What are the common causes of stiff neck, dizziness, and headache. How can these symptoms be treated effectively. What are the warning signs that require immediate medical attention.

Cervical Headaches: Understanding the Neck-Head Connection

Cervical headaches, also known as cervicogenic headaches, are a type of chronic headache originating from structural issues in the cervical spine. These headaches can be particularly troublesome, often accompanied by neck stiffness, dizziness, and fatigue.

What causes cervical headaches? The root of the problem lies in damage or strain to the cervical spine, which can occur due to various factors:

• Injuries from accidents or surgeries
• Compression fractures
• Herniated discs
• Spinal cord inflammation
• Poor posture leading to neck strain

How do cervical headaches manifest? Patients often experience persistent pain lasting for days or intermittent discomfort. Additional symptoms may include:

• Neck stiffness and limited range of motion
• Nausea
• Fatigue
• Dizziness

Diagnosing and Treating Cervical Headaches

How are cervical headaches diagnosed? Medical professionals typically employ a combination of physical examination and imaging techniques to assess the cervical spine and identify the underlying cause.

What treatment options are available for cervical headaches? The approach varies depending on the root cause, but may include:

1. Pain relievers to alleviate neck pain and headaches
2. Physiotherapy to improve neck function and mobility
3. Surgical interventions to address cervical spine issues
4. Nerve blocks to target specific pain areas

Migraines: More Than Just a Headache

Migraines are intense, throbbing headaches that typically affect one side of the head. These debilitating episodes often come with a host of additional symptoms, making them particularly challenging to manage.

What are the hallmark symptoms of a migraine? Beyond the severe headache, individuals may experience:

• Heightened sensitivity to light and sounds
• Dizziness
• Nausea and vomiting
• Visual disturbances (aura)

While the exact cause of migraines remains elusive, several factors are believed to contribute to their occurrence:

• Alterations in brain chemistry
• Changes in neural and vascular structures within the brain
• Genetic predisposition

Identifying Migraine Triggers and Treatment Options

Can certain factors trigger migraines? Many individuals report specific triggers that can precipitate a migraine attack, including:

• Hormonal changes, particularly during menstruation
• Stress and anxiety
• Fatigue and sleep disturbances
• Certain foods and beverages
• Environmental factors like bright lights or strong odors

How can migraines be effectively managed? While there is no cure for migraines, several treatment approaches can help alleviate symptoms:

1. Resting in a dark, quiet room during an attack
2. Over-the-counter pain relievers like acetaminophen or ibuprofen
3. Prescription medications such as triptans, which target the underlying brain changes
4. Antiemetics to reduce nausea and vomiting
5. Preventive medications for frequent migraine sufferers

Viral Gastroenteritis: When Stomach Bugs Cause Head Woes

Viral gastroenteritis (VG) is an inflammation of the gastrointestinal tract caused by viral infections. While primarily affecting the digestive system, VG can lead to a range of symptoms that include headaches, dizziness, and fatigue.

What is the most common cause of viral gastroenteritis? The norovirus is the leading culprit, responsible for a significant portion of VG cases worldwide.

How does viral gastroenteritis manifest? The infection can cause a constellation of symptoms:

• Nausea and vomiting
• Abdominal pain and cramping
• Diarrhea
• Headaches
• Body aches and fever
• Dizziness, particularly upon standing
• Fatigue

Managing Viral Gastroenteritis and Preventing Complications

Does viral gastroenteritis require medical treatment? In most cases, VG resolves on its own without specific medical interventions. However, managing symptoms and preventing dehydration are crucial.

How can individuals alleviate VG symptoms and avoid complications?

1. Stay hydrated by drinking plenty of clear fluids
2. Consider low-sugar fruit juices or sports drinks to replenish electrolytes
3. Use over-the-counter medications like loperamide or bismuth subsalicylate to control diarrhea
4. Rest and allow the body to recover

When should you seek medical attention for viral gastroenteritis? Consult a healthcare provider if symptoms persist beyond a few days or if signs of severe dehydration develop.

Cerebral Aneurysms: A Silent Threat

A cerebral aneurysm is a weakened, bulging area in a blood vessel within the brain. While small aneurysms may remain asymptomatic, larger ones can exert pressure on surrounding tissues, leading to various neurological symptoms.

