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Signs of an “Emergency Headache”

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This month the National Neurosciences Advisory Group in the UK published a paper of recommendations for headache and facial pain diagnosis and treatment. Part of the purpose of the document was to help doctors recognize emergency situations.

ambulance

Today we’ll take a look at that part of the paper as a reminder of certain signs to look for if you are someone you love is experiencing new or changed symptoms. This is just a summary, you can view the full paper below.

New Headache

New or changed symptoms are always a reason to get to a doctor as soon as possible. But there are certain symptoms that could especially be signs of an emergency:

  • A new headache late in your pregnancy, or soon after the birth of your baby.
  • You’re over 50 years old – your doctor may want to test for inflammation (ESR test)
  • Neurological symptoms such as problems speaking, hearing, or seeing, or even feeling (numbness, pins and needles…). If these symptoms are getting worse, that’s another urgent sign.
  • Seizures
  • Unusual changes in personality or trouble thinking. “Unusual” because we’re assuming this is not a known mental or physical illness. This is something that needs to be noticed by someone else.

Other New Facial Pain

  • Jaw pain in patients taking bisphosphonates (a group of medications designed to increase bone density)
  • New pain in your temple, especially if you’re over 50

Other Headaches/Facial Pain

  • Any headache with a change in consciousness, drowsiness, or fainting
  • Thunderclap headache (headaches that appear suddenly and are at “full power” in 60 seconds or less)
  • Headache or facial pain with other symptoms such as fever, vomiting, visual problems, etc.
  • Headache or facial pain when you already have related medical problems or a history of them
  • Red eyes with headache (especially in seniors)
  • Trigeminal Neuralgia – sudden severe facial pain (like an electric shock)
  • Facial pain with a nosebleed, thick coloured nasal discharge, continuous change in your sense of smell, hearing loss on the same side as the pain

This might sound confusing, but it really can be summarized for the most part in new or changed headache, facial pain, or accompanying symptoms.

But whereas some mild changes or progressions might mean booking an appointment, when the symptoms are sudden and show signs of neurological problems and serious illness, going to emergency right away is important. There are also symptoms that may be ongoing that should be watched carefully and continuously.

These symptoms are also an important reminder to be aware of your friends and family. You may notice certain things before they do, and you can help them get the treatment they need.

Headaches are common, but they’re not “normal”. And at times they can be an important warning that immediate treatment is needed. Don’t ignore them.

To read the full report, go to Optimal clinical pathway for adults with headache and facial pain and download the pdf version.

More on “Midface Migraine” – and Tooth Aches.

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“Midface migraine” is not a type of migraine, but a description of a migraine attack with pain in the face. It’s not unusual for patients to experience pain in various areas at various times.

Pain in the face could be a sign of a related condition, but on the other hand, it could lead to misdiagnosis. Recently we talked about the too common misdiagnosis of sinusitis.Toothache and Migraine

But a case study pointed out that two conditions can affect each other. In this case (actually two cases), it was dental issues (see: Midface migraine with concomitant dental disease: A report of two cases.)

Now, the report does point out that migraine is actually sometimes misdiagnosed as a dental issue, such as a tooth infection. But these cases there was an actual dental issue.

Both patients had midface migraine-type pain and symptoms. The first patient found that the tooth pain and migraine pain were lessened by a root canal, and then went on to find more relief with sumatriptan (a common migraine abortive).

The second patient tried sumatriptan first, and it didn’t help much. However, a root canal provided significant relief.

If you’re experiencing facial pain, or tooth pain, that is accompanied by migraine symptoms, it may be wise to see a dentist. And if you’re a dentist, remember that migraine and tooth decay or infection may actually go together. A careful diagnosis can help alleviate pain and additional symptoms.

New Insights Into Trigeminal Neuralgia

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Researchers in Denmark are providing new insights into the painful condition known as trigeminal neuralgia (TN).

Have you ever had a stabbing pain on one side of your face – almost like an electric shock? Maybe it just happens, or maybe it seems to come when you’re brushing your teeth, or even putting on makeup.

Trigeminal neuralgia is not a common disease, and so it hasn’t been studied nearly as much as many other pain disorders. But this study of 158 patients gives us a clearer picture.

