Headaches are one of the most common medical symptoms that you will see in your role as medic.  The brain matter itself doesn’t have pain receptors, but there are several structures around the brain that are sensitive.  Muscles, blood vessels, sinuses, lining tissue, and others can be the site for significant discomfort.

Headaches: What Are the Causes?

Many consider headaches to be, well, more of a headache than an actual danger, but headaches can be associated with a large number of medical conditions, not to mention traumatic injuries.

There are almost more causes for headaches than you can reasonably write down; in a collapse, however, common causes will be:

• Hunger
• Dehydration
• Stress
• Infections
• Fevers
• Elevated blood pressures
• Caffeine or Alcohol withdrawal
• Fumes

Headache pain is the interaction between the brain, blood vessels, and local nerves. Nerves associated with blood vessels and muscles are activated and send pain signals to the brain. Headaches that occur suddenly may be related to infection or colds/flus, but may be the herald of a life-threatening event such as a stroke.  Ear and sinus infections are particularly likely to cause headaches.

Tension Headache

By far, the most frequently-seen type of headache is the tension headache.  This is caused by spasms of the muscles of the neck and head.  Tension headache is usually seen bilaterally (on both sides) and/or the back of the head and neck. They may be related to stress, anxiety or depression, a head injury, or even just time spent with the head or neck in an abnormal position. Lack of sleep, teeth grinding, and poor posture are also factors.

Tension headaches may last a half hour or they can last a week. A sensation of pressure or tightening is the most common symptom. This type of headache may be improved by massaging the back of the neck and temples.  Ibuprofen and Acetaminophen are old standbys as treatment.  Identifying the situation that triggers the headache may help avoid future episodes.

Sinus Headache

Sinus headaches are associated with constant pain in the front of the face. A sinus is an air-filled cavity in the bones of the skull. The forehead, cheeks or the bridge of the nose are the areas affected most by sinus infections; oftentimes, they may be one-sided, which will help you to make the diagnosis. Sudden head movement may intensify the pain.

Antibiotics may be helpful to treat the infections that can cause this type of headache. Amoxicillin (Fish-Mox Forte) 500mg three times a day for a week is a reasonable first choice.  If you are allergic to Penicillin family drugs, consider Trimethoprim-Sulfamethoxasole (Bird-Sulfa) 160mg/800mg twice daily. Nasal decongestants such as Pseudoephedrine (Sudafed) may give some relief; so may sterile saline nasal rinses.

Migraines

The other common cause of headache is the migraine.  The exact cause of migraines is uncertain. It is thought by some to be related to spasms in the blood vessels. Migraines may be genetic in nature, as they seem to run in families.  Women are more susceptible than men.

A specific pattern of symptoms is seen in this variety of headache:

• Pain behind the eye (usually one-sided)
• Sensitivity to light, noise or odors
• Nausea and vomiting (causing loss of appetite or stomach discomfort)
• Vision changes (blurring, light and color phenomena)

Bed rest in the dark will be helpful here, as well as Ibuprofen and/or Acetaminophen.  Some migraine medications use caffeine, and sometimes are effective.  Teas and Coffee might be alternatives in an austere setting.  If you are a chronic migraine sufferer, ask your physician for Sumatriptan (Imitrex), a strong anti-migraine medication, to stockpile.

Other causes

Headache is a symptom of many different medical conditions.  Here are just a few:

In women, hormonal changes may be responsible for headaches. Pregnancy, menopause, menstruation, and the use of birth control pills have all been implicated as risk factors. Cranberry juice and other natural diuretics may be helpful to limit swelling that may cause some headaches in these cases. Limiting pre-menstrual salt intake may also help.

Headache caused by dehydration will be rampant in a long-term survival situation.  This variety will also present bilaterally and is commonly made worse by standing up rapidly from a lying position.  These patients need fluids, which will gradually improve their symptoms.

Less common causes of headache would include an infection of the central nervous system called “meningitis”.  Along with headaches, meningitis presents with a stiff neck, fever, and possibly a rash.  This condition may be caused by bacteria or viruses.  Without modern medical facilities and labs, you could treat this condition with antibiotics and antivirals in the hope of improvement.  Expect variable results.

Uncontrolled high blood pressure or a burst blood vessel in the brain may cause a stroke (medical name: cerebrovascular accident or CVA).  Besides the sudden onset of a severe headache, you will notice that your patient has lost strength in the arm and leg on one side; you will also note decreased motion on one side of the face and absent or slurred speech.  Loss of vision in one eye is sometimes seen.

This condition, in a collapse, will be treated only with bed rest.  There is often some improvement over the first 48 hours or so.  Beyond this point, further recovery may be limited.  This is one of the main reasons why it is so important for you as medic to treat all cases of high blood pressure.

Natural Relief

If you would like a strategy to deal with a headache without drugs, try the following:

•  Place an ice pack where the headache is.
•  Have someone massage the back of your neck.
•  Using two fingers, apply rotating pressure where the headache is.
•  Lie down in a dark, quiet room.  Get some sleep if at all possible. If your blood pressure is elevated, lay on your left side (pressure is usually lowest in this position).
•  Track what you were doing or perhaps what you ate before the headache started, and avoid that activity or food if possible.

A number of herbal remedies are available that might help headache.  Feverfew is an herb that stops blood vessel constriction and is anti-inflammatory.  This can be taken on a daily basis (1-2 leaves) for those with chronic problems (warning: Feverfew should not be ingested during pregnancy or nursing). Gingko Biloba has a similar action.

The pain of tension headaches can be relieved if you utilize herbs that have sedative and antispasmodic properties.  Teas made from Valerian, skullcap, lemon balm, and passion flower have both. Herbal muscle relaxants may also help:  rosemary, chamomile, and mint teas are popular options.

For external use, consider lavender or rosemary oil.  Massage each temple with 1-2 drops every few hours.

Joe Alton, MD

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