What are the warning signs of a cerebral aneurysm? Symptoms may include:

• Pain above and behind the eye
• Visual disturbances
• Dilated pupil
• Facial paralysis on one side
• Numbness or weakness
• Persistent headaches
• Neck stiffness
• Dizziness and fatigue

Aneurysm Rupture: A Medical Emergency

What happens when an aneurysm ruptures? A ruptured aneurysm is a life-threatening emergency requiring immediate medical attention. Symptoms of a rupture include:

• Sudden, severe headache often described as the “worst headache of my life”
• Blurred or double vision
• Extreme sensitivity to light
• Stiff neck
• Nausea and vomiting
• Seizures
• Loss of consciousness

How are cerebral aneurysms treated? According to the National Institute of Neurological Diseases and Stroke (NINDS), not all aneurysms require immediate treatment. Management options include:

1. Monitoring for signs of growth in small, stable aneurysms
2. Surgical clipping to seal off the aneurysm
3. Endovascular coiling to block blood flow to the aneurysm
4. Flow diverters to redirect blood flow away from the aneurysm

Dehydration: An Overlooked Cause of Multiple Symptoms

Dehydration, often underestimated, can be a significant contributor to headaches, dizziness, fatigue, and even neck discomfort. When the body lacks sufficient fluids, various physiological processes are affected, leading to a cascade of symptoms.

How does dehydration manifest? Common signs include:

• Thirst and dry mouth
• Reduced urine output or dark-colored urine
• Fatigue and weakness
• Dizziness, especially when standing up quickly
• Headaches
• Muscle cramps, including in the neck area

Preventing and Treating Dehydration

What steps can be taken to prevent dehydration?

1. Drink adequate amounts of water throughout the day
2. Increase fluid intake during hot weather or physical activity
3. Consume hydrating foods like fruits and vegetables
4. Monitor urine color as an indicator of hydration status

How is dehydration treated? For mild to moderate cases:

• Gradually increase fluid intake
• Consume oral rehydration solutions to replenish electrolytes
• Rest in a cool environment

Severe dehydration may require medical intervention, including intravenous fluid administration.

Temporomandibular Joint (TMJ) Disorders: The Jaw-Neck Connection

Temporomandibular joint (TMJ) disorders affect the joint connecting the jawbone to the skull. These conditions can surprisingly lead to a combination of headaches, neck pain, dizziness, and fatigue.

What causes TMJ disorders? Common factors include:

• Jaw injury or trauma
• Chronic teeth grinding (bruxism)
• Arthritis affecting the TMJ
• Stress-induced muscle tension

How do TMJ disorders manifest beyond jaw pain? Symptoms can include:

• Headaches, often resembling tension headaches
• Neck and shoulder pain
• Dizziness or vertigo
• Tinnitus (ringing in the ears)
• Fatigue due to sleep disturbances

Diagnosing and Treating TMJ Disorders

How are TMJ disorders diagnosed? Healthcare providers may use a combination of:

1. Physical examination of the jaw and surrounding muscles
2. Dental X-rays or more advanced imaging like MRI or CT scans
3. Assessment of jaw movement and listening for clicking or grinding sounds

What treatment options are available for TMJ disorders?

• Physical therapy to improve jaw mobility and reduce muscle tension
• Oral appliances or night guards to prevent teeth grinding
• Pain relief medications, including anti-inflammatories
• Stress management techniques
• In severe cases, surgical interventions may be considered

When to Seek Medical Attention: Red Flags and Warning Signs

While many causes of headaches with neck pain, dizziness, and fatigue can be managed at home, certain symptoms warrant immediate medical attention. Recognizing these red flags is crucial for timely intervention and prevention of serious complications.

What are the warning signs that require urgent medical evaluation?

• Sudden, severe headache described as the “worst ever”
• Headache accompanied by fever, stiff neck, and confusion
• Visual disturbances or loss of vision
• Sudden weakness or numbness, especially on one side of the body
• Difficulty speaking or understanding speech
• Loss of balance or coordination
• Seizures
• Headache following a head injury

Diagnostic Approaches for Complex Symptom Presentations

How do healthcare providers approach diagnosis when multiple symptoms are present? The process typically involves:

1. Comprehensive medical history taking
2. Physical examination, including neurological assessment
3. Laboratory tests to rule out infections or metabolic disorders
4. Imaging studies such as CT scans or MRI, when indicated
5. Specialized tests like electronystagmography for dizziness evaluation

Why is a multidisciplinary approach often necessary? The complex interplay of symptoms may require input from various specialists, including neurologists, ENT physicians, and physical therapists, to arrive at an accurate diagnosis and comprehensive treatment plan.

By understanding the diverse causes of headaches accompanied by neck pain, dizziness, and fatigue, individuals can better recognize when to seek medical attention and work with healthcare providers to develop effective management strategies. Remember, while many conditions are benign and self-limiting, others may require prompt intervention to prevent serious complications.

Headache, dizziness, fatigue, and neck pain: Causes and treatment

A headache, along with neck pain, dizziness, and fatigue, can be debilitating. Numerous conditions can cause these symptoms, including migraines, tumors, or even dehydration. Some are relatively benign, while others can be serious or life threatening.

This article explores the potential triggers of headaches with dizziness, fatigue, and neck pain, along with their treatment options. We also outline tips for preventing these symptoms and offer advice on when to see a doctor.

There can be several reasons for a headache with neck pain, dizziness, and fatigue.

