Just a headache?

Short White Coat is a blog about learning to be a doctor. Posts appear here as part of White Coat Notes. Ishani Ganguli is a third-year Harvard medical student. E-mail her at shortwhitecoat@gmail.com.

The headache occupies a unique place in our society, as both an over-worn excuse to avoid marital sex and a rare but often feared portent of brain cancer. We've all had one (mine tend to be of the caffeine-withdrawal variety), and they’re easy to write off. But for some, headaches represent a debilitating lifelong condition or a sign of an underlying disease process originating far from the head itself.

I chose to spend a morning in a headache clinic during my neurology rotation, in large part because the symptom carries such a fascinating range of implications. Plus, as medical students, the most bread-and-butter complaints are often the ones we feel least qualified to address, both in patients and in advice-seeking friends.

I hadn’t known headache clinics existed in the first place (so this was lesson #1). By the time a patient shows up in one, the immediately life-threatening causes of headache (acute brain bleed, bacterial meningitis) have long been ruled out. At this point, a pattern, and in turn the diagnosis, emerges from a detailed history: Did the headache begin suddenly or gradually? Is it dull or throbbing? Can you point to the location with your finger? Are they triggered by certain foods?

Once the clinician rules out more insidious causes of headaches, the chronic headache syndromes -- tension, migraine, cluster -- tend to predominate. The treatments include everything from ibuprofen to antidepressants and beta-blockers, even Botox injections for migraines.

The headache specialist I worked with told me that a surprisingly large percentage of people ignore their headaches rather than seek treatment, even from their primary care physician. He’s biased, of course. But for all the over-medicalization we hear about, here's an instance of the opposite -- a fixable problem that often goes unchecked.

For headache sufferers out there, the pain may be common but it’s certainly not trivial. And with entire clinics dedicated to the cause, there are no more excuses not to see a doctor.