Dear Doctor,

I have constantly had mild headaches for the past few months. I also experience strong sensitivity to light and sound, and this is at times accompanied by nausea and vomiting. What could be causing this?

Diana

How old are you? How long does the headache last? Are there some factors initiating it? How is it relieved?  Is there some kind of stress in your life?

Mild to moderate headache with strong sensitivity to light and sound can be due to tension headache. The headache manifests as a feeling of a tight band around the head. There may be accompanying features of anxiety like dry mouth, disturbed sleep and palpitations. This is said to occur due to increased sensitivity of muscles to stress.

Migraine also occurs due to mental tension and is more common in young women. The pain is commonly throbbing, occurs on one side of the head, but may be generalised or bilateral in some cases. There may be accompanying nausea and or vomiting, increased sensitivity to light and or sound.

A person may suffer from both tension headache and migraine, episodically. The episodes of headache may occur once or twice every month or may be more frequent, occurring once every week. The duration may last from few hours to a day or two.

Headache can be due to overuse of pain killer medications. There is no defined quantity of medicine use which gives rise to headache; this varies between individuals based on several factors. It mostly occurs due to use of barbiturate or opioid containing pain killers. Due to their frequent use, the body no longer responds to them. One has to take them in a higher dose to get the same effect. Due to dependency formed on these tablets, failure to take them can precipitate headache.

One may have frequent headache due to refractive error of the eyes. Due to some impairment of vision, the eyes are stressed particularly with activities like reading or working on a computer, or looking at a screen for a long time. The pain may be aggravated on exposure to light. Nausea and vomiting can occur in response to pain anywhere in the body, including headache.

Medical disorders like infection and inflammation in the eyes, ears, nose, throat or teeth can also cause headache with sensitivity to light and sound. One can have a frequent headache due to cervical spondylosis (stiffness of the cervical spine), affecting the upper part of neck. Infection of the brain or its coverings, brain tumour, are sinister medical conditions causing frequent headache.

Diagnosis of the underlying cause for the headache can be made by a thorough history of the headache, physical examination, blood and stool test and imaging of the head by scans like C.T (computerised tomography) and MRI (magnetic resonance imaging).

Treatment depends on the underlying cause. In case of stress-related headaches, along with pain killers, relaxation techniques, psychotherapy, and cognitive behavioural therapy are also beneficial. A healthy lifestyle is also useful in preventing such headaches. That includes a balanced diet, adequate (but not excess) sleep, regular physical exercise, avoiding excess caffeinated products, smoking and alcohol, avoiding physical and mental stress.

Even if the headache is not fully cured by these measures, the frequency and intensity can still be reduced to the extent where it does not affect the quality of life.

Dr. Rachna   Pande is a specialist in internal medicine.