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4. Other non-migraine headaches

There are many ‘primary’ headaches that are not migraine, tension type headaches or cluster headache. They are not very common but are included in this course so that, if you have these symptoms, you may be able to identify and diagnose the headache.

There are also headaches that are ‘secondary’ headache – the result of exposure to a substance or when that substance is removed.

Stabs, Jolts, Exertional and other Sudden Onset or Severe Headaches

My father has started waking in the night with a headache. It doesn’t happen every night. The specialist has said it is hypnic headache. Can you tell me a bit more about it?

Hypnic headache used to be called an ‘alarm clock’ headache because it always wakes the person from sleep. Hypnic headache affects only people over the age of 50, occurs only during sleep and wakes the person with the headache. The headache tends to be dull,

but may be severe in up to 20% of people. It can be associated with nausea or sensitivity to light or sound, but not both. There is none of the red eye or runny or blocked nose symptoms associated with cluster headache. The headache occurs at least 15 times each month and lasts for at least 15 minutes after waking, but no longer than180 minutes.

I have been told that I have hypnic headache but I read somewhere that, if you get a new headache when you are older, you should be concerned about it. I have had a normal brain scan - should I be worried?

If your specialist feels that your headache fits into the ‘hypnic headache’ label and you have had a normal brain scan, there is no real cause for concern. It depends on how well your symptoms fit in the ‘diagnostic box’ and whether any change in your symptoms

occurs over time.

I have heard of people having nerve pain and sciatica but what is neuralgia?

Neuralgia is a sharp, very short-lived, one-sided nerve pain. It can be described as like an electric shock or ‘lancinating’ (piercing), and lasts a few seconds with no symptoms between times. Different nerves can be affected and the pain is felt along the path of the nerve involved.

My aunt has trigeminal neuralgia. Can you tell me a bit about it?

Trigeminal neuralgia affects the cheek and chin most commonly and the pain never crosses the midline (the imaginary line that divides the left side of the body from the right). The pain is just like an electric shock and can be triggered by a variety of actions such as washing, shaving, talking, brushing teeth and other normal day-today activities. In any one person the attack follows the same pattern and is often precipitated by the same trigger spot. Trigeminal neuralgia is not usually associated with a structural cause but, if it occurs on only one side of the face and is always on the same side, further assessment by a specialist might be a good idea.

My cousin has been getting these really sharp stabbing pains around his eye and temple. They are gone as soon as they have started. What sort of headache is it?

It is not always easy to answer this sort of question without gathering a lot more information. Assuming that your cousin has no other symptoms, such as nausea or a red watery eye that might suggest a different sort of headache, it may be a primary stabbing headache, previously known as ‘ice-pick headache’ or ‘jabs and jolts’. The stabbing

pain may move about the head, or swap sides.

Why do I get a headache when I am doing my aerobics class?

Aheadache can be triggered during exercise as a result of the exercise itself (a benign exertional headache), or as a result of dehydration or hypoglycaemia (low blood sugar) that can occur during exercise, and as such is a ‘benign’ headache. Exertional headache tends to occur more often at high altitude or during hot weather. The headache may last for at least five minutes and up to 48 hours after the exercise. More rarely, exertion can trigger a headache as a result of an underlying structural problem or anatomical abnormality – a secondary headache.

The first time such a headache occurs, a subarachnoid haemorrhage (SAH) needs to be excluded. This requires an emergency assessment, when a CT scan of the brain is done and, often, a lumbar puncture as well to look for red blood cells in the cerebrospinal fluid

(CSF) that surrounds the brain.

I read a magazine article recently that indicates that it is possible for a migraine to happen after having sex. Can having sex really cause a headache?

Yes, it can, and is sometimes referred to as ‘coital’ or ‘orgasmic headache’. The headache is often quite ‘explosive’ and of high impact when it occurs at orgasm. In someone with migraine the headache may be very like their usual migraine episode. This type of headache is usually benign but if it occurs for the first time, the person should see their doctor to make sure that the cause is not a subarachnoid haemorrhage.

A milder headache can occur before orgasm, which is of much lower impact and may be more like a tension-type headache.

I have, in the past, had a really bad migraine triggered during intercourse. Should I be worried?

A severe, high-impact headache that occurs for the first time at orgasm is probably benign but you should see your doctor to make sure that it is not the result of a subarachnoid haemorrhage (SAH). If the headache recurs over time, it is more likely to be benign.

If the headache is one-sided and is always on the same side, it might be wise for you to see your doctor to rule out an underlying structural cause, such as an aneurysm that might lead to a SAH.

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