Cervical headache

A cervical headache, or cervicogenic headache, is a type of long-term or chronic headache due to structural issues with parts of the cervical spine, including the vertebrae, disc, muscle, or spinal cord. The cervical spine is the section of the spine that includes the neck.

Cervical spine damage can occur due to:

• injury resulting from accidents or surgery
• compression fractures
• a herniated disk
• inflammation of the spinal cord
• general neck strain due to posture issues

A cervical headache may cause pain that persists for several days, or the discomfort can come and go. Other possible symptoms include:

• neck stiffness
• nausea
• fatigue
• limited neck movement

Treatment

A doctor can usually diagnose cervical headaches by examining the neck and assessing the spine using medical imaging techniques.

The treatment will depend on the underlying cause, with options that include:

• pain relievers to ease neck pain and headaches
• physiotherapy to restore function and improve neck movement
• surgery to correct issues with the cervical spine
• nerve blocks to treat specific areas of pain

Migraine

A migraine is a moderate or severe throbbing headache that occurs on one side of the head. They may also cause additional symptoms, such as:

• increased sensitivity to light or sounds
• dizziness
• nausea
• vomiting

The exact cause of migraines remains unknown. However, experts believe that the following factors may play a role:

• changes in brain chemicals
• changes to the nerves and blood vessels inside the brain
• genetic factors

Some people report that certain factors can trigger their migraines, which commonly include:

• menstruation
• stress
• tiredness
• certain foods and drinks

Treatment

Although there is no cure for migraines, certain treatments can help reduce the symptoms, including:

• sleeping or lying in a dark room during a migraine
• taking over-the-counter pain relievers, such as acetaminophen and ibuprofen
• taking triptans, which help reverse brain-changes that can trigger migraines
• taking antiemetics to help reduce nausea and vomiting

Viral gastroenteritis

Gastroenteritis is the medical term for inflammation and irritation of the gastrointestinal tract. Viral gastroenteritis (VG) is gastroenteritis that occurs as a result of a viral infection.

Many viruses can trigger VG. The most common is norovirus, which can cause a range of symptoms, including:

• nausea
• vomiting
• stomach pain
• diarrhea
• headaches
• body aches
• fever

Persistent diarrhea and vomiting can also lead to dehydration. This may lead to additional symptoms, such as:

• dizziness when standing up
• dry mouth and throat
• reduced urine

Treatment

Viral gastroenteritis usually goes away on its own without medical treatment. Until then, people can take medications to control their diarrhea. Examples include loperamide (Imodium) or bismuth subsalicylate (Pepto Bismol).

People can help prevent dehydration by:

• drinking plenty of water and other clear fluids
• drinking low-sugar fruit juices or sports drinks to help replace lost electrolytes

Contact a doctor if symptoms do not improve within a few days.

Cerebral aneurysm

An aneurysm refers to an enlarged blood vessel. This occurs due to a weakness in the blood vessel wall. An aneurysm that occurs within a blood vessel in the brain is known as a cerebral aneurysm.

A small cerebral aneurysm that does not increase in size might not come with any symptoms. However, larger aneurysms may put pressure on the surrounding nerves or brain tissue, which can trigger the following symptoms:

• pain above and behind the eye
• changes in vision
• a dilated pupil in the eye
• paralysis on one side of the face
• numbness
• weakness

In some cases, an aneurysm may leak or rupture, which requires emergency medical attention. Symptoms to look out for include:

• a sudden, severe, and intense headache
• blurred or double vision
• sensitivity to light
• stiff neck
• nausea
• vomiting
• seizures
• brief or prolonged loss of consciousness
• cardiac arrest

Treatment

According to the National Institute of Neurological Diseases and Stroke (NINDS), not all aneurysms require treatment. In some cases, a doctor may recommend monitoring them for signs of growth.

NINDS recommend people take the following steps to help reduce the risk of a ruptured aneurysm:

• monitoring and controlling blood pressure
• quitting smoking
• avoiding the use of stimulant drugs

Some people may require surgery to reduce or cut off blood supply to the aneurysm.

Stroke

A stroke is a potentially life threatening condition where the blood supply to part of the brain becomes cut off, which can result in brain cell death. A stroke can occur for the following reasons:

• an artery that supplies blood to the brain becomes blocked
• blood vessel within the brain ruptures

A sudden and severe headache can sometimes be a warning sign of stroke, though it is not a common symptom. In a 2015 study, only 49 out of 263 people who experienced a stroke reported a simultaneous headache.

Besides a headache, other possible stroke symptoms include:

• sudden numbness or weakness in a limb, or on one side of the face
• vision problems in one or both eyes
• difficulty speaking or understanding speech
• confusion
• dizziness
• loss of balance
• lack of coordination
• difficulty walking

Treatment

A stroke is a medical emergency. Without rapid treatment, it may result in severe brain damage or death. A person who shows signs of a stroke should phone for an ambulance immediately if possible. People should also look out for these symptoms in others and seek emergency medical care if they suspect a stroke.

