Increased Headache Frequency: When to Seek Medical Advice

Increased frequency of headaches?

Hello Doctor: I have experienced headaches since childhood, especially during stressful times.
In the fourth grade, I underwent an EEG due to frequent headaches, which showed no abnormalities.
Recently, the frequency of my headaches has increased.
The pain is mostly not very intense; it feels like a dull ache, and actions such as sneezing or suddenly standing up can exacerbate the pain.
Additionally, during vigorous activities, I experience a pulsating pain in my head.
The pain is usually located at the top of my head, the back of my skull, and my neck, with the location of the pain varying each time and even changing during the same episode.
Mild headaches can resolve on their own after sleeping, but for more intense pain, I need to take acetaminophen, which starts to take effect in about 30 minutes.
For the past few days, I have been waking up with a headache that tends to peak in intensity by the afternoon.
Sometimes, the headache is accompanied by very mild dizziness, making me feel like I am swaying.
Additionally, I occasionally see flashes and spots in my vision, and sometimes it feels like a light is flickering, along with a recent sensation of slower focusing in my eyes.
Could these symptoms indicate a serious brain condition? Also, could my tendency to be anxious contribute to these issues? I am considering visiting a large hospital but am unsure how to effectively communicate my symptoms to the doctor, as I have read that headache diagnoses often rely on patient history.

Ma Li, 20~29 year old female. Ask Date: 2020/02/13

Dr. Jiang Junyi reply Neurology

Based on your description, the most common cause is tension-type headache.
The symptoms of tension-type headache include: (1) Typically bilateral, located in the occipital and parietal regions, sometimes with a widespread area of pain.
The nature of the pain is dull, aching, with a sensation of pressure or tightness, and it is non-pulsating.
There may be tightness and stiffness in the occipital and cervical regions, which is more pronounced when turning the neck, with intensity ranging from mild to moderate.
(2) There are tender points in the muscles at the site of pain, and sometimes pulling the scalp can also elicit pain.
The muscles may feel stiff, and one or more nodules, referred to as myofascial trigger points, may be palpable.
(3) It does not interfere with daily activities; for example, walking or climbing stairs does not exacerbate the headache.
(4) Fatigue, tension, excitement, anxiety, insomnia, or depression can worsen the headache.
Pain may be triggered by flexion and extension of the head.
However, you mentioned recently experiencing a slower focus in your eyes.
Could the above symptoms indicate a serious brain condition? It is advisable to consult a neurologist for examination and follow-up if symptoms worsen or if there are localized neurological symptoms.
Typically, the physician will conduct imaging studies.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Medical Center cares about you.

Reply Date: 2020/02/13

More Info

Increased headache frequency can be a concerning symptom, especially when accompanied by other neurological signs. Based on your description, it seems that you have a history of headaches that have recently intensified, which is a significant change in your pattern. The characteristics of your headaches—such as the location, intensity, and associated symptoms like dizziness and visual disturbances—are crucial for understanding the underlying cause.

From what you've shared, your headaches appear to have a few notable features. They are not always severe but can become more pronounced with certain movements, such as sneezing or standing up quickly. This could suggest a tension-type headache or possibly a migraine, especially since you mentioned a pulsing sensation during physical activity. The variability in pain location and the fact that you experience some relief after sleeping are also important indicators.

The presence of visual disturbances, such as flashes of light or spots, could indicate a migraine with aura, which is a type of migraine that includes sensory disturbances before the headache begins. Additionally, the feeling of dizziness and the sensation of your eyes having difficulty focusing could be related to the headaches or may indicate other issues that warrant further investigation.

Given your history of anxiety, it is also worth noting that anxiety can exacerbate headache symptoms. Stress and anxiety are known triggers for tension-type headaches and can also contribute to the frequency and severity of migraines. Therefore, managing stress through relaxation techniques, cognitive behavioral therapy, or other methods may help alleviate some of your symptoms.

When considering whether to seek medical advice, it is essential to look for specific "red flags" that may indicate a more serious condition. These include:
1. Sudden onset of a severe headache: Often described as a "thunderclap" headache, which could indicate a serious condition like a subarachnoid hemorrhage.

2. Neurological symptoms: Such as weakness, numbness, difficulty speaking, or changes in vision that are new or worsening.

3. Headaches that worsen over time: If your headaches are progressively getting worse or changing in character.

4. Headaches that disrupt your daily life: If they are affecting your ability to work, sleep, or perform daily activities.

5. Accompanying symptoms: Such as fever, stiff neck, or rash, which could indicate an infection or other systemic issue.

If you experience any of these symptoms, it is advisable to seek medical attention promptly.
When you visit a healthcare provider, it is helpful to provide a detailed account of your symptoms. Here are some tips on how to communicate effectively:
- Describe the headache: Include details about the intensity (mild, moderate, severe), duration, and frequency. Mention any patterns you’ve noticed, such as when they occur (e.g., upon waking, after stress).

- List associated symptoms: Note any other symptoms that accompany your headaches, such as dizziness, visual disturbances, or nausea.

- Discuss triggers: Mention any known triggers, such as stress, lack of sleep, or specific activities.

- Share your medical history: Include any previous diagnoses, treatments, and how they have worked for you.

In conclusion, while your symptoms may suggest a common type of headache, the recent increase in frequency and the presence of additional symptoms warrant a thorough evaluation by a healthcare professional. A neurologist can perform a comprehensive assessment, which may include imaging studies if necessary, to rule out any serious underlying conditions. Taking proactive steps to manage stress and maintain a healthy lifestyle can also contribute to reducing headache frequency and severity.

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