Recurring Headaches and Migraines: When Medical Assessment Is Needed

Headaches are common and are often linked to temporary factors such as stress, dehydration, poor sleep, illness or eye strain. However, headaches that repeatedly return, become more severe or begin interfering with work, sleep and daily activities should be medically assessed.

At Hout Bay Family Medical Clinic, our doctors can evaluate recurring headaches and migraines, look for possible triggers and determine whether treatment, blood tests, imaging or specialist referral may be appropriate.

What Is a Recurring Headache?

A recurring headache is one that happens repeatedly over days, weeks or months. The pattern may be predictable, such as headaches occurring around menstruation, after stressful periods or during certain activities, or it may seem to develop without an obvious cause.

Recurring headaches may:

• Occur several times a month
• Become progressively more frequent
• Last for hours or days
• Return after temporary relief
• Interfere with sleep, concentration or exercise
• Require frequent pain medication
• Change in intensity, location or character

Most recurring headaches are not caused by a dangerous condition, but establishing the likely type and pattern is important for choosing appropriate treatment.

What Is a Migraine?

Migraine is a neurological condition that can cause moderate to severe head pain together with other symptoms. The pain is often throbbing or pulsating and may affect one side of the head, although it can occur on both sides.

A migraine attack may also cause:

• Nausea or vomiting
• Sensitivity to light
• Sensitivity to sound or smells
• Dizziness
• Difficulty concentrating
• Fatigue
• Neck discomfort
• Symptoms that worsen with movement or physical activity

Migraine attacks may last from several hours to several days and can significantly disrupt normal activities.

Migraine With Aura

Some people experience an aura before or during a migraine. Aura symptoms usually develop gradually and may include:

• Flashing lights or zigzag lines
• Blind spots or changes in vision
• Tingling or numbness
• Difficulty finding words
• Temporary speech disturbance
• Dizziness

Aura symptoms are generally temporary. New neurological symptoms, symptoms that differ from a person’s usual aura or aura lasting longer than an hour require prompt medical assessment because they may resemble other neurological conditions.

Other Common Types of Headache

Not every recurring headache is a migraine. Other possibilities include:

Tension-type headaches

These may feel like pressure, tightness or a band around the head. They are commonly associated with stress, poor posture, jaw tension, fatigue or prolonged screen use.

Cluster headaches

Cluster headaches cause severe pain, usually around one eye, and may occur repeatedly at similar times of the day. The affected eye may become red or watery, and the nose may feel blocked or runny on the same side.

Sinus-related pain

Sinus inflammation may cause facial pressure, nasal congestion and discomfort around the forehead, eyes or cheeks. Many headaches described as “sinus headaches” may instead be migraines, particularly when nausea or sensitivity to light is present.

Medication-overuse headaches

Taking pain medication too frequently can contribute to increasingly regular headaches. This can create a cycle in which medication provides temporary relief but the headaches continue to return.

What Can Trigger a Migraine?

Migraine triggers differ between individuals and do not always cause an attack every time. Possible triggers include:

• Poor or irregular sleep
• Stress or the period after stress
• Missed meals
• Dehydration
• Hormonal changes
• Bright or flickering light
• Strong smells
• Excessive screen exposure
• Alcohol
• Changes in caffeine intake
• Certain foods in susceptible people
• Intense exercise
• Weather changes
• Some medications

A trigger is not necessarily the underlying cause of migraine. Migraine is a neurological condition, and attacks may occur even when no clear trigger can be identified.

When Should You Book a Doctor’s Appointment?

Arrange a medical assessment when headaches:

• Occur more often than usual
• Are becoming more severe
• Have changed in character or location
• Regularly interfere with work, school, exercise or sleep
• Wake you during the night
• Require increasingly frequent pain medication
• Do not improve with appropriate over-the-counter treatment
• Are accompanied by recurring nausea or visual symptoms
• Begin after starting a new medication
• Are causing significant concern or anxiety

Medical guidance recommends assessment when headaches become more frequent, more severe, difficult to control or disruptive to ordinary activities.

When Is a Headache an Emergency?

Seek urgent medical assistance when a headache:

• Begins suddenly and becomes extremely painful within seconds or minutes
• Feels like the worst headache you have ever experienced
• Occurs with weakness or numbness on one side
• Causes facial drooping
• Occurs with difficulty speaking, walking or understanding speech
• Is accompanied by confusion, fainting or unusual drowsiness
• Occurs with a seizure
• Causes sudden loss of vision or double vision
• Occurs with a high fever, stiff neck or rash
• Follows a significant head injury
• Occurs with severe vomiting and rapidly worsening symptoms

These features may indicate a stroke, bleeding, infection or another serious condition and should not be treated as an ordinary migraine.

Headaches During Pregnancy or After Childbirth

New or severe headaches during pregnancy or shortly after childbirth require prompt medical advice, particularly when accompanied by:

• High blood pressure
• Visual disturbances
• Swelling
• Upper abdominal pain
• Shortness of breath
• Confusion
• Seizures

Severe headache can be associated with pregnancy-related blood-pressure disorders such as pre-eclampsia. Early assessment is important because these conditions may pose serious risks to both mother and baby.

