family practices. Almost everyone will experience an episode of headache pain at some point during his or her life. Specifically, acute headaches are those episodes of headache pain that occur very suddenly and worsen very rapidly.
Acute headache pain can have a variety of sources. Contrary to perception, the symptoms of pain and discomfort associated with acute headaches occurs within the tissue that surrounds the brain, not the brain itself as brain tissue does not contain pain receptors, making it unable to sense to pain. These pain-sensitive structures surrounding the brain that are generally found to be the source of acute headache pain include: the cranium, nerves, muscles, subcutaneous tissue, arteries and veins, ears, eyes, paranasal sinuses, and mucous membranes.
Most cases of acute headache pain are not life threatening. It is important to understand the signs and symptoms that may indicate a more serious condition exists. Symptoms that indicate immediate medical care is necessary include:
- New onset headache
- Most severe headache the patient has ever experienced
- Atypical aura or focal neurologic symptoms (e.g., dizziness, weakness, loss of balance, numbness, tingling, difficulty speaking, mental confusion, seizure, personality or behavior change, or vision changes)
- Headache pain is accompanied by fever, rash, stiff neck, or shortness of breath
- Severe nausea and vomiting
- Loss of consciousness
- Pain that awakens the patient from sleep
- Pain following a head injury or accident
- Tenderness in the area near the temporal artery
- Onset of pain was triggered by cough, exertion, or during sexual intercourse
In general, individuals who are reported to have had headaches in the past and do not exhibit any of the above symptoms are believed to be at a low risk for a serious underlying condition.
Causes of Acute Headaches
Despite having a sudden onset and rapid severity progression, acute headaches are relatively common and, in general, are not associated with a significant underlying illness. In fact, there are over 150 different classifications of headaches. Given this wide range of symptomatology, determining the cause of a headache can be somewhat difficult at times. Indeed, in some instances physicians are not able to clearly identify the precise cause of acute headache pain at all.
When assessing for the source of headache pain, physicians will primarily focus on the patient’s description of symptom onset and progression. It is common for patients to have difficulty recalling precise symptoms and descriptions for the pain. Thus, it is recommended that patients keep a “headache diary” where they are able to document, in as much detail as they can, their description of their symptoms so that they are able to provide their physician with the most accurate information possible. When considering diagnoses, physicians will also gather information about the patient’s individual history, family history, and any relevant precipitating events. Interestingly, it is very rare that the physical examination of a headache patient elucidates any information to aid in determining the appropriate diagnosis.
All headaches are divided into two broad classifications: primary headaches and secondary headaches. More specifically, headaches that are the result of a disturbance within the tissue surrounding the brain that is capable of sensing pain are classified as primary headaches. Those that are secondary occur as the result of another medical condition, which affects other areas of the body.
Some of the most common types of headaches include:
- Tension headache: Tension headaches are the most common type of headache. They are categorized as pain or discomfort in the area of the forehead or the back of the neck, and usually occur in the late afternoon or evening. These headaches are generally experienced daily and may be accompanied by sensitivities to bright light and loud sounds.
- Migraine: The pain associated with migraine headaches is reported to be moderate to severe, and typically described as throbbing at the temples, back of the head, or even behind the eye. Most reports of migraine pain lasts, on average, between one to three days.
- Migraine with aura: A portion of patients suffering from migraine pain report that they experience a sensory warning sign of an impending migraine, also known as auras. These can be described as visual experiences, such as metallic lines that appear within the field of vision, or even smell or touch sensations.
- Cluster headache: The symptoms of pain associated with cluster headaches are described as severe pain, which are localized to only one side of the head or neck. They can occur several times a day and the pain can persist for up to two hours.
The most common causes associated with the onset of acute headaches include: fatigue or lack of sleep, hormones, stress, reactions to food, medical problems, and trauma.
Treatments for Acute Headaches
There are a large number of classifications for the symptom clusters of acute headaches, and as such there are a number of different treatment options available.
For patients who report that their acute headaches are either not severe, they occur infrequently, or are not debilitating in the sense that they are interfering with their ability to maintain daily functioning, at-home treatments are generally recommended as a first-line intervention. Depending on the type of headache and the patient’s reported symptoms, however, more specific recommendations may be made. For a large percentage of headache cases, physicians will recommend an over-the-counter analgesic.
Patients having difficulty with chronic headaches are strongly encouraged to maintain a “headache diary.” This allows them to track their symptoms of headache pain, such as time of onset, how intense their pain was, how long it took for the pain to reach its peak, the total length of the pain episode, any associated symptoms, their behavior prior to the onset of symptoms, any atypical factors, etc., so that they are able to provide their physician with an accurate report. Indeed, most headache diagnoses are made using the patient’s description of the pain only. Physical examinations rarely provide much information with regard to diagnosing headache pain. Along with providing an accurate account of symptoms, maintaining a diary of symptoms also allows the patients to identify common headache triggers that can be used for preventing future headache episodes.
Several over-the-counter painkillers are available. In fact, most patients report that they are able to effectively manage their acute headache pain using non-steroidal anti-inflammatory drugs (NSAIDs). However, should these not be effective in managing headache pain, there are prescription medications available that act to constrict blood vessels, which helps reduce the inflammation thought to be involved in acute headaches.
The medications that have received some support in their prophylactic qualities for treating headache pain, include fluoxetine, amitriptyline, gabapentin, tizanidine, topiramate, and botullinum toxin type A.
For patients who wish to try other forms of pain management or want to augment their medication, two types of non-pharmacological interventions have received support for providing pain relief: biofeedback and cognitive-behavior therapy. The goal of these interventions is to assist patients with increasing their awareness of their symptom patterns and common triggers. Patients are trained in relaxation practices and taught coping skills for managing and reducing stress. Many patients report having a stronger sense of control over their pain following these interventions.
Alternative interventions are available for patients who report chronic and severe headache pain. Some of these interventions include botox injections, steroid injections in either the cervical facet joint or the cervical epidural space, occipital nerve stimulation or peripheral nerve stimulation, occipital nerve block, sphenopalatine ganglion block, supratrochlear nerve block, supra/infraorbital nerve block, and radiofrequency ablation. It is recommended that you speak with your physician when considering these intervention options.
Complaints of headache pain are incredibly common. Most individuals will experience an episode of headache pain at some point in their life. Headache pain is pain or discomfort that is experienced anywhere in the head or neck region. Headaches that are described as acute are defined by their sudden onset and rapid increase in severity.
In general, headaches are classified into two types: primary or secondary. Pain that emerges as the result of a disturbance to the tissue within the head and neck that is capable of sensing pain is classified as a primary headache. Secondary headaches are classified as headache pain that emerges as a result of other medical conditions occurring within the body. Acute headache pain can have a wide range of underlying sources from those that are not serious and low risk, such as a tension headache, to those that are serious and may be life threatening, such as meningitis. Given the diversity with regard to the causes of acute headache pain, there are also a number of available treatment options that generally depend on the individual’s specific headache characteristics. Patients are encouraged to speak with their physician in order to develop an appropriate treatment strategy for pain management.
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