Headaches

Headaches are common, and many people treat themselves with simple painkillers, drinking extra water, having a rest, or simply by waiting for the headache to go away. A headache is one of the most common reasons for attending a doctor’s surgery or a neurology clinic.

Almost everyone will experience headaches at some time. Most headaches are not caused by serious or sinister conditions. However, people understandably worry if headaches seem different (either particularly severe, particularly frequent or unusual in any other way). The most common worry is that the headache is a symptom of a brain tumour.

The different types of headache?

Headaches can be primary, or they can be secondary which means they are a side-effect of a separate illness or injury.

Primary headaches

Tension-type headaches

Tension-type headaches are usually felt as a band or across the forehead. They can last for several days. They can be uncomfortable and tiring, but they do not usually disturb sleep. Most people can carry on working with a tension-type headache. They are not usually made worse by physical activity, although it’s not unusual to be a bit sensitive to bright light or noise.

Tension-type headaches tend to worsen as the day goes on and are often mildest in the morning. Tension-type headaches are usually felt on both sides of the head (referred to as symmetrical pains) – most often the front.

Tension-type headaches are thought to be caused by tightness in the muscles at the back of the neck and over the scalp. The underlying causes include anything which makes those muscles tense. This includes both physical and mental tension. Tiredness, stress, anxiety and an awkward sleeping position can make them worse. Working long hours bent over a computer may trigger them.

Treatment for tension-type headaches
Tension-type headaches usually respond to simple painkillers, often with a large glass of water. However, the best approach is to treat the underlying reason). Changes in lifestyle can help – such as having less caffeine and drinking more water. So, too, can a sensible diet in which one eats regularly and has a good balance of slow-release energy foods rather than lots of sugars. Reducing the number of pillows you sleep on can sometimes help. Sleeping on your side on high pillows means your neck is bending sideways during the night, and this may trigger muscle tension and hence headaches. Other things which help improve tension-type headaches are adequate sleep and avoiding excessive noise.

Occasionally, tension-type headaches can be caused by poor vision, particularly if reading in low light for long periods.

Migraines (see page XX)

Migraines are also very common. A typical migraine is one-sided and throbbing. Indeed, headaches that are one-sided, headaches that throb and headaches that make you feel sick are more likely to be migraines than anything else. Migraines are often severe enough to be disabling. Some patients need to go to bed to sleep off their headache.

Migraines can be triggered by stress, hunger, certain foods such as chocolate and red wine, tiredness, and lack of body fluid (dehydration). They can also be triggered by tension-type headaches.

Cluster headaches

Cluster headaches are very severe headaches, sometimes called ‘suicide headaches’. They occur in clusters, often every day for a number of days or even weeks. Then they disappear for months on end. They are uncommon, and tend to occur particularly in adult male smokers. They are severe, one-sided headaches, which are really very disabling (they prevent regular activity). People often describe them as the worst pain they have ever felt.

Cluster headaches are usually one-sided. Patients often have a red watery eye on the affected side, a stuffy runny nose and a droopy eyelid.

Treatment for cluster headaches
Cluster headaches usually require treatment from your doctor, which can be with tablets or occasionally with inhaler oxygen.

Chronic daily headaches

Chronic daily headache or chronic tension-type headache is usually caused by muscle tension in the back of the neck and affects women more often than men. Chronic means that the condition is persistent and ongoing. These headaches can be started by neck injuries or tiredness and may be made worse by medication overuse (see below). A headache that occurs almost every day for three months or more is called a chronic daily headache.

Treatment for chronic daily headaches?
This type of headache is best treated by physiotherapy, avoiding painkillers and occasionally by certain antidepressant medications (many of which can be effective against chronic headaches). Using painkillers regularly for chronic daily headache is likely to make things worse, as you may also develop a medication-induced headache (see below).

 

Primary stabbing headaches

Primary stabbing headaches are sometimes called ‘ice-pick headaches’ or ‘idiopathic stabbing headache.’ The term ‘idiopathic’ is used by doctors for something that comes without a clear cause. These are short, stabbing headaches which are very sudden and severe. They usually last between 5 and 30 seconds, at any time of the day or night. They feel as if a sharp object (like an ice pick) is being stuck into your head. They often occur in or just behind the ear and they can be quite frightening. Although they are not migraines they are more common in people who have migraines – almost half of people who experience migraines have primary stabbing headaches. They are often felt in the place on the head where the migraines tend to occur.

Treatment for primary stabbing headaches?
Primary stabbing headaches are too short to treat, although migraine prevention medications may reduce their number.

Trigeminal neuralgia

Trigeminal neuralgia causes facial pain. The pain consists of extremely short bursts of electric shock-like sensation in the face – in the area of the eyes, nose, scalp, forehead, jaws, and/or lips. It is usually one-sided, and is more common in people over the age of 50. It can be triggered by touch or light breeze on the face.

Treatment for trigeminal neuralgia?
Trigeminal neuralgia is usually treated with preventative medicines.

Secondary headaches

Sometimes headaches have underlying causes, and treatment of the headache involves treating the cause. People often worry that headaches are caused by serious disease, or by high blood pressure. Both of these are extremely uncommon causes of headache – indeed high blood pressure usually causes no symptoms at all.

Chemicals, drugs and substance withdrawal

Secondary headaches can be due to a substance, or its withdrawal – for example:

  • Carbon monoxide (which is produced by gas heaters which are not properly ventilated).
  • Drinking alcohol (with headache often experienced the morning after).
  • Lack of body fluid (dehydration).