Headaches After a Head Injury

A headache may occur after a bump, fall or sporting injury. Seek urgent care when it is accompanied by:

• Repeated vomiting
• Increasing confusion
• Loss of consciousness
• Severe drowsiness
• Weakness or numbness
• Balance problems
• Seizures
• Worsening pain
• Clear fluid or blood from the nose or ears

Even when the initial injury seemed minor, new or worsening symptoms should be assessed.

Headaches Associated With Vision Changes

Migraine can cause temporary visual symptoms, but new vision changes should not automatically be assumed to be migraine.

Arrange prompt assessment when visual symptoms:

• Affect only one eye
• Begin for the first time
• Last longer than an hour
• Occur without a previous history of migraine aura
• Are accompanied by weakness or speech changes
• Begin after the age of 50
• Cause persistent loss of vision

New visual symptoms may require assessment of the eyes, circulation and nervous system.

Headaches After the Age of 50

A new headache beginning after age 50 deserves medical assessment, particularly when it is accompanied by:

• Scalp tenderness
• Jaw pain while chewing
• Blurred or double vision
• Unexplained weight loss
• Fever
• Muscle aching or stiffness
• Neurological symptoms

These symptoms may occasionally be associated with inflammation of blood vessels and require timely investigation.

How Are Recurring Headaches Assessed?

Your doctor will usually begin by asking about the pattern and characteristics of your headaches, including:

• When they started
• How often they occur
• Where the pain is located
• What the pain feels like
• How long each episode lasts
• Whether nausea or visual symptoms occur
• Possible triggers
• Medication use
• Menstrual or hormonal patterns
• Family history of migraine
• Sleep, stress and lifestyle factors
• Recent illness or injury

A physical and neurological examination may include checking blood pressure, vision, coordination, reflexes, strength and sensation.

Will You Need a Brain Scan?

Most people with a typical migraine pattern and a normal neurological examination do not automatically require brain imaging. A scan may be considered when there are warning signs, an abnormal examination or a significant change in the headache pattern.

Possible reasons for imaging or specialist referral include:

• A sudden severe headache
• Progressive worsening
• New neurological symptoms
• Headaches following a significant injury
• New headaches during pregnancy
• New headaches after age 50
• Seizures
• Unexplained fever or weight loss
• A history of cancer or reduced immunity
• Headaches that are strongly affected by posture, coughing or straining

Your doctor will determine whether imaging is likely to provide useful information.

Keeping a Headache Diary

A headache diary can help identify patterns and guide treatment. Record:

• The date and time the headache began
• How long it lasted
• The location and type of pain
• Severity
• Associated symptoms
• Food and fluid intake
• Sleep
• Stress
• Exercise
• Menstrual cycle where relevant
• Medication taken and whether it helped

Bringing this information to your appointment may help distinguish migraine from other headache types.

Can Lifestyle Changes Help?

Healthy routines may reduce headache frequency for some people. Helpful measures can include:

• Eating regular meals
• Drinking enough water
• Maintaining consistent sleep times
• Managing stress
• Taking regular breaks from screens
• Exercising gradually and consistently
• Limiting excessive caffeine
• Avoiding known triggers where practical

Avoid creating an overly restrictive diet based on suspected triggers unless a clear pattern has been identified.

Using Pain Medication Safely

Over-the-counter pain medication may help occasional headaches, but frequent use can contribute to medication-overuse headaches and may also cause stomach, kidney or other health problems.

Speak to a doctor when you are:

• Taking headache medication regularly
• Needing medication on several days each week
• Increasing the dose to obtain relief
• Combining several pain medicines
• Using migraine medication more frequently than prescribed

Do not stop prescribed medication suddenly without medical advice.

How Are Migraines Treated?

Migraine treatment depends on the frequency and severity of attacks, associated symptoms, medical history and response to previous treatment.

Management may include:

• Medication taken at the start of an attack
• Treatment for nausea
• Preventative medication for frequent attacks
• Identification of avoidable triggers
• Sleep and lifestyle support
• Review of hormonal factors
• Assessment of medication overuse
• Referral to a neurologist where necessary

Preventative treatment may be considered when migraines occur frequently, last a long time, respond poorly to acute medication or significantly affect quality of life.

When a Migraine Lasts Longer Than Usual

Seek prompt medical advice when a migraine continues for more than approximately 72 hours or when aura symptoms last longer than one hour. A prolonged attack may require a different treatment approach and assessment for another cause.

Headache and Migraine Assessment in Hout Bay

Hout Bay Family Medical Clinic provides medical assessment for recurring headaches, migraines, visual symptoms and unexplained head pain.

A consultation may include a review of your symptoms, medical history, blood pressure, medication and possible triggers. Where appropriate, your doctor can recommend treatment, arrange investigations or refer you to a neurologist, ophthalmologist or another suitable specialist.

Book a Headache Assessment

Experiencing recurring headaches, migraines or a change in your usual symptoms? Contact Hout Bay Family Medical Clinic to arrange a consultation with one of our doctors.

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This article provides general health information and does not replace an individual medical consultation, examination, diagnosis or treatment plan.