What is a headache?

Headache includes many types of head and facial pain. These vary in how severe they are, how long they last, how they feel, their causes, and how they respond to different treatments. The most common headaches are tension headache and migraine but there are many others. Most headaches are not a cause for concern but an examination by your doctor will help find effective ways to minimise the impact on your life.

Tension headache

Tension headaches are common. They can begin with shoulder or neck tension or sensitivity then a dull pain that feels like someone is tightening a band around your head
or blowing a balloon up inside your head. They can last for hours or days, sometimes for years.

It helps to learn to avoid the triggers for these headaches (eg, reduce stress, improve workstation set-up) and, if possible, remove yourself from the situation when a headache occurs; take a break or lie down and try using a simple pain reliever (analgesic).

Migraine

Migraine may be like tension headache but it is usually, 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 migraine takes hold.

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 mostly responsible – no other single explanation has been found. Migraine may cease with age but can return.

Three ways your doctor may be able to help are:

• to review and discuss lifestyle factors
• to find a ‘rescue medicine’ that relieves your migraine attacks – these work best when taken at the first sign of migraine and may be a simple pain reliever (analgesic) or a specific migraine drug (known as ‘triptans’)
• if your migraine is frequent, to prescribe a ‘prophylactic medicine’ to take every day.

If you are using ‘rescue medicines’ more than three times a month, talk to your doctor about ‘prophylactic medicines’.

Cluster headache

Cluster headaches 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 headache

Some people have headaches daily or near daily for months. The headaches can be any of a number of types. But a common factor in many people with daily headache is overuse of medicines for headache – this may sound odd but overuse of simple pain relievers and other migraine drugs can establish a regular pattern of headaches. To help your doctor, keep a diary of your use of medicines.

Women and headache

Migraine often happens around menstruation or at other regular times of the menstrual cycle (menstrual migraine); non-migraine headache is also a common feature of pre-menstrual syndrome. Female hormone fluctuations influence these headaches.

The oral contraceptive, menopause and pregnancy also may affect migraine; many women find migraine disappears during pregnancy. Oral contraceptives containing oestrogen may change migraine frequency and contribute to stroke risk in some settings.

How to describe your headache

• Where is the pain? - eg, one side or both, behind the eye(s), forehead
• How severe are they? - eg, on a scale of 1 to 10
• What do they feel like? - eg, vice-like, stabbing, throbbing, splitting
• How long do they last? - eg, minutes, hours or days
• How often do they occur? - eg, daily, monthly, only on weekends or weekdays
• When do they occur? - eg, on waking, in the afternoon
• When did they begin? - eg, childhood, middle age
• What triggers them? - eg, some foods, alcohol, caffeine, exertion, noise, bright light, hunger, stress, tiredness, weather
• What else do you feel? - eg, neck or shoulder tension, sinus pain, tender scalp
• Is your vision affected? - eg, blind spots, strange lights or patterns.

Pain relief for headache

Paracetamol, aspirin or ibuprofen are simple pain relievers (analgesics) that can ease occasional tension headache. Caffeine also sometimes helps. If analgesics are taken
soon enough, they can dispel migraine.

Some people find combination pain relievers work better, but it is important to be careful with these. The ingredient codeine can be addictive and has side effects. With paracetamol and ibuprofen, it is important to take the prescribed dose; take care if using cough-cold medicines as they also often contain these ingredients.

Children under the age of 12 (under 16 if they have a viral infection) should avoid aspirin entirely. Paracetamol causes few problems if doses are not exceeded but anyone with gastric, kidney, breathing or bleeding problems should consult their doctor about using analgesics that are also anti-inflammatory, such as aspirin and ibuprofen.

More information on over-the-counter (OTC) headache treatments

Talk to your doctor again if:

• headaches remain frequent, persistent or worsen
• you take simple pain relievers more than twice a week
• you get no relief from simple pain relievers.

Lifestyle changes also help prevent headaches. Getting more exercise, avoiding known stresses or triggers, improving your sleep and diet can all have considerable benefits.

Headaches needing urgent attention

You should get a headache checked right away if:

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

Original material provided by everybody, November 2010.