Medication-induced headaches are the most common cause of secondary headache.

Medication-induced headaches

Medication-induced headache is an unpleasant and long-lasting headache. It is caused by taking painkilling medication – usually for headache. Unfortunately, when painkillers are taken regularly for headaches, the body responds by making more pain sensors in the head. Eventually the pain sensors are so many that the head is super-sensitive and the headache won’t go away. People who have these headaches often take more and more painkillers to try to feel better. However, the painkillers have often long ceased to work.

Treatment for medication-induced headaches?
Unfortunately, the treatment is to stop all painkillers for at least a month. Most patients find this very hard to do and take a lot of convincing to even try, as this means living with the headaches without treatment. The headaches may take weeks or even months to lessen (subside) and may get worse first.

Many doctors feel that the best way forward is to stop all headache pills and weather the worsening of the headache in order to get better in the end.

Headaches due to referred pain

Some headaches can be caused by pain in some other part of the head, such as tooth or ear pain, pain in the jaw joint and pains in the neck.

Sinusitis is a common cause. The sinuses are ‘holes’ in the skull which are there to stop it from being too heavy for the neck to carry around. They are lined with mucous membranes, like the lining of the nose, and this produces mucus in response to colds or allergy. The lining membranes also swell up, and may block the drainage of the mucus from the space. It then becomes thickened and infected, leading to headache. The headache of sinusitis is often felt at the front of the head and also in the face or teeth. Often the face feels tender to pressure, particularly just below the eyes and beside the nose. It may be accompanied by a stuffy nose and the pain is often worse on bending forwards. Acute sinusitis is the type that comes on quickly in association with a cold or sudden allergy. Chronic sinusitis can be caused by allergy, by overusing decongestants or by an acute sinusitis that doesn’t settle. The sinuses become chronically infected and the sinus linings chronically swollen. The contents of the sinuses may be thick but often not infected.

Acute glaucoma can cause severe headache. In this condition the pressure inside the eyes goes up suddenly and this causes a sudden very severe headache behind the eye. The eyeball can feel very hard to touch, the eye is red, the front of the eye (cornea) can look cloudy and the vision is usually blurred.

Exertional headaches/sexual headaches

Exertional headaches are headaches associated with physical activity. They can become severe very quickly after a strenuous activity such as running, coughing, having sex (intercourse), and straining with bowel movements. They are more commonly experienced by patients who also have migraines, or who have relatives with migraine.

What types of headache are serious or dangerous?

All headaches are unpleasant and some, such as headache from medication misuse, are serious in the sense that when not tackled properly they may never go away. However, a few headaches are signs of serious underlying problems. These are uncommon – in many cases very rare.

Dangerous headaches tend to occur suddenly, and to become progressively worse over time. They are more common in older people. They include the following:

Bleeding around the brain (subarachnoid haemorrhage)

Subarachnoid haemorrhage is a very serious condition which occurs when a small blood vessel bursts on the surface of the brain. Patients develop a severe headache and stiff neck and may become unconscious. This is a rare cause of severe headache.

Meningitis and brain infections (see page xx)

Meningitis is infection of the tissues around and on the surface of the brain and encephalitis is infection of the brain itself. Brain infections can be caused by germs called bacteria, viruses or fungi.

Giant cell arteritis (temporal arteritis)

Giant cell arteritis (temporal arteritis) is, generally, only seen in people over the age of 50. It is caused by swelling (inflammation) of the arteries in the temples and behind the eye. It causes a headache behind the forehead (a frontal headache). Typically the arteries in the forehead are tender and patients notice pain in the scalp when they comb their hair. Often the pain gets worse with chewing. Temporal arteritis is serious because if it is not treated it can cause sudden loss of eyesight. Treatment is with a course of steroids. The need to continue these steroids is usually monitored by a doctor.

Brain tumours

Brain tumour is a very uncommon cause of headaches – although most patients with long-lasting, severe or persistent headaches start to worry that this may be the cause.

 

 

When should one be worried about a headache?

  • You have had a significant head injury in the previous three months.
  • Your headaches are worsening and accompanied by high temperature (fever).
  • Your headaches start extremely suddenly.
  • You have developed problems with speech and balance as well as headache.
  • You have developed problems with your memory or changes in your behaviour or personality as well as headache.
  • You are confused or muddled with your headache.
  • Your headache started when you coughed, sneezed or strained.
  • Your headache is worse when you sit or stand.
  • Your headache is associated with red or painful eyes.
  • Your headaches are not like anything you have ever experienced before.
  • You have unexplained vomiting with the headache.
  • You have low immunity – for example, if you have HIV, or are on oral steroid medication or immune suppressing drugs.
  • You have or have had a type of cancer that can spread through the body.

Summary

Most headaches, whilst unpleasant, are harmless and respond to simple measures. Migraine, tension headache and medication-induced headache are all very common. Most of the population will experience one or more of these. Working out the underlying cause of any headaches through discussion with a doctor is often the best way to solve them.

Remember that headaches are less likely to occur in those who:

  • Manage their stress levels well.
  • Eat a balanced, regular diet.
  • Take balanced regular exercise.
  • Pay attention to posture and core muscles.
  • Sleep on two pillows or fewer.
  • Drink plenty of water.
  • Have plenty of sleep.

Anything that you can do to improve any of these areas of life will improve health and well-being and reduce the number of headaches experienced.

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