Chronic headaches and migraines: What can you do and when should you worry

KUALA LUMPUR - Tension headaches and migraines can turn into chronic headaches with studies showing that two per cent of patients with migraine turned to having chronic migraine each year.

Sunway Medical Centre Velocity (SMCV) Consultant Neurologist and Internal Medicine Physician Dr Kok Chin Yong said tension headaches are the most prevalent in Malaysia (26.5 per cent), followed by migraines (9.0 per cent) and a range of other types of headaches (28.2 per cent).

The community study on headache in Malaysia was based on International Headache Society (IHS) diagnostic criteria, from Headache: the Journal of Head and Face Pain.

According to Dr Kok, chronic headaches are defined as headaches that last 15 days or more in a month, for more than three months and it should not be taken lightly.

"While it (chronic headaches) may not always be a marker of something serious, one should seek medical attention if the headache is accompanied by other symptoms such as numbness, weakness, difficulty speaking and walking, visual disturbance, fever and loss of weight,” he said in a statement.

Dr Kok shares that most patients have episodic headaches that come and go, with some needing little to no painkillers to manage the pain.

He said half of patients with chronic headaches also suffer from what is called a medication overuse headache (MOH), which is largely underdiagnosed but can be treated by managing the usage of painkillers to reduce its severity.

He added that migraines can be debilitating by affecting one’s life and work, while it can worsen with physical activity, affecting focus and concentration that in return reduces one’s efficiency at their workplace.

"Episodic migraines can be prevented from turning into chronic migraines by taking good preventative medications and making lifestyle changes. These lifestyle changes include regular exercise, managing stress levels and getting proper hours of sleep,” said Dr Kok.

According to him, non-drug strategies are crucial as it can worsen and trigger migraines. One needs at least seven hours of good quality sleep - do not consume alcohol in order to sleep or take caffeine later than 3pm as it affects your sleep quality.

"High screen time can also trigger migraines especially in young adults, and these patients are sensitive to lights and flickering sound, which can also worsen the migraines,” he said.

Dr Kok said the key to prevent migraines is regularity. Patients with migraines need to have a regular eating and sleeping time because a lack of it can trigger migraine attacks.

He said if someone has high frequency of migraine attacks, one has to be aware that there are good and effective preventative medications to reduce the burden as some come in the form of pills and injections.

"The latter is very easily administered and can reduce the frequency and severity of migraine attacks,” according to Dr Kok.

Meanwhile, SMCV Consultant Neurosurgeon Dr Gerard Arvind Martin said patients with gradually or worsening headaches can occasionally be diagnosed with life-threatening neurosurgical conditions, and if left untreated, could be fatal.

He said that some headaches can be signs of anomalies such as tumours, which can then result in a headache that may involve the entire head or part of it, and it is especially true for those whose headaches are caused by tumours or vascular conditions such as aneurysms.

Dr Gerard said a tumour may announce itself by affecting that specific area it is pressing against or developing in, therefore causing those symptoms related to that part of the brain.

"A growing tumour may grow, either quickly or slowly over time, and push aside the brain, causing the brain to react to tumour tissue and brain swelling occurs, and headache ensues,” he said.

Aside from these headaches, Dr Gerard said patients should also look out for other affected neurological functions such as impairment of decision making, thinking and memory.

The presence of a seizure, either before, during or after the onset of headaches can also be an accompanying feature to brain tumours, he added.

"When a patient comes to a hospital with some or all of these symptoms, a preliminary CT (computed tomography) scan is done, with an MRI (magnetic resonance imaging) in due course depending on the initial CT finding and proposed treatment route,” he said.

However, Dr Gerard reassures patients that not all headaches are an indication of a serious neurological condition, and that they should rule out other causes first.

"While it is alarming yet almost natural to think that all bad headaches are always caused by something sinister occurring within ones’ head, the truth is that headaches can also be caused by other parts of the head such as the eyes, ears, neck, the sinuses or even teeth. Therefore, it is also a good practice to rule out anything occurring in these areas as well during the initial consultation.

"Those who act upon their symptoms in a timely manner and get themselves treated are able to mitigate their conditions and depending on the diagnosis, able to continue to lead fuller lives,” he concludes. - BERNAMA