A long, pink scar curls behind his graying hairline, but former Illinois Gov. James Thompson is back on the road to health. Just weeks after a persistent headache led to emergency brain surgery, Thompson walked on a treadmill for 15 minutes at the East Bank Club in Chicago.
"I'm very excited to get my normal life back," said Thompson, 68, the chairman of the law firm Winston & Strawn, who served on the federal commission that investigated the Sept. 11 attacks. "The notion of sitting at home, well, I'm not used to it. I'm antsy."
That Big Jim is even alive is a result of one thing: his willingness to call the doctor about an unusually severe headache. Although nearly everyone has had one, the ability to differentiate between a throbbing tension headache -- which can be quieted with stress-reduction techniques or medication -- and something more serious ultimately saved his life.
"Headaches are very common, but some are more worrisome than others," said Bernard Bendok, co-director of the neuroendovascular program at Northwestern Memorial Hospital in Chicago. "If the quality of the headache has changed, it's sudden in onset or it's the worst someone has experienced -- and has a thunderclap quality -- it should not be ignored."
Thompson's trouble began in late December when he slipped on the ice while walking home after having dinner at Gibson's Steakhouse. The blow to the head didn't just blacken his eye. It triggered bleeding in his brain, though no one knew it at the time.
"We both dismissed it," said wife Jayne. "It was so easy (to do). There were no symptoms, and he wasn't having headaches."
More than a month later, Thompson's mother died and the headaches began. Thompson naturally linked the two events and kept popping Tylenol to keep the pain at bay.
But the headaches kept returning. On Feb. 4, four days after the first one, Thompson was in New York for business and woke up in excruciating pain. He downed 10 Advil throughout two meetings, a business lunch and a delayed flight home. The headache grew even worse.
"The pain started in the sinus area and the back of the head," said Thompson, rubbing his hand over where his gray hair had been shaved for surgery. "It didn't throb, but it hurt like hell."
By the time Thompson flew home that night, he was in agony. He called the doctor, who prescribed Tylenol with codeine. Two hours later, when the pain hadn't subsided, the doctor ordered him to the emergency room.
A CAT scan found the clot and Thompson was instantly admitted to Northwestern Memorial Hospital and monitored throughout the night. The next morning he felt drowsy and lethargic, another warning sign. Neurosurgeon Robert Levy removed the clot in a three-hour procedure called a craniotomy that required 37 staples.
Most headaches -- about 75 percent -- are tension related and nothing to worry about. Tension headaches can be a steady ache, tightness or pressure and affect both sides of the head.
Migraines, which are less common but often incapacitating, can be accompanied by sensitivity to light and smell, nausea and vomiting. Unlike tension headaches, which involve the neck and shoulder muscles, migraines are caused by disturbances in blood flow to the head.
Thompson's headache was different: It warned of a subdural hematoma, or a pool of blood between the brain and the skull. But in addition to older bleeding from the fall six weeks earlier, he also had more recent bleeding, most likely because he was taking the blood thinner Coumadin, Levy said.
Thompson's clot was big enough that "the brain was compressed about an inch from inside the skull," Levy said. "The center of the brain had shifted over half an inch," a potentially life-threatening shift.
Ten days after Thompson was released from the hospital on Feb. 11, he already was back in his law office, promising to work just three-hour days. Now, much to his delight, he can work a full day and even step on an airplane.
More than a headache
For those concerned that their headache could be life-threatening, here are the warning signs. Note: All headaches are not created equal.
Benign headaches: More than 90 percent of headaches fall in the categories of tension, migraine and cluster headaches. Though painful and sometimes debilitating, they are often termed "benign" to indicate that they are not symptoms of something severe or life threatening.
Serious headaches: The remaining 10 percent of headaches can result from other medical conditions, such as infection or increased pressure in the skull due to a tumor.
Call the doctor if:
You have three or more headaches per week.
You take a daily pain reliever.
You have a stiff neck or fever in addition to a headache.
In addition to a headache, you feel dizzy, unsteady or have slurred speech and your arms or legs are weak, numb or tingle. These can be signs of a stroke.
The headache gets worse and won't go away.
If after a fall -- even weeks later -- a headache persists and you're confused or drowsy.
Headaches begin after coughing or exertion.
Vomiting accompanies the headache.
If the headaches you normally get change in character or intensity.