Ask a NurseThe ExCS site has teamed with a registered nurse and paramedic with a background in healthcare education and public health. Married to a former-CS, the Nurse would like to share their experience with the healthcare system, and answer any questions former-CS may have! The Nurse will NOT get involved in diagnosing or giving medical advice, but if there are questions folks have related to going to a doctor, explaining medical terminology, how to advocate for yourself in healthcare, and so on, they might have a perspective that can help.
Why pray it away, just pop a pill
A question posed recently to me was, “when is it ok to take something for a headache and when should you just tough it out?” Back in my younger days I might’ve been stricken with a little “Irish flu” after a night of debauchery and believed I should suffer as the price of having fun. Lately, social distancing and avid masking has helped me avoid the Irish flu but when I do get a headache, regardless of the cause, I treat it. Fact is, headaches can be debilitating so my short answer is, never tough out a headache. Now I could end my post here, but since I think you’ll appreciate a little more information, I’ll elaborate.
In the process of deciding just how aggressively to treat a headache, one of the things to evaluate is the cause. Dehydration, certain foods, lack of sleep and overexertion are all potential modifiable causes of headaches. I typically see if I can address the underlying cause (for example if I suspect dehydration, I’ll try to hydrate), then take some acetaminophen (eg. Tylenol) or ibuprofen (eg. Motrin/Advil), or both. Point being, I almost always take some over-the-counter pain relief for a headache. Taking a combination of acetaminophen and ibuprofen is safe as they act on pain receptors differently (refer back to this post on medications for more info). Just remember to eat something when taking ibuprofen as it can be rough on an empty stomach.
Migraines are another cause of headaches and these can be so incapacitating they require powerful medications that should only be administered in the hospital. People who suffer migraines may also be sensitive to bright light or sounds, and/or they may feel nauseous or vomit. Migraines can last for days and people who suffer them typically have been diagnosed previously. These folks usually know what brings them on and how best to treat them. If you suffer a headache so debilitating, I’d recommend getting evaluated by a neurologist.
Two headache causes that should be checked out immediately, ideally in an emergency department, include head trauma and strokes:
If you were struck in the head or suffered some trauma involving the head, get it checked out. The story of actor/comedian Bob Saget is fresh in the news and highlights the importance of head trauma being evaluated by a professional. We’ll likely never know what exactly happened to him, but from what I’ve read, it sounds so catastrophic he might have lost consciousness and not have even recognized the head trauma he suffered. Something similar happened to my uncle once, fortunately his injuries were identified quickly and the ER was able to treat him. People who suffer severe head trauma tend to have a significant “mechanism of injury” (MOI), meaning whatever caused the injury involved dramatic force. Getting hit in the head with a baseball bat for instance, or in the case of my uncle, falling off a bicycle. One big sign of head trauma is called “retrograde amnesia.” Whereby the victim of the head trauma cannot recall events that occurred in the minutes or hours preceding the traumatic incident.
Another concerning cause of headaches are strokes (aka cerebral vascular accidents or CVA’s). Strokes are a leading cause of death and disability and therefore need to be taken very seriously. Not all people who have strokes complain of headaches though. Typically they have other symptoms such as a loss of consciousness (permanent or temporary), visual disturbances/blurry vision, weakness on one side of their body or slurred speech.
In the case of either head trauma or strokes, time is of the essence. The person should be taken to the hospital, if possible, by ambulance. This is especially true if you’re taking something like aspirin or other medication, sometimes referred to as “blood thinners” (coumadin, warfarin, etc.) that interrupts the clotting process. These medications have been implicated in worse outcomes in patients who suffered head trauma. Due to reduced ability of the blood to clot though, the bleeding in the brain was more significant than it might otherwise be, causing death or disability.
While many headaches are benign (meaning they’re not life threatening) and can be treated at home, some reasons to seek out medical advice include:
- You don’t have a clear reason for the headache and/or it doesn’t improve or worsens over time
- Known or suspected head trauma
- Signs of head injury or stroke (dizziness, unsteady gait, slurred speech, weakness, amnesia, seizures, etc.)
Other factors to consider in your decision to seek out medical care for a headache could include preexisting conditions, such as hemophilia, or the persons age. For most people, headaches are an occasional nuisance, listen to your body though. If a headache feels worse or you’re suffering some of the symptoms listed above, get checked by your local doctor or ER.
References:
Collins, C. E., Witkowski, E. R., Flahive, J. M., Anderson, F. A., Jr, & Santry, H. P. (2014). Effect of preinjury warfarin use on outcomes after head trauma in Medicare beneficiaries. American journal of surgery, 208(4), 544–549.e1. https://doi.org/10.1016/j.amjsurg.2014.05.019
Head Injury. (n.d.). Retrieved February 24, 2022, from Johns Hopkins Medicine: https://www.hopkinsmedicine.org/health/conditions-and-diseases/head-injury
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Associationexternal icon. Circulation. 2020;141(9):e139–e596.
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