This produces a very severe headache, usually in older people over the age of 55 years. The arteries in the temples can be seen to be more thickened and tortuous and they are particularly tender. The sufferer is generally unwell and may have had pains all over the body (polymyalgia rheumatica) for weeks with loss of appetite and loss of weight. The diagnosis is easily made by doing a simple blood test with confirmation by examining a small piece of the temporal artery under the microscope (and finding ‘giant-cells’) – Early diagnosis is important in this condition because a major complication is blindness. The headache disappears completely following treatment with steroids.
Of all the causes of headache, this is the one that most patients and doctors fear most. In fact, it occurs only in a very small minority of headache sufferers and can often be recognized by the characteristics of the headache.
The history is usually of short duration e.g. less than three months, but of increasing severity. The headache is made worse by coughing, sneezing, and bending down (but this can also occur in benign headaches). The headache may wake the patient from sleep and tends to be worse in the morning. There is often associated morning nausea or vomiting.
Other ominous symptoms include drowsiness, yawning, or hiccup. If there are neurological signs present, then further investigation is mandatory.
These occur frequently and have no serious significance. Two types of these have recently been described by Dr. John Pearce: The ‘exploding head’ occurs in middle aged or elderly people, most often women. It always occurs at night when the sufferer is woken up with a painful sensation as if a forceful explosion has taken place in the head. Although the sensation soon goes, it leaves the person with a sense of fear, sweating, and rapid pulse rate. The ‘needle-in-the-eye’ syndrome is more common and feels like a sharp jab with a needle in the corner of the eye. It lasts only a matter of seconds and can recur several times a day.