DEAR MAYO CLINIC:

I get a headache in the same spot almost every day, and many nights it wakes me from sleep. It's a very sharp pain that usually lasts a few hours and it comes in waves. What could be causing these headaches?

ANSWER:

You ask a common question but, unfortunately, there's no simple answer. Headaches have many causes. From just the description you've provided, it's not possible for me to identify the source of your problem. This headache could be something benign, or it could be serious. For an accurate diagnosis, you should be evaluated by a physician, preferably one who has expertise in treating headaches.

In general, headaches can be split into two main groups: secondary and primary. Secondary headaches are caused by another medical problem. For example, secondary headaches may result from an injury, infection, sleep disorder, tumor or medication, among many other conditions. Primary headaches don't have an easily identifiable underlying cause; some may involve a genetic predisposition. Common types of primary headaches include migraine and tension-type headaches.

Distinguishing between primary and secondary headaches is not always straightforward. An accurate diagnosis depends heavily on, first, having a comprehensive consultation with your doctor. A detailed discussion about your symptoms, a full and accurate review of your medical history, and thorough physical and neurological examinations are needed to point your doctor in the right direction for an appropriate headache diagnosis.

The consultation will also determine what tests, if any, may be needed to gather more information. Magnetic resonance imaging (MRI) of the head is commonly the first diagnostic test used if a doctor suspects that a structural brain process is the cause of headaches. Additional imaging exams, a lumbar puncture (spinal tap) and blood tests, among other diagnostic tests, may also be indicated when evaluating a patient with headache.

An accurate diagnosis is critical to designing the right headache treatment strategy. Treatment for secondary headaches usually rests on addressing the underlying cause. Often (but not always), once the condition causing a secondary headache is effectively treated, the headaches subside. Primary headache treatments differ, depending on the specific diagnosis, as well as the person's associated symptoms.

The symptoms you describe aren't unique to any one type of headache, nor do they indicate a clearly identifiable underlying cause. But the fact that you have headaches in the same spot repeatedly and that your headaches are painful enough to wake you from sleep indicate that you do, indeed, need to have your symptoms carefully evaluated. Ideally, it would be best to see a neurologist with expertise in headache care. If that's not an option, make an appointment to see your primary care physician.

Also, keep in mind that you should seek prompt medical care if, at any time, your headache suddenly becomes severe; is accompanied by fever, stiff neck, confusion, seizure, double vision, weakness, numbness or difficulty speaking; or if it gets progressively worse despite rest and pain medication.

The pain you're having could have many possible explanations, but there's no way to know the cause for sure without a thorough evaluation. In the same way that a diagnosis can't be made based on this information alone, I'm unable to suggest specific treatment. I strongly recommend that you seek help for your headaches.

Ivan Garza, M.D., Neurology, Mayo Clinic, Rochester, Minn.

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