Stroke treatments depend on the underlying cause. Some possible options include:

• Thrombolytics: Medications can help break up blood clots.
• Endovascular procedure: A procedure where a surgeon guides surgical instruments through a tube inserted into a limb to repair a broken blood vessel.
• Surgical treatment: Involves placing a metal clip around a ruptured blood vessel to reduce further bleeding.

Brain tumor

A brain tumor is when a collection of cells within the brain multiply abnormally and uncontrollably.

Doctors classify brain tumors into grades, depending on how fast they grow and how likely they are to grow back after treatment.

Grade 1 and 2 brain tumors are non-cancerous or benign, and slow-growing. Grade 3 and 4 brain tumors are cancerous or malignant. These tumors may originate in the brain or may spread from elsewhere in the body. They are fast-growing and more likely to re-occur following treatment.

Brain tumor symptoms depend partly on the area of the brain that they affect. Some common symptoms include:

• headaches
• dizziness
• seizures
• persistent nausea
• vomiting
• drowsiness and fatigue
• progressive weakness or paralysis on one side of the body
• problems with speech, vision, or memory
• changes in personality or behavior

Treatment

Brain tumor treatments depend on the following factors:

• type, grade, and location of the tumor
• how abnormal the cells are
• how big the tumor is and how far it has spread
• the person’s overall health and fitness

Some possible treatment options include:

• steroids to reduce swelling around the tumor
• antiepileptic medications to control seizures
• pain medications to ease pain
• surgery to remove the tumor
• radiation therapy or chemotherapy to help destroy any abnormal cells

Other possible causes of headaches, dizziness, neck pain, and fatigue include dehydration and anxiety.

Dehydration

Dehydration occurs when the body does not have enough water to function properly. This can result in the following symptoms:

• headaches
• dizziness or lightheadedness
• tiredness
• dry mouth, lips, and eyes
• dark, strong-smelling urine
• reduced urine

Anxiety

According to the Anxiety and Depression Association of America, headaches are a common symptom of anxiety. People with this condition may also experience panic attacks, which can trigger the following physical symptoms:

• heart palpitations
• chest pain or discomfort
• shortness of breath
• sweating
• trembling or shaking
• numbness or tingling sensations
• dizziness or lightheadedness
• nausea

Cervical headaches indicate that there may be an injury in the cervical spine or surrounding soft tissue.

People who experience them may benefit from the following treatments:

• physical therapy to help regain function
• alternative therapies, such as acupuncture
• medications to alleviate pain
• surgery to address serious injuries

Anyone with severe, persistent, or worsening headaches should see a doctor for a diagnosis and appropriate treatment.

The acronym SNOOP can help people decide when a headache may be serious, which stands for:

• Systemic symptoms:
  • fever
  • persistent vomiting
  • stiff neck
• Neurological symptoms:
  • changes in mood, personality, or behavior
  • confusion
  • memory problems
  • seizures
  • loss of consciousness
  • weakness or paralysis
• Onset: New or sudden onset of headaches.
• Other conditions: A headache that develops following another condition or head injury.
• Prior history: If the headache differs from previous headaches, or they get steadily worse, this could signal a serious issue.

It is not possible to prevent all headaches. However, certain strategies can reduce a person’s risk of developing diseases that may trigger them. These include:

• Following a healthful lifestyle: Exercising regularly and eating a healthful and varied diet can lower the risk of stroke, aneurysm, and other life threatening medical conditions.
• Monitoring headaches: People should keep a diary that records when their headaches occur, as well as their duration and intensity. This will allow them to detect possible headache triggers.
• Managing anxiety and stress: Proper anxiety and stress management may help reduce headaches and other symptoms. People can try relaxation techniques, such as:
  • massage
  • exercise
  • meditation
  • talking therapy
• Managing underlying medical conditions: It is essential that people tend to any underlying medical issues to reduce the risk of serious complications.

Headaches, dizziness, fatigue, and neck pain can be a worrying combination. Various conditions can cause these symptoms, while some are more serious than others. Potentially life threatening triggers include aneurysms, stroke, and brain tumors.

As headaches can indicate serious health issues, people who experience severe, persistent, or worsening headaches should see a doctor for diagnosis and treatment.

Anyone who experiences symptoms of an aneurysm or stroke should seek emergency medical care immediately. Timely treatment can reduce the risk of serious complications, including death.

Neck pain with a headache: Symptoms, causes, and treatments

Various conditions, such as infections, stress, and illness, can cause neck pain and a headache. Although people can usually manage symptoms at home, they may need to contact a doctor in some cases.

People sometimes worry that a headache means they have cancer or another serious medical issue. Most headaches, though, are harmless and go away on their own.

Monitoring for other symptoms, such as fever, and tracking whether or not symptoms get worse can tell a person if they should seek medical attention.

Read more to learn about what causes neck pain and headache, how to treat the symptoms, and when to contact a doctor.

