Headache

Headaches are one of the most common reasons people come to general-medicine OPD. The overwhelming majority — about 90% — are tension-type headaches or migraines. These are debilitating but not dangerous. The remaining 10% are headaches with an identifiable underlying cause (high BP, sinus infection, eye strain) and a small fraction (less than 1%) signal something serious (meningitis, stroke, brain bleed).

Common types

• Tension-type headache — band-like pressure across both sides of the head, lasts hours to days, related to stress / poor sleep / screen work.
• Migraine — one-sided throbbing pain, often with nausea, light sensitivity, sound sensitivity. Lasts 4-72 hours. Sometimes preceded by visual aura (zigzag lines, blind spots).
• Cluster headache — severe one-sided pain around the eye, comes in clusters over weeks, then disappears for months.
• Sinus headache — pressure across forehead / cheeks, worse on bending forward, often with nasal congestion.

When investigation is needed

Most headaches don't need a scan. We order brain imaging (CT or MRI) only when one or more of these are present: sudden very severe "thunderclap" onset, new headache after age 50, headache with fever and neck stiffness, headache that wakes you from sleep, headache that gets steadily worse over days, headache after head injury, headache with new neurological symptoms (weakness, slurred speech, vision change). Without these red flags, scanning has near-zero diagnostic yield and we don't do it.

Treatment

Tension-type headaches usually respond to: hydration, regular sleep, screen breaks, neck stretches, and occasional paracetamol. Chronic tension headaches benefit from amitriptyline at low dose at night.

Migraines have two arms of treatment: acute (triptans, NSAIDs, anti-emetics during an attack) and preventive (beta-blockers, topiramate, newer CGRP-blockers — used when migraines happen more than 4 days a month). Trigger identification helps a lot — sleep, food, hormones, stress.