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Almost everyone will suffer from the occasional headache. However, if you are suffering with them frequently, this is known as a – headache disorder. What this essentially means is that you are suffering from headaches enough that they are affecting how you live, in one way, or another.
Around 5% of people will have a headache either every day, or almost once every day.
There are many different types of headaches, some with serious underlying health conditions. However, the vast majority are unlikely to cause you any harm.
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Primary headaches are ones which are not caused by an underlying health condition, and secondary headaches are ones caused by something else. There are lots of different types of primary headaches, but by far the most common ones are tension and migraine ones.
This is generally felt like a band across the forehead. This type can last for days and typically gets worse throughout the day. Usually, the pain is moderate, or mild. Still, it can sometimes be severe, with some people finding bright lights and noise uncomfortable.
Some causes of a tension headache include:
The best way to prevent a tension headache is to figure out what generally causes them for you, and to avoid that thing. For example, if you tend to get one every time you become very tired, try to practise good sleep hygiene.
Painkillers are often all that is needed for a tension headache. They may not entirely take the pain away, but they will lessen it so that the headache becomes tolerable.
Painkillers in the morphine class (opioids) are not recommended for the treatment of headaches. This is because the use of them can lead to something called a medication overuse headache.
The second most common type of headache is a migraine. Generally, people get “attacks” of migraines, meaning that it comes in episodes and then goes away. This type of migraine can last up to 72 hours.
Some people will suffer from chronic migraines. This is where someone has a constant headache with spikes of worse ones over three months. This can be very difficult to treat and may need the involvement of a neurologist.
Some of the most typical symptoms of migraine include:
Aura – this is generally the first thing people think about when they think of a migraine. It describes the symptoms that some people get before the headache part of their migraine starts. Not everyone gets an aura, in fact, it is more common to have migraines without one than it is to have one with them. Everyone experiences auras differently, and what you get may change over time. Some of the more common symptoms associated with an aura are:
Headache – this is generally on one side of the head. It can start on one side and then spread to the other. It is usually described as a “throbbing” at the front, or side of the head.
Nausea – you may feel sick.
Not liking any stimulation – bright lights and loud noises may increase the pain. Some people find lying in a darkened room helps.
Some symptoms which can occur, but are less common are:
There isn't a test that your doctor can do which will confirm if you’re suffering with migraines, or not. If your symptoms are “suggestive” of a migraine, and you have no concerning symptoms, then you will probably not need any tests.
Investigations used to aid in a diagnosis will be done to rule out other conditions, for example, an MRI head scan to rule out a brain tumour.
Treatment for migraines is aimed at the symptoms which you get during the event.
Painkillers which you can buy over-the-counter are the best for this type of headache, as stronger painkillers have no added benefit and come with a higher risk of side-effects. Please make sure you read the instructions on the box before taking any painkillers, and if you have any concerns at all, then speak with your doctor.
Aspirin has been shown to be helpful. If taken early, in some people, it can completely take away the pain.
If you have any bleeding conditions, or have ever had bleeding from your gut, then avoid using aspirin in this way and urgently talk to your doctor. Do not take aspirin with other anti-inflammatories.
There are other types of medication which can only be prescribed by your doctor.
Sometimes a medication called a Triptan can be prescribed by a doctor. This should be taken as soon as the onset of the migraine is felt, and it can stop the pain from developing further.
There are no medications which will completely stop you having a migraine.
There are however, a few different types which can be used to try and increase the amount of time between migraines. These medications have to be taken every day. The most common ones used are:
Beta-blockers – these are drugs that end in -olol, for example, bisopr-olol, or propran-olol.
They are also used to slow down people’s heart rate and reduce high blood pressure. If you have severe asthma, or usually have quite a low blood pressure, you may not be able to take these.
Anti-epileptics – some medications which are used for epilepsy can be used to prevent migraines.
Amitriptyline – this medication was first used as an anti-depressant. It is rarely prescribed now for this purpose, but is frequently prescribed for people who suffer with nerve pain. People who have problems with their heart, or are known to have seizures, may not be able to take amitriptyline.
There are a few common things which may trigger migraines in people who suffer from them. If you get them, trying to avoid these triggers may help reduce the frequency of your migraines. Common triggers include:
These headaches tend to affect men more than women. They can often be severe and disabling. People who suffer with this type of headache will sometimes have a red eye that waters a lot.
It is called a cluster headache, as it arrives in “clusters,” with people getting these headaches sometimes daily for a short period of time. They will then stop getting them for a while, though they frequently come back.
Treating cluster headaches involves particular painkillers which your doctor will prescribe and show you how to use. Standard painkillers do not work, as they take too long to absorb, and the pain will have gone by the time they are working. There are also medications which can be taken to try and reduce how often the headache returns.
Unfortunately, this type of headache is often caused by people taking painkillers for a long time such as paracetamol, ibuprofen and codeine, though pretty much any painkiller can cause it.
If you have been using painkillers for a long time, then your body responds by increasing the number of pain receptors. They become less and less sensitive to the medication and, after a while, some people will develop a chronic headache.
This type is very difficult to treat, and managing the headache typically means slowly decreasing the painkillers that you are taking.The headaches listed so far are the most common types of headaches which people get. There are plenty of other types of headaches, and you may suffer from more than one type. If you are suffering from frequent ones, speak to your GP.
When you go to a doctor about a headache, they will ask some very pointed questions. In medicine, these are called “red flag symptoms.”
Red flag symptoms are ones which may mean that there is a serious medical condition causing your headaches that needs urgent medical treatment.
Some of these symptoms are:
If you develop any of these symptoms, then you should call NHS 111. If the headache is present with any weakness in any part of the body, or an inability to walk, call 999 for immediate help. These symptoms could be signs that you are having a stroke.
Most of the time, people who suffer with headaches don’t need any further investigations. If you have any of the red flag symptoms listed above, then the investigations which you get will be tailored towards looking for what might be underlying those specific symptoms. There is no “one approach fits all” because each of the different types of headache requires different investigations.
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The Brain Charity is a UK based charity which is dedicated to people who suffer with migraines. They run support groups and have a wealth of information on their website. You can get to their website via this link.
The Brain and Spine Foundation is another UK based charity which is dedicated to helping people with neurological conditions. If you do not have a diagnosis as of yet, but are suffering from chronic, or debilitating headaches, they operate a helpline which you can call for support and advice. You can access their website by this link.
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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.
Aura – the odd sensation that people get before a migraine. People have similar sensations before having seizures when they have epilepsy, and this is also known as an aura. The symptoms which you get can be varied and may change over time.
Neurologist – a doctor who specialises in treating the nerves and brain.
Opioids – a class of painkillers which include morphine. Other common opioids are codeine, tramadol, and zapain.