There are many different types of headaches. The most common are migraine, cluster, and tension.

Tension headache

A tension headache gradually gets worse with time, and neck pain can accompany it. Fatigue, stress, and muscle strain are often underlying causes of these headaches.

These headaches often lead to a dull, throbbing pain on both sides of the head. The pain might come and go.

Learn more about tension headaches here.

Cervicogenic headache

According to the American Migraine Association, a specific source of pain in the head or neck causes a cervicogenic headache. It leads to a dull, aching pain on one side of the head.

In addition to pain, a person may experience:

• a limited range of motion of their neck
• a headache that worsens as a result of specific movements
• increased headache pain due to pressure on the neck
• pain that typically occurs on one side of the head
• pain that starts in the back of the head or neck and travels behind the eyes

Learn more about cervicogenic headaches here.

Cluster headache

A cluster headache is a sudden, intense headache that can be debilitating. It usually begins near the eyes or temples and affects just one side of the head.

This headache can make a person have red eyes, a runny nose, and congestion.

Cluster headaches typically last less than 3 hours. They often begin with a prodromal phase, which is when a person may have changes in mood, personality, or sensations. Some people may also have neck stiffness.

Learn more about cluster headaches here.

COVID-19 headache

A COVID-19 infection can cause headaches in some people. According to a 2020 study, 11–34% of people receiving hospital treatment for COVID-19 reported experiencing a headache. People with a COVID-19 headache may also have a stiff neck as well as widespread muscle pain, aches, and stiffness.

A COVID-19 headache can happen for several reasons, including:

• muscle stiffness, especially in the neck and back
• a sinus headache from congestion
• inflammation
• damage to blood vessels
• changes in blood pressure

The virus can also lead to meningitis, which causes a stiff neck, headache, light sensitivity, and sometimes changes in thinking or personality.

Learn more about COVID-19 headaches here.

Migraine

Migraine is a type of neurological headache that can cause severe pain.

A 2020 study suggests that neck pain may be the most common migraine symptom, beginning at the same time as the headache.

The study, which included 50 participants, found that neck pain occurred alongside a migraine headache in about 90% of people. The remaining 10% experienced neck pain at other points during their migraine headache.

Learn more about migraine here.

Meningitis

Meningitis is swelling of the meninges, which are membranes that line the skull and spinal column. It happens when an infection attacks the meninges. Bacteria, viruses, fungi, and parasites can all cause meningitis.

People with meningitis often have a very bad headache and a stiff neck that makes it difficult to move the head. It can also cause other symptoms, including:

• fever
• confusion
• loss of consciousness
• dizziness
• nausea and vomiting
• sensitivity to light

Learn more about meningitis.

The treatment for a headache and neck pain depends on the type of headache a person has. The following are common treatments for different types of headaches.

Tension headache

Tension headaches often cause mild to moderate pain. In some instances, over-the-counter (OTC) medication, massage, or rest will relieve pain. If the pain is persistent or occurs frequently, a person may need additional treatment options.

Some prevention strategies include:

• eating regular meals
• managing stress
• getting regular rest
• exercising each day for at least 30 minutes
• avoiding triggers such as stress or lack of sleep
• drinking enough water
• keeping a headache log to identify triggers
• stretching to reduce neck and upper body tension

Learn about home remedies for headaches here.

Cervicogenic headache

Cervicogenic headaches are the result of an underlying condition in the neck, so treatments focus on the neck. People experiencing these headaches should contact a doctor.

Typical treatments for cervicogenic headaches can vary but may include:

• using nerve blocks
• taking pain medication
• having physical therapy

Migraine headache

Migraine treatments often involve improving a person’s symptoms and preventing future migraine.

Some treatment options include:

• using medications, such as pain relievers, triptan, or ergotamine drugs
• resting in a dark, quiet room
• drinking plenty of fluids
• applying a cool, damp cloth or ice pack on the forehead
• undergoing hormone therapy
• recording triggers and trying to avoid them
• managing stress

Learn more about tips for migraine relief here.

Many people do not need to contact a doctor for a headache and neck pain. Usually, taking OTC medications, such as ibuprofen or acetaminophen, or applying heat packs can adequately manage pain.

A person should contact a doctor if:

• the headache does not go away or gets worse
• OTC medications do not stop the pain
• the headache interferes with daily activities
• sexual activity, coughing, sneezing, exercise, or bending over trigger the headache
• they develop nausea or dizziness

A person should seek emergency medical treatment if they experience:

• vomiting that will not stop
• loss of vision
• pain lasting more than 72 hours
• the presence of unusual symptoms
• an intense “thunderclap” sensation in their head
• weakness or numbness of the face or arms
• slurred speech
• stiff neck and fever

Neck pain and headaches are often connected. Several types of headaches, including tension and migraine headaches, may correlate with neck and other pain.

