Pressure Headache
By pressure headache I mean a headache which feels like there is too much pressure inside your head. The pain feels tight, squeezing, or like a band over or around the head. Some of the severe, serious headache types will be experienced as a pressure symptom in the head (more on these below). However, the quality of the pain is not quite as important as the onset and progression.
Pressure pains that occur day after day without changing much in intensity and without limiting daily activity are not associated with serious disease. A pressure headache that is worst on wakening and causes severe vomiting on wakening might be serious. A new onset pressure-type headache which gets worse and worse over a few days or weeks may also be due to one of the more dangerous headache conditions. However, before you think a pressure headache is the end of the world, remember that by far the most common cause of a pressure feeling in the head is Tension-type Headache (TTH). The most common headache syndrome known is TTH, and about 40-60% of people will experience a TTH each year! Tension-type Headache can cause a pressure, tight, squeezing or band-like sensation all over the head, on part of the head, or around the head. Tension-type headache can be intermittent (episodic tension-type headache) of experienced day-in-day-out (chronic tension-type headache). Tension-type Headache is not usually physically disabling, but unfortunately medication is not that effective in chronic cases. In episodic cases it is hard to know if medicines work or whether the headache was going to go away itself anyway. Most people who take a headache, reach for paracetamol (acetaminophen in the USA) and never bother their doctor about the headache have episodic tension-type headache.
What are the Serious Causes of a Pressure Sensation in the Head?
For the very, very small number of people (I estimate <0.1%) with a serious cause of pressure headaches, here is the list of potential causes:- Venous Sinus Thrombosis
- Idiopathic Intracranial Hypertension
- Intracranial Hypotension
- Temporal Arteritis
- Brain Tumours
- Cervicogenic Headache
- Sphenoid Sinusitis
- Carbon Monoxide Poisoning
- Hemicrania Continua
- Tolosa-Hunt-Syndrome (painful ophthalmoplegia)
- Acute Stroke (although the patients main complaint will be the stroke, not the headache!) Sleep Apnoea (a percentage report tension-type headache symptoms)
- Sleep Deprivation Headache
- Cardiac cephalalgia (Heart Disease Headaches)
- HIV Infection
References
A Verdelho. Headache in acute stroke. A prospective study in the first 8 days. Cephalalgia 2008;28:346-354 (Free Abstract only)DD Mitsikosta. Refractory chronic headache associated with obstructive sleep apnoea syndromeCephalalgia 2008;28:139-43 (Free Abstract only) JN Blau. Sleep deprivation headacheCephalalgia 1990;10:157-60 (Free Abstract only) CJ Schankin. Characteristics of brain tumour-associated headacheCephalalgia 2007;27:904-11. (Free Abstract only)
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