Headaches

What is a headache?

The term ‘headache’ refers to different types of head and facial pain. Headaches vary in how severe they are, how long they last, their causes, and how they respond to different treatments. The most common types of headache are tension headache and migraine but there are many others.

Tension headaches

Tension headaches are the most common type of headache and may occur occasionally or every day. Occasional tension headaches are often described as a mild to moderate constant band-like pain, tightness, or pressure around the forehead or back of the head and neck and can last from 30 minutes to several days, often starting in the middle of the day. Regular or chronic tension headaches come and go over a prolonged period of time with a throbbing pain affecting the front, top, or sides of the head. It helps to learn to avoid the triggers for these headaches (such as reducing stress, and improving the set-up of your workstation) and, if possible, taking a break and using a simple pain reliever.

There is no single cause for tension headaches but for some people they are caused by tightening of the muscles in the back of the neck and scalp. This muscle tension may be caused by:

       
  • Inadequate rest
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  • Poor posture
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  • Emotional or mental stress, including depression
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  • Anxiety
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  • Fatigue
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  • Hunger
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  • Overexertion

Migraine

A migraine headache may be like a tension headache but is usually recognised as being different as it tends to be one-sided, pulsating, more severe and debilitating. Migraine most commonly brings other symptoms, such as nausea, vomiting and aversion to light and noise. The migraine may or may not be preceded by gradual visual disturbances (aura, spectra) such as moving lights, patterns and shapes, which develop over a few minutes and disappear as the headache worsens. The most common migraine symptoms are;

       
  • Throbbing, pulsating pain
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  • Sound sensitivity
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  • Pain on one side of the head
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  • Vision changes, blurred vision
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  • Aura
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  • Vomiting

More women than men suffer from migraine, and it is common in children, teenagers and young adults but may begin at any age. Your genes are most likely responsible – no other single explanation has been found. Ways of treating a migraine include reducing lifestyle factors that can trigger it, using a ‘rescue medicine’ that relieves migraine attacks when taken at the first sign of migraine, and - if migraines are frequent – to take a preventative type of medicine, a ‘prophylactic medicine’, every day. If you are using ‘rescue medicines’ more than three times a month, talk to your doctor about taking a ‘prophylactic medicine’.

Cluster headaches

These are repeated, sudden, short-lived, usually one-sided and severe, frontal headaches (often ‘behind the eye’). They can recur many times over weeks or months and then the person may have a spell with no headaches. Men are more prone to these and, once diagnosed, treatment with ‘prophylactic medicines’ can help.

Chronic daily headaches

Some people have headaches daily or near daily for months and the headaches can be any of a number of types. A common factor in many people with daily headache is overuse of medicines for headache which in itself causes what is called a ‘painkiller headache’. This may sound unusual but overusing simple painkillers and other migraine drugs can trigger regular headaches.

Women and headaches

Migraine often happens around menstruation or at other regular times of the menstrual cycle and are called menstrual migraines. Non-migraine headache is also a common feature of pre-menstrual syndrome, with female hormone fluctuations influencing these headaches. The oral contraceptive, menopause and pregnancy also may affect migraine.

What pain relief is best for a headache?

Occasional tension headaches can be eased by medicines such as paracetamol, aspirin or ibuprofen. Some people find combination pain relievers work better, but it is important to be careful with these because if the medicine contains codeine, it can be addictive as well as having side effects. With paracetamol and ibuprofen, it is important to take the prescribed dose; take care if using cough-cold medicines at the same time as they also often contain these ingredients, and you could end up taking too much of an ingredient.

Children under the age of 16 should avoid aspirin entirely. Anyone with gastric, kidney, breathing or bleeding problems should consult their doctor before using analgesics that are also anti-inflammatory, such as aspirin and ibuprofen. Paracetamol causes few problems if doses are not exceeded.  Lifestyle changes also help prevent headaches. Getting more exercise, avoiding known stresses or triggers, improving your sleep and diet can all help.

Getting a headache checked

Most headaches are not a cause for concern but if they are occurring regularly, or suddenly develop and are severe, or if simple treatments do not seem to help then an  examination by your doctor can help provide a diagnosis and advice on treatments to minimise the impact on your life.

You should get a headache checked right away if:

       
  • you have a really severe headache ‘out of the blue’
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  • you were headache-free but now get them
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  • you have nausea, a stiff neck, rash, fever, shakes or are sensitive to light (warning signs of meningococcal disease or meningitis)
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  • you have lost sensation, control or strength
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  • your speech is slurred or vision altered
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  • you have confusion, fits or blackouts
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  • your headache follows a head injury
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  • your headache is triggered by standing up, coughing, straining, physical exertion or sexual intercourse
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  • you are over 50 and start to get regular headaches or there is face or jaw pain