People should contact a doctor if they are not sure what is causing their headache and neck pain, treatments are not working, or they experience other worrying symptoms.

What diseases can cause a headache?

Vostretsova Yulia Vladimirovna, an anesthesiologist-resuscitator, specialist in pain treatment of the department for the treatment of patients with chronic pain syndromes of City Clinical Hospital No. 52.

Secondary headache is a symptom of some underlying disease.
With secondary headaches, the main task is to treat the underlying disease, since if it is successful, this also has a positive effect on the symptom of headache – it either stops completely or at least greatly decreases.

Headache associated with brain tumors

Contrary to popular belief, headache is not a common symptom of a brain tumor. Only 30% of patients with a diagnosed tumor complain of headache at the initial appointment, and only 1-2% of patients have headache as the only symptom of the tumor.

This pain is often accompanied by other neurological symptoms, aggravated by exertion or changes in body position, and causes nocturnal awakenings. However, such symptoms can also occur with primary headaches, such as cluster headache and migraine, which we discussed in the previous article.

Vomiting a week before the onset of headache may be a sign of a posterior fossa mass, as can pain from coughing, lifting heavy objects, or bending over. The appearance of discharge from the nipples or amenorrhea in itself should alert the doctor and the patient, and in combination with a headache should suggest such diseases as polycystic ovary syndrome or prolactin-secreting pituitary adenoma. In patients with an already confirmed oncological diagnosis, a new headache requires the exclusion of brain metastases or carcinomatous meningitis.

Headache associated with vascular disease

Subarachnoid haemorrhage – “the most terrible pain imaginable”, a thunderous headache. Accompanied by stiff neck muscles at normal body temperature. Approximately 25% of all thunderclap headache cases are associated with subarachnoid bleeding. However, in 50% of patients with hemorrhages, the headache may be milder. The main features of headache associated with subarachnoid hemorrhage are localization in the occipital region, a piercing character, an ultra-rapid increase in pain intensity, and meningeal signs.

Isolated headache may be a symptom of a ruptured aneurysm, arteriovenous malformation, or intracerebral hemorrhage. Aneurysm of the posterior communicating artery can be manifested by double vision, absence or decrease in the reaction of the icon to light, loss of focus, divergent strabismus, anterior communicating artery – weakness of both lower extremities, middle cerebral artery – weakness in the limbs on one side. A sharp increase in intracranial pressure in the posterior cranial fossa can lead to limited eyeball mobility, strabismus, double vision, nystagmus, dizziness, and loss of balance. In the presence of the above symptoms and suspicion of subarachnoid hemorrhage, CT without contrast and lumbar puncture are performed, if necessary, MR or CT angiography.

Arterial dissection

Headache occurs in most cases of dissections (dissections) of the carotid artery – it is unilateral and intense, often accompanied by pain in the face and neck on the same side, the occurrence of Horner’s syndrome (drooping of the eyelid, pupillary constriction, exophthalmos).

Stroke

In ischemic stroke, headache occurs in only 27% of cases. The diagnosis is made on the basis of clinical symptoms, which vary depending on the location of the stroke. It must be borne in mind that migraine with aura increases the risk of stroke.

Thrombosis of the venous sinus

This is a rather rare pathology in which headache is present in 90% of cases. Other symptoms are altered consciousness and papilledema. Risk factors include female gender, pregnancy and the postpartum period, as well as taking estrogen-containing hormonal contraceptives.

Reversible cerebral vasoconstriction syndrome

Characterized by recurrent attacks of very high intensity headache with sudden onset and rapid peaking (thunder headache). Angiography visualizes vasoconstriction (narrowing) of the arteries of the brain, which resolves within the next 3 months. The cause of this pathology is not fully understood, however, it is known that certain substances, such as marijuana, tacrolimus, cyclophosphamide, as well as some drugs from the group of antidepressants, can be triggers. The incidence is also higher in the postpartum period. Headache is usually bilateral with attacks lasting 1 to 3 hours recurring over several weeks. Approximately 40% of patients experience nausea, vomiting, and neurological deficits. This condition is transient and requires symptomatic treatment.

Arterial hypertension

More often develops with an increase in systolic pressure up to 180 mm Hg. Art. or diastolic up to 120 mm Hg. Art. This type of headache usually worsens with increasing pressure and decreases with decreasing pressure. The pain is usually bilateral or diffuse, may be throbbing and worse with physical activity.

Headache due to heart disease

It is known that myocardial ischemia may also be accompanied by headache. A characteristic feature of such pain is its reduction against the background of resolution of ischemia (with the introduction of nitroglycerin, etc.).

Headache associated with systemic diseases

Giant cell arteritis

Headache, which first appeared in a patient after 50 years of age and is accompanied by a weakening of the temporal artery pulsation, should suggest giant cell arteritis.