  1. TN seems to strike later in life than conditions like migraine. The average age when symptoms appeared was about 53 years.
  2. Although both men and women get TN, it is somewhat more likely to affect women.
  3. Almost 50% of patients had persistent pain in addition to the stabbing pain. Sometime TN with persistent pain has been called “atypical”, but it doesn’t seem to be as atypical as some think (the more proper name, by the way, is classical trigeminal neuralgia with concomitant persistent facial pain. Has a ring to it, wouldn’t you say?).
  4. The pain is more often on the right side.
  5. A little less than a third had “autonomic symptoms”, such as dizziness, and a little less than a third had “sensory abnormalities”, even if they hadn’t had surgery.

Researchers also investigated the nerve that TN affects. TN can affect different branches of the trigeminal nerve in the face. They discovered that the first branch alone was rarely the problem. Usually the culprits were the second and/or third branches.

TN is usually treated with medications such as anticonvulsants and muscle relaxants. Botox has also been used successfully for TN, and in much smaller doses than are used for migraine.

In rare cases, surgery is recommended. However, surgery is not always a guarantee that the pain is gone for good.

A clinical trial is beginning in the USA also, in Philadelphia, to investigate the use of Botox for TN. If you would like to be a part of the study, you can find more information by clicking the last link below.

For more information:

Pain During Migraine: Not Just in Your Head

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Our latest poll asked this question:  Other than your head, where else do you sometimes/always experience pain during a migraine attack? (choose as many as apply)

The results were not surprising, but they do reinforce what a complex disease migraine really is.  Here are the stats, with some comments.

During I migraine attack, I also have pain here:

  • Neck (83%):  The question with all of these is – does the pain come from the migraine attack, or is there a related cause.  Or, for example, does the cause of neck pain also trigger the migraine attack?  There’s no doubt that neck pain (and neck stiffness) come along with migraine.  For more on neck pain, read Methods that are Really Fighting Neck Pain and Get rid of neck pain!
  • Face (60%):  Facial pain is very common in migraineurs.  In fact, in rare cases facial pain is the main pain in a migraine attack.  Sometimes, migraine is mistaken for sinusitis because of the pain in the sinus area.  See Migraine: Does your face hurt?
  • Stomach (37%):  Another very common issue in migraine, and again, stomach pain (abdominal pain) may be the main symptom in your attack.  This is especially common in children.  Read about abdominal migraine here.
  • Back (32%):  Back pain is another prime suspect when it comes to migraine triggers.  Could pain and tense muscles trigger (not cause) an attack?  Also, could your body’s reaction to migraine pain cause back pain?  I think the answer to both could be yes.  Read Dissolving tension.
  • Arms (22%):  This was an interesting response that I hadn’t given much thought to.  But I do know that migraine can cause pain from head to toe – been there, done that.  But why is arms so high on the list?  What are your experiences with this?
  • Skin (19%):  Sensitive and painful skin is very common in migraine.  The technical term is cutaneous allodynia, and it commonly strikes on the scalp and arms.  Combing your hair or wearing a shirt can be very painful.  Read My Hair Hurts! Migraine and Allodynia
  • Other (16%):  As I said, head to toe.  And I could say inside to outside.

These were the most common answers.  However, visitors also included hands (14%), legs (12%), chest (12%), fingers/toes (12%), feet (8%), and finally pelvis (6%).

I’ve taken to saying that migraine attacks can cause pain all over the body – and they really can.  It’s time to bust the myth that migraine is a bad headache.  Oh yes, migraine often brings on bad headaches – really bad – but that’s not all.

Pain

Be sure to take our new poll on migraine triggers!

Migraine: Does your face hurt?

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Facial pain in migraine

A small study published in June suggested that almost 9% of migraineurs have facial pain during an attack.  Now this is of course another of those chicken-and-egg questions, because some of those patients likely have jaw issues that are triggering migraine attacks.  But others simply have migraine attacks that cause the facial pain.  Read about the study from Germany, Prevalence of facial pain in migraine: a population-based study.

In fact, in rare cases, there is something rare called isolated facial migraine, where the pain in the face is the main feature of the migraine.

Sometimes treatment for the jaw is needed, such as an NTI-tss device.  In other cases, when the pain is coming from the migraine attack, simply treating migraine as a whole will solve the facial pain issue as well.

What about you?  Do you have facial pain during an attack?  What’s it like?

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The articles on Headache and Migraine News are © 2004-2024 J. Cottrill.
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