Ask Dr Gary: Tension a likely culprit

My 21-year-old daughter has had headaches for almost a year now. She can't concentrate and she gets sparkling flashes of light in her eyes that make reading hard. It's a constant throbbing pain that never goes away completely and has been getting worse. She had a CT scan which didn't show anything, and she's taken every headache medicine there is, with very little relief.

  - Frustrated Mum

Most chronic headaches are benign, not caused by tumours, ruptured aneurysms, or the like.

Most will be tension-type headaches (often bilateral dull squeezing headaches brought on by stress) or migraines (one-sided, throbbing headaches made worse by light, sound, and movement).

The causes are debated, as are the treatments, which range from medicines that abort migraines (such as sumatriptan), to analgesics such as paracetamol, anti-inflammatories and anti-depressants, to a host of holistic therapies.

Some chronic headaches will be caused by mental health issues such as anxiety or depression, both of which can be well treated.

But a very small number won't be benign, and one possibility that should be considered is idiopathic intracranial hypertension (IIH). This occurs when there is abnormally high pressure in the cerebrospinal fluid that surrounds the brain; the exact cause of which is unknown.

It can occur in anyone, but the textbook case is an overweight woman of reproductive age, with a chronic headache that's worse with bending or straining, roaring in the ears (tinnitus), nausea and vomiting, and visual symptoms. This disease can cause blindness if untreated. It's diagnosed with a lumbar puncture rather than a CT scan.

Other serious causes of chronic daily headache are rare, but include dysfunction of the head's sensory nerves; tumours; blood vessel problems such as narrowing, aneurysms, blood clots, or chronic infections.

Most headaches are not dangerous to your health, but there are some red flags: those that last weeks, are worse with straining or coughing, are present on awakening, or those that get worse over time.

Gary Payinda, MD, is an emergency physician who would like to hear your medical questions.

Email: drpayinda@gmail.com (This column provides general information and is not a substitute for the advice of your doctor.)