This is a systemic vascular disease with a predominant lesion of the extracranial arteries of medium and large caliber. The disease begins acutely or subacutely with general weakness, subfebrile temperature, night sweats, insomnia, nausea, loss of appetite, weight loss, pain in muscles and joints. Headache is the most characteristic symptom of temporal arteritis. It is localized more often in the temporal region, sometimes in the frontal and parietal regions of the head, less often in the occipital region (in case of involvement of the occipital artery).

The spread of the process to the arteries of the face is accompanied by the appearance of acute spontaneous facial pains or a kind of “intermittent claudication” syndrome, that is, pain in the masticatory muscles and tongue when eating and talking. This symptom is pathognomonic for temporal arteritis. Many patients develop visual impairment that can lead to complete blindness. The cause of blindness is either ischemic damage to the optic nerve with damage to the ophthalmic and posterior ciliary arteries, or blockage of the central retinal artery. Laboratory revealed an increase in CRP and ESR. This diagnosis can be accurately confirmed only after a biopsy of the temporal muscle.

Tholos-Hunt Syndrome

The syndrome is characterized by intense unilateral headache, accompanied by impaired movement of the eyeball, attacks occur every few months or even years. Most often, people over 40 years of age are affected. The pathogenesis is associated with non-specific inflammation in the cavernous sinus of the superior palpebral fissure or orbital cavity. Violation or complete absence of movement of the eyeball occurs as a result of granulomatous inflammation of the cranial nerves. The main clinical manifestations are acute unilateral pain in the eye area, the appearance of double vision.

Headache associated with infection

It is not worth dwelling on this point in detail, since so many infectious diseases can be accompanied by headache. With a very high intensity headache accompanied by neck stiffness and other meningeal symptoms, it is important to perform the necessary examinations in time and start treatment.

Post-traumatic headache

Headache occurs in 70-90% of head injuries. It can be considered post-traumatic if it occurs within 7 days after the injury or 7 days after the recovery of consciousness and the withdrawal of painkillers. The pain phenotype can be variable, often migraine or tension-type headache, and may be accompanied by nausea, dizziness, cognitive impairment, anxiety, and insomnia.

Pain after craniotomy

This pain also occurs within 7 days after surgery and usually regresses over the next 3 months. In some cases, headache can become chronic. As risk factors for chronicity, the patient has a history of primary headaches, as well as surgical interventions in the suboccipital region.

Headache associated with diseases of the eyes, nose, ear, sinuses and other craniofacial structures

Acute angle-closure glaucoma

Angle-closure glaucoma is a form of pathology in which fluid accumulates inside the eye due to lack of access to the drainage system (the iris covers the anterior chamber angle). The result is an increase in intraocular pressure, which can lead to an acute pain attack. An attack of angle-closure glaucoma can be similar to migraine, as it is a unilateral pain in the eye area, accompanied by nausea/vomiting, photophobia, visual disturbances in the form of blurred visual images and iridescent halos around the light spot. When examined during an attack, redness of the conjunctiva and a moderately dilated pupil are noted. Between attacks, the appearance of the eyeball and intraocular pressure are usually normal. Seizure triggers are often: a sudden change in lighting, prolonged reading, as well as certain drugs, such as tricyclic antidepressants, topiramate, acetazolamide, etc. An ophthalmologist will help establish the diagnosis.

Trochleitis

Trochleitis is an inflammation of the oblique muscle of the eye. The pain most often occurs in the inner corner or above the eyeball and can spread to the entire half of the head. The pain increases with eye movement, the paraorbital region is painful on palpation. Lachrymation and nasal discharge are usually absent. Some patients may experience diplopia. The cause of trochleitis is often unknown (idiopathic trochleitis), but most commonly occurs in patients with rheumatic diseases such as systemic lupus erythematosus, rheumatoid arthritis, enteropathic arthropathy, and psoriasis.

Rhinosinusitis

The symptoms of rhinosinusitis are familiar to many. Rhinosinusitis can be both an independent cause of headache, and can exacerbate the primary headache. The diagnosis is made on the basis of X-ray diagnostics by an ENT doctor. Usually this pain is preceded by an infectious disease with rhinorrhea and nasal congestion.

Headache associated with pathology of the temporomandibular joint

Joint dysfunction can be caused by trauma, joint asymmetry, disc displacement, joint hypermobility, osteoarthritis. The headache associated with this pathology usually corresponds to the side of the affected joint, but may be bilateral if the muscles are involved in the pathological process. Pain occurs in the projection of the joint and the periarticular region and has the character of a pulling, aching, pulsating or acute pain that can radiate to the ear, temporal or parietal region. Pain can also occur at rest, but is often provoked by chewing or simply by movement in the temporomandibular joint.

Ask for help!

Headache must not be ignored! A specialist in the pain treatment clinic is called upon to deal with the probable causes of its appearance. After a detailed neurological examination, an additional examination may be prescribed to clarify the underlying disease, the symptom of which is pain in the head. Our pain treatment clinic uses a variety of treatment methods – which one can help a particular patient, the doctor will decide at an in-person consultation.

