Two Types of Headaches: When to See a Neurologist

Two types of headaches?

Hello, doctor.
I have a few questions regarding headaches.
A friend of mine often experiences pain on both sides of the temples when he doesn't get enough sleep and feels fatigued.
He finds relief through massage and sometimes uses essential oils.
Additionally, he experiences dizziness once or twice a year, accompanied by severe vomiting.
The symptoms come on quickly, and he usually goes to the emergency room, where the doctor (who has not encountered a neurology resident) administers anti-nausea medication, and after one or two hours of IV treatment, the symptoms disappear, allowing him to go home.
Recently, I heard that he could seek a diagnosis from a neurologist, and I would like to ask you what kind of issue this might be.
If he visits a doctor when the symptoms are not present, how should he proceed?
Personally, I often feel symptoms similar to a cold, especially when exposed to cold air.
I experience discomfort in the upper eye socket and nasal bridge, and sometimes I have a dull ache in the forehead and back of the head.
When it gets worse, I feel a more pronounced headache, which resembles the pain I experience during a cold or fever, and it is usually accompanied by nasal congestion and a bit of runny nose.
Therefore, I have always consulted an ENT specialist.
Typically, when I have a cold, if the doctor prescribes some medication and I use a nasal spray, it usually alleviates the symptoms.
I never considered seeing a neurologist.
However, recently, I have been feeling discomfort in my nasal and head areas, similar to the onset of a cold, but without a fever.
I have nasal congestion and a bit of runny nose, but I don't have much sneezing or coughing, yet the headache is quite noticeable.
After a thorough examination by an ENT doctor, he stated that there were no obvious symptoms, but the middle turbinate was slightly enlarged.
He believes the pain is not caused by nasal issues and suggested I consult your department.
I would like to ask you, as I personally feel that I am not under much stress, could this pain be caused by emotional stress? I usually notice that the pain occurs when I am exposed to cold air or experience significant temperature changes, which feels like the onset of a cold (mostly a dull pain, with visual disturbances and discomfort in the nasal bridge and eye sockets).
What could be the underlying issue?

Niming, 40~49 year old female. Ask Date: 2015/04/25

Dr. Gao Chunde reply Neurology

The first type of headache, characterized by symptoms and related descriptions, tends to be tension-type headache, which is caused by muscle contraction.
It can be alleviated through massage, relaxation techniques, and rest.
However, it may not necessarily be related to episodes of dizziness.
The second type is a more severe vascular headache, commonly known as migraine.
In severe cases, it can present with pulsating pain, nausea, vomiting, and sensitivity to light and sound, with physical activity exacerbating the symptoms.
If these episodes occur frequently, it is advisable to use analgesics and seek a detailed evaluation from a neurologist.

Reply Date: 2015/04/25

More Info

Understanding headaches can be quite complex, especially when distinguishing between different types and their underlying causes. Based on the symptoms you've described, it seems that your friend is experiencing tension-type headaches, which are often triggered by stress, lack of sleep, or physical strain. These headaches typically manifest as a dull, aching pain on both sides of the head, often described as a feeling of tightness or pressure around the forehead or temples. The fact that your friend finds relief through massage or the application of essential oils suggests that these headaches may be related to muscle tension or stress.

On the other hand, the episodes of dizziness and severe vomiting that occur once or twice a year could indicate a different issue, potentially related to migraine or vestibular disorders. Migraines can sometimes present with nausea and vomiting, and they may be accompanied by dizziness or vertigo. The rapid onset of these symptoms, along with the need for emergency care, suggests that these episodes are significant and warrant further investigation.

When it comes to seeking help from a neurologist, it is essential to consider the frequency and severity of the headaches and associated symptoms. If your friend experiences headaches that disrupt daily activities, are accompanied by neurological symptoms (such as visual disturbances, weakness, or numbness), or if the pattern of headaches changes, it is advisable to consult a neurologist. They can conduct a thorough evaluation, which may include a detailed medical history, physical examination, and possibly imaging studies like an MRI or CT scan to rule out any serious underlying conditions.

Regarding your own symptoms, the combination of facial pain, nasal congestion, and headache could suggest a sinus-related issue, especially if these symptoms worsen with changes in temperature or during a cold. However, since your ENT specialist did not find significant sinus pathology, it may be worthwhile to explore other potential causes with a neurologist. Conditions such as sinus headaches, tension-type headaches, or even migraines can sometimes mimic sinus-related pain.

It's also important to consider that headaches can be multifactorial. Stress, environmental factors, and even dietary triggers can contribute to headache development. Keeping a headache diary can be beneficial in identifying patterns and potential triggers, which can be helpful information for any healthcare provider.

In summary, both you and your friend may benefit from consulting a neurologist, especially if symptoms persist or worsen. A neurologist can help differentiate between tension-type headaches, migraines, and other potential neurological issues. They can also provide guidance on effective treatment options, which may include lifestyle modifications, medication, or alternative therapies. Remember, early intervention can often lead to better management of headache disorders and improved quality of life.

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