An epidural hematoma can be another cause of a headache, which usually has a traumatic origin.
A blow to the head with a hard object or getting up and banging the head against an overhead cupboard or a heavy shelf could cause a skull fracture with a line in the temporal bone of the skull. Right adjacent to this bone is the middle meningeal artery (thanks to en.wikipedia.org for this link) that can get damaged this way.
Blood can accumulate in the space between the skull and the hard membrane lining called “dura mater”. Images of head injuries with an epidural hematoma are shown in this link (thanks to http://www.hawaii.edu/ for this link; scroll down halfway for images).
This epidural hematoma causes brain pressure that is building up slowly and there is an initial “lucid interval”, in which the patient is conscious and thinks perhaps that other than a headache nothing much has happened.
A few hours (typically 3 to 8 hours) later though the patient who complained about a severe headache all along, will pass out and turn unconscious. Prior to this there may have been a sudden fall from a loss of muscle power.
This coma is caused by increased intracranial pressure. The pupils often are fixed and dilated, a poor prognostic sign, if surgical evacuation of the epidural hematoma is not done very quickly. Diagnostic X-ray films sometimes show a temporal bone fracture line or an emergency CT or MRI scan will show the neurosurgeon the location of the epidural hematoma.
The neurosurgeon places a burr hole right over the center of the hematoma to drain it and relieve the pressure inside the skull. This allows the patient within a short period of time to get out of the coma. After about another day or two the patient can go home. Left untreated, death from pressure onto the brain would have been almost certain. Although epidural hematomas are less common than subdural hematomas, quick action of everybody around the patient is very important. The sequence of events should be: Calling an ambulance, rushing to the hospital, telling the staff the exact history, mentioning a blow to the head followed by a “lucid interval”. Some tests will confirm the condition and surgery would follow immediately.
Before considering treatment of the headache, it is important to find out the cause of the headache, in this case an epidural hematoma.
1. Goldman: Cecil Textbook of Medicine, 21st ed.,2000, W. B. Saunders Company
2. B. Sears: “The top 100 zone foods”. Regan Books, Harper Collins, 2001.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 176.
4. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001, Mosby, Inc.
5. Goroll: Primary Care Medicine, 4th ed.,2000, Lippincott Williams & Wilkins
6.Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998, Mosby-Year Book, Inc.
7. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001, W. B. Saunders Company
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
9. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
10. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008