Headaches

What are headaches?

Headaches are pain that arises from the head or the upper neck of the body. The pain comes from tissues or structures that surround the skull or the brain because the brain itself has no pain fibres. The pain may be described as:

  • Dull
  • Sharp 
  • Throbbing

The pain may be

  • Intermittent or constant
  • Mild or Intense 

What are the types of headaches?

Broadly speaking headaches can be divided into 2 types;

Primary headaches where the pain is the main problem

Secondary headaches where the pain is a symptom of an underlying medical condition.

Primary headaches 

  • Tension headaches 

Tension headaches are the most common type of primary headaches, occurring more commonly in women than in men. It is a diffuse and dull, mild to moderate pain in the head that feels tight around the sides and back of the head. They may be episodic or chronic. 

  • Migraines

These are the second most common type of primary headaches. They affect both the young and adults. About 12% of people in the world, including children, get migraines. 

Migraines often present themselves as intense throbbing pain or a pulsing sensation. It is usually on one side of the head but can occur on both sides or shifts. Common symptoms, in addition to the pain, include nausea, vomiting, and sensitivity to light and sound. 

Migraines may come with or without aura. These are sensory changes that occur shortly before a migraine attack. Sometimes, an aura may also occur without a headache.

Common examples include: 

  • Blind spots (scotomas) 
  • Vision loss in part of one or both eyes 
  • Seeing zigzag patterns (fortification spectra) 
  • Seeing flashing lights 
  • Prickling, tingling, or numbness (paresthesia) 
  • Cluster headaches 

These are severe headaches that often occur in periods lasting weeks or months, termed as “cluster periods”. During cluster periods, sufferers experience frequent bouts of attacks that can last weeks or months. These are usually followed by longer periods of remission during which there are no headaches. 

Cluster headaches can have the following symptoms:

  • The excruciating pain is generally behind or around one eye, but may radiate to other areas of the face, head and neck 
  • One-sided pain
  • Excessive tearing 
  • Redness of the eye on the affected side
  • Stuffy or runny rose on the affected side 
  • Forehead or facial sweating on the affected side
  • Pale skin or flushing on your face 
  • Swelling around the eye on the affected side
  • Drooping eyelid on the affected side 

Secondary headaches 

These occur due to an underlying structural or infectious problem in the head or the neck. This is a broad category that includes dental pain from infected teeth, pain from an infected sinus, bleeds in the brain, or infections like encephalitis or meningitis. 

  • Traumatic headaches

Post-concussion headaches also fall into this category. 

  • Hangover headaches 

People who drink too much, often wake up the next day with a headache due to the effects of alcohol and dehydration. 

How are headaches diagnosed? 

Most of the time, headaches don’t require special diagnostic tests. The first step would be to give the doctor a history of the headaches that include descriptions of the symptoms and how frequently they occur. Give the doctor a list of what helps or worsens the headaches. The doctor may look for signs and symptoms of an illness that may be causing the headaches. 

Occasionally, brain scans such as computerised tomography (CT) scans or magnetic resonance imaging (MRI) scans may be used to take images of the brain to find out whether the headaches are caused by a serious underlying medical condition such as a brain tumour. 

How are headaches treated?

Most headaches that are tension-type are easily treated with over-the-counter medicines like 

  • Paracetamol ( Panadol)
  • Ibuprofen 

Treatment for migraines is aimed at relieving symptoms and preventing future attacks. Finding out your triggers and avoiding them would be effective at preventing migraines. Treatments for migraines include: 

  • Resting in a quiet and darkroom
  • Over-the-counter medicines such as paracetamol, ibuprofen
  • Prescription medicines such as triptans
  • Preventive medicines such as propranolol, amitriptyline, topiramate or cGRP inhibitors.