Headache is the commonest symptom in the world. Only 4% of people will never have a headache during their life. Fortunately most headaches are not caused by sinister disease. As a general rule, the worse the headache, the less likely that there is an underlying brain tumour which is the commonest worry of any person who has regular headaches.


Different terms are used for headache including pain in the head, migraine (which is an actual diagnosis), a pressure in the head and occasionally other complaints such as burning, stinging or crawling feelings.



The Timing of the Headache

The neurologist will always want to know when the headache comes and how long it lasts. It is worth writing this down in a diary to present to the doctor.



The Site of the Headache

The part of the head involved may also be very important. The pain may involve the whole head. It may just affect one side of the head and/or face. It may be localised perhaps around the jaw joint or ear or more frequently at the back of the head extending down into the neck. An important site of pain is around the eye. This may be in the eye, around the eye or behind the eye. It is very helpful to write down in your headache diary where you feel the pain.



What makes the pain worse?

It is useful to record if anything makes the pain worse, such as stress or alcohol. Likewise maybe bending, coughing, straining or sneezing makes the pain increase.



Worrying Features

There are a number of what I call "red flags". These are as follows:

  1. Headache for the first time over the age of fifty

  2. Instant onset of severe headache (I mean instant)

  3. Change in the pattern of well established headache

  4. Headache always only on one side

  5. Headache associated with fever, neck stiffness, with or without rash

  6. Headache that wakes during the night or present only first thing in the morning with vomiting

  7. Headache with tender scalp over the age of fifty

  8. Headache with uncontrolled vomiting with or without drowsiness


Each of these situations requires urgent medical attention and referral to a neurologist.



Associated Features

Headache may be associated with other features such as:


  1. Vomiting

  2. The light hurting the eyes (photophobia)

  3. Sound hurting the eyes (phonophobia)

  4. Dislike of smells (osmophobia)

  5. The need to lie down

  6. Loss of appetite

  7. An eye or eyes watering
  8. The eye going red on one side
  9. The nose blocking on one side


Characteristic of the Pain

The pain may either be constant or intermittent. It is useful for the doctor to know if the pain is a) throbbing or pulsing, b) a constant pressure feeling, c) sharp and jabbing.