headache-illustrationEvery head has its own headache. – Arab Proverb

In the literal sense, a headache is a nervous system disorder that refers to pain felt in the head region – above the eyes and ears as well as back of the head and upper neck. Frequently occurring headaches can become a disability leading to poor personal, social and professional quality of life. Also chronic headaches may be a symptom or indicator of other health conditions e.g. depression risk is three-fold higher in (otherwise healthy) people who suffer from regular migraine or severe headaches. The International Headache Society (IHS) classifies headaches into three categories: primary headaches, secondary headaches, and headaches caused by other causes such as cranial neuralgias and facial pain.

 What are primary headaches?

Migraines, tension-type and cluster-type headaches are the three major primary headache disorders. A tension-type headache (TTH), the most common type, is induced by tight muscles in the shoulders, neck, scalp and jaw which are caused by stress, depression or anxiety. It is experienced as mild pain that affects both sides of the head and is accompanied by strong pressure above the eyebrows. Other features of TTH are:

  • Begins during teenage years
  • Affects more women than men (3:2)
  • Causes are stress-related (such as overwork, sleep deprivation), dietary, alcohol-induced or some neck condition
  • Occurs in episodes that last for a few hours or several days

 A migraine is often experienced as a one-sided headache of moderate to severe intensity accompanied by nausea and throbbing feeling. It becomes worse with any physical activity. Other features of a migraine are:

  • Begins during teenage years, although mostly between 35 to 45 years
  • Affects more women than men (3:1)
  • Caused by the release of pain-producing inflammatory substances near the nerves and blood vessels
  • Occurs as recurrent attacks, once a week or once a year
  • Lasts for a few hours or 2-3 days
  • In children, attacks are of shorter duration with abdominal discomfort

 A cluster headache (CH) is rare with symptoms that include short but extremely severe headache along with severe eye pain, redness and tearing, runny or blocked nose and drooping eyelid. Other features of a CH are:

  • Begins after 20 years or older
  • Affects more men than women (6:1)
  • Occurs in 30-90 minutes episodes, or as a long-term condition, generally at the same time of the day
  • May have a genetic component
  • Causes include changes in sleep patterns, medications (e.g. nitroglycerin used to treat heart disease), smoking, alcohol, and some foods (e.g. chocolate)
  • Characteristics include restlessness, waking-up from sleep with worsened condition

What are secondary headaches?

This category of headaches is a result of structural head/neck complications, bleeding or tumors in the brain region, sinusitis, meningitis or encephalitis. Secondary headaches are further classified based on their cause(s):

  • Head and neck trauma (e.g. whiplash in a car accident)
  • Blood vessel disorders in the head and neck (e.g. stroke)
  • Non-blood vessel brain disorders (e.g. HIV/AIDS)
  • Infections (e.g. meningitis)
  • Multiple eyes, ears, nose, throat, teeth and neck disorders
  • Psychiatric disorders
  • Medications
  • Other health conditions (e.g. high blood pressure, dehydration, hypothyroidism, renal dialysis)

A medication-overuse headache (MOH), most common type of secondary headache, is caused by chronic and undue use of headache medicine. It affects more women than men and is experienced as an overwhelming pain that worsens in the morning.

Sometimes, facial pain or cranial neuralgia (nerve pain) causes headaches because of nerve inflammation in the head and upper neck region.

When is a headache more than just-a-headache?

Suddenly occurring and severe headaches or headaches accompanied by a stiff neck, fever, confusion, unconsciousness, eyes or ear pain should be considered as a warning sign of another health condition such as stroke or intracerebral bleeding. Diagnosing the underlying cause of such headaches can include blood tests, CT or MRI scans and lumbar puncture.

How are headaches treated?

Often headaches can be eliminated by lifestyle modifications and relaxation techniques with or without and pain relievers. Headache disorders are treated with several classes of drugs including analgesics or pain-killers, anti-emetics, anti-migraine medications, and prophylactic drugs. Frequently used over-the-counter (OTC) pain relievers include aspirin, ibuprofen, acetaminophen and naproxen.

Treatment options for cluster headaches include tryptan-containing medicines (e.g. Imitrex), local anaesthetics (e.g. lidocaine), vasoconstrictors (e.g. dihydroergotamine – causes constriction of blood vessels) and caffeine. Preventive measures are recommended and include calcium channel blockers, diltiazem, prednisone, antidepressants, lithium and topiramate (for seizure control)

A word of caution when popping pain-killers or analgesics

Most over-the-counter (OTC) medications have been linked to serious side-effects. Aspirin use is not recommended in children because of the risk of Reye’s Syndrome – leads to coma, brain damage and death. Aspirin and ibuprofen use can induce bleeding in the stomach and their use should be monitored in patients who have peptic ulcers or those who use blood thinners. Acetaminophen should be used with caution in patients with liver disorders or high alcohol intake, since it increases the risk of liver damage.

Overuse of such OTC pain relievers displays addictive characteristics such that stopping the medication leads to a rebound headache. These medicines also contain secondary chemicals that may be a health hazard e.g. caffeine (triggers fast heartbeats) or diphenhydramine (causes drowsiness).

Non-medicated treatment options

Headaches can often be treated with non-drug therapies such as lifestyle modifications (stop smoking and reduce alcohol use), relaxation and stress management techniques such as massage and biofeedback, acupuncture, herbal remedies (e.g. ginger), aromatherapy (e.g. essential oils of lavender or peppermint), dietary changes (identify and remove trigger foods e.g. chocolate, dairy) and supplements (e.g. omega-3 fatty acids).

Read more about causes, symptoms, diagnosis and treatment of stress.

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  • Mike

    Have to agree with the two previous comments. Very misleading.
    Mike OUCH UK..

  • Catherine

    Children suffer from cluster headaches too. Sometimes from a very young age, suggesting they are caused by medication, sleep, or drugs, and stating they occur from 20 years of age can lead to late or misdiagnosis.

  • Colin

    The section on cluster headache is completely misleading.The male/female ratio is 2-1 and not 6-1. Change in sleep patterns,smoking,alcohol and dietary issues are not causes of CH.Misleading information is more harmful than no information at all.