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Headache – causes, examination and treatment | Symptoms

Cluster headache
Signs: Severe, piercing pain that affects one part of the head and is concentrated in the periocular region, usually lasts from 30 minutes to 1 hour, often occurs at the same time of day, occurs in clusters and is separated by intervals with no headache at all, is usually not aggravated by exposure to light, sounds or smells and is not accompanied by vomiting. Inability to lie down and restlessness. On the part of the manifestation of pain: runny nose, lacrimation, drooping eyelid (Bernard-Horner syndrome) and sometimes swelling under the eye.

Migraine headache
Signs: Moderate to severe headache, usually throbbing, unilateral and bilateral, lasting hours to days, may be caused by lack of sleep, head trauma, hunger, or consumption of certain wines and foods, may be aggravated by physical activity and relieved by sleep, often accompanied by nausea, vomiting, and sensitivity to loud noises, bright lights, and/or smells, including possible mood changes, loss of appetite, and nausea, sometimes preceded temporary disturbances in sensation, balance, muscle coordination, speech or vision (seeing flashes or blind spots).

Tension headache
Signs: Usually mild to moderate headache that feels like a hoop on the head and starts in the front of the head or around the eyes, affects the entire head, lasts for 30 minutes to several days, may worsen at the end of the day, is not aggravated by exercise, light, sounds or smells, is not accompanied by nausea, vomiting or other symptoms.

Altitude sickness
Signs: Dizziness, loss of appetite, nausea and vomiting, fatigue, weakness, irritability, or trouble sleeping. People who have recently climbed to high altitudes (including those who have been in an airplane for 6 hours or longer).

Brain tumor, abscess or other neoplasm in the brain
Signs: Mild to severe headache that may get progressively worse, usually comes on more frequently and eventually becomes constant without signs of relief, may cause blurred vision with a sudden change in body position, may be accompanied by clumsiness, weakness, disorientation, nausea, vomiting, seizures, or blurred vision.

Carbon monoxide exposure
Signs: Possible unawareness of exposure as carbon monoxide is colorless and odorless.

Dental infection (upper teeth)
Signs: Pain, which is usually felt in the facial region and is mainly one-sided, aggravated by chewing, toothache.

Encephalitis (brain infection)
Signs: Headaches with variable characteristics. Often accompanied by fever, increased drowsiness, confusion, agitation, weakness and/or poor coordination. Convulsive seizures and coma.

Giant cell (temporal) arteritis
Signs: Unilateral throbbing pain in the temporal part of the head. Pain when combing hair or while chewing. Sometimes enlarged arteries in the temples (temporal arteries) and aching and dull pain, especially in the shoulders, hips, and pelvis. Vision may be impaired or lost, and is more common in people over the age of 55.

Glaucoma (angle-closure glaucoma)
Signs: Moderate to severe pain that occurs in the front of the head or in the ocular or supraocular region. Redness of the eyes, iridescent circles around light sources, nausea, vomiting, and loss of vision.

Head injury (post-concussion syndrome)
Signs: Headache begins immediately or shortly after a head injury (with or without loss of consciousness). Sometimes memory lapses, personality changes, or both.

Idiopathic intracranial hypertension (increased intracranial pressure)
Signs: Headaches that occur daily or almost daily with fluctuating intensity, affecting both sides of the head, sometimes double vision or blurred vision, nausea, or ringing in the ears in rhythm with the beats of the pulse (throbbing tinnitus).

Cerebral hemorrhage
Signs: Mild or severe pain that starts suddenly, occurs on one or both sides of the head, is often accompanied by nausea and sometimes vomiting. Possible severe drowsiness, clumsiness, weakness, difficulty speaking and understanding speech, loss of vision, loss of sensation or disorientation, occasionally seizures or coma.

Headache associated with low blood pressure (due to removal or leakage of cerebrospinal fluid)
Signs: Intense headaches, often accompanied by neck stiffness and nausea. Pain that gets worse when the person is sitting or standing and gets better when the person lies down. It usually occurs after a spinal tap (lumbar puncture) is performed.

Medicine overuse headache
Signs: Chronic and often daily headaches. Often with migraine or tension headaches

Meningitis
Signs: Severe, persistent headache. fever, stiff neck, in connection with which it is painful to lower the chin to the chest, sometimes it is impossible. Malaise, drowsiness, nausea or vomiting.

Sinusitis
Signs: Pain, which is sometimes felt in the face, front of the head, or like a toothache, may start suddenly and last for days or hours, or start gradually and become persistent. Runny nose, sometimes with pus or blood, malaise, cough at night, and often fever.

Subarachnoid hemorrhage (bleeding between the inner and middle layers of tissue covering the brain)
Symptoms: Severe, persistent pain that starts suddenly and reaches its maximum intensity within a few seconds is often described as the worst headache ever experienced.