Ask a Nurse: Not Tonight, Dear…

Not tonight, dear…

Before I get into the subject of headaches, I want to thank Madame Deals for having me as her featured health writer for one year this month! I can hardly believe it has been that long already! You dear readers have been with me through the death of several ones dear to my heart and blessed me with your comments and readership! I am beginning another journey in a few short days. You may remember my post on zero deductible  healthcare where I described my experience as a missionary nurse. Well, my husband (a physician assistant), my youngest daughter (almost 13 years old) and I will be leaving Monday to work in a small rural village in West Africa for 6 months. I will try to write articles as often as I can, but the internet connection is very unreliable in that part of the world. Those of you who are praying people, we sure would appreciate your prayers! If you would like to follow our journey, you can follow our blog at

Now, to the subject of headaches! There are different kinds of headaches. Tension, sinus, cluster, migraine are the most common, so we will discuss these.


Tension headaches are located on both sides of the head, and sometimes the neck. The pain from a tension headache is described as dull pressure or tightness. The duration of a tension headache can be from 30 minutes to a full week.


A sinus headache usually occurs with congestion and cold symptoms. The pain is located behind the browbone and cheekbones. The pain may worsen when you lean forward. There is usually post nasal drip and you may have yellow, greenish or even blood tinged drainage.  You may have a fever and feel generally lousy. If you have this type of headache, antibiotics may be needed for recovery, if the cause is bacterial.  Allergies and viruses can also cause sinus headaches.


Cluster headaches are often around and behind one eye. They are considered one of the most painful kinds of headaches. They occur in “clusters” in a cycle. A person will have bouts of these headaches close together for days or weeks and then have a period of time with no headache. This type of headache is rare and not life threatening, although the person having them may feel like they will die from the pain.


Migraines occur with and without an “aura.” An aura is a sensory warning that can occur before or as a migraine begins. Some kinds of auras are seeing flashing lights or feeling numbness or tingling in your face, arm or leg.

A migraine is often accompanied by nausea and/or vomiting, and sensitivity to light, movement and sound. The pain of a migraine can be quite extreme and is often on one side of the head. A migraine can last from 4 to 72 or more hours, especially if it is untreated. A person with a migraine usually wants to lie very still in a dark room with no noise.

Warning signs with headaches

There are a few rules to follow with headaches, to know if you need to see a doctor. The first step would be to see a doctor if you begin to have bad headaches and have never been diagnosed with a certain kind of headache pattern. Even when the family history is positive for certain types of headaches, many doctors will want to do their own tests to make sure they are not missing something serious.

Here are some warning signs that warrant a doctor or emergency room visit:

New headache pain if you are over 50 (pain you have never had before)

Headache with fever, stiff neck, weakness, rash, double vision, mental confusion, trouble speaking, seizures, or numbness

Headache that continues to worsen after a blow to the head (most doctors want to check out anyone that has hit their head hard enough to cause a bad headache)

A sudden severe headache that hits like a thunderclap (“worst headache of my life”)

A chronic headache that worsens with movement, straining, coughing or exertion


There are two types of treatment, pain relieving and prevention. These are usually medicines. The medicine that works perfectly for your friend’s migraines may not help yours at all, or could cause serious side effects. Never share medication! Let a doctor work with you to find the best treatment. With migraines especially, certain foods and events can trigger an attack. Finding out what your migraine triggers are is one of the first steps to successful treatment.


Typical triggers are:

  • Stress
  • Hormone changes
  • Certain foods and drinks, such as red wine, beer, aged cheeses, chocolate, caffeine, aspartame (sugar free sweetener also known as Nutrasweet) and MSG found in many foods (especially Asian cuisine)
  • Skipping or delaying a meal
  • Too little sleep
  • Changes in barometric pressure ( like when a storm is brewing)
  • Sensory stimuli such as bright light, flashing lights, perfume, second hand smoke, paint thinners or other strong smells

Did any of the symptoms and triggers for migraines remind you of another disease? If you noticed, many of these triggers and symptoms can also be used to describe epilepsy or seizures. When I went to a neurologist for my migraines, he told me that a brain wave test (EEG) done on a person having a seizure looks very much like one done on a person having a migraine! He said that doctors now believe that these two illnesses are related. Does that mean if you have migraines that you will have a seizure disorder, too? No, it just means that the brain acts the same way during each event. Doctors use seizure medicines to prevent migraines for some people, and it works!

Well, I must go finish packing for West Africa and weigh our suitcases again! I hope to be writing at least once a month while I am in Africa; it all depends on internet availability.

God-Bless you, dear readers, remember to…

Be Well,
Nurse Pam   

Pamela is an RN, MSN/Ed.

Pamela is a mother of 6 amazing children ages 11 to 24. She is a nurse educator and loves to travel overseas to work in medical clinics and teach health-related topics to schools and communities. She has been married to her best friend, Steve, for 29 years. She has many different interests including reading, writing (NOT arithmetic!), baking, teaching, and spending time with her family. She lives in central Pennsylvania with her husband and two youngest daughters.

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