Headaches are very common, it can be mild in the background and not intrusive or can be severe enough to interfere with daily activities. Many people treat themselves with simple painkillers, drinking extra water, having a rest, or simply by waiting for the headache to go away. It is a common reason for which people see their doctors.
Almost everyone will experience headaches at some time. Most headaches are not caused by serious or sinister conditions. However, people understandably worry if headaches seem different (either particularly severe, particularly frequent or unusual in any other way) and the commonest worry is whether their headache is a symptom of brain tumor.
Our discussion here is focused on headaches generally. It explains the different types of headache you may experience and describes those very rare situations where a headache is, in fact, a symptom of serious disease.
Types of Headache.
Headaches can occur on their own and they have no specific cause or they are a side-effect of a separate illness or injury or occur as a symptom of an underlying cause. Once you are able to work out the cause of your headaches (usually with the help of your doctor) then you will be able to decide how to reduce or stop the headaches. This may involve taking medication only when you get the headaches, taking daily medication to prevent them or, sometimes, stopping medication you are already taking. Very occasionally, headaches need further investigation to rule out more serious underlying causes.
About 90% of the time, headaches occurs on its own with no serious underlying cause and though distressing are usually harmless. Commonest headaches are Migraines, Tension headaches and Cluster headaches and these usually occur on their own without any underlying causes.
This tops the list of headaches. It typically feels like a tight band around the head and is due to the muscles of the scalp going into spasm in reaction to stress. They can last for several days. . They can be uncomfortable and tiring, but they do not usually disturb sleep. Most people can carry on working with a tension headache. They tend to worsen as the day progresses and are not usually made worse by physical activity. The story about the man who was cured of ‘tension headaches’ when his doctor told him to buy a larger hat may be an urban myth, but it gives you some idea of what it feels like.
Cluster headaches are very severe headaches, sometimes called ‘suicide headaches’. They occur in clusters, often every day for a number of days or even weeks. Then they disappear for months on end. They are uncommon and tend to occur particularly in adult male smokers. They are severe, one-sided headaches, which are really very disabling (they prevent regular activity). People often describe them as the worst pain they have ever felt. Patients often have a red watery eye on the affected side, a stuffy runny nose and a droopy eyelid.
Migraines are also very common. A typical migraine is one-sided and throbbing. Indeed, headaches that are one-sided, headaches that throb and headaches that make you feel sick are more likely to be migraines than anything else. Migraines are often severe enough to be disabling. your eyes can go funny, with zigzag lines, flickering lights or blind spots. It’s disabling Some patients need to go to bed to sleep off their headache.
Chronic Tension Headache.
Chronic tension headache (or chronic daily headache) is usually caused by muscle tension in the back of the neck and affects women more often than men. Chronic means that the condition is persistent and ongoing. These headaches can be started by neck injuries or tiredness and may be made worse by medication overuse (see below). A headache that occurs almost every day for three months or more is called a chronic daily headache.
Medication Over-use Headache.
Sometimes called ‘medication overuse headache’ results when people get into a vicious cycle of taking headache treatment but the medication itself can make the headache worse. Painkillers are often the cause but a lot of other types of medication taken for headaches may also be involved.
Exertional Headaches/Sexual Headache
Exertional headaches are headaches associated with physical activity. They can become severe very quickly after a strenuous activity such as running, coughing, having sex (intercourse), and straining with bowel movements. Headaches related to sex can particularly be worrying for those involved. They can occur as sex begins, at orgasm, or after sex is over. Headaches at orgasm are the most common type. They tend to be severe, at the back of the head, behind the eyes or all over. They last about twenty minutes .
Exertional and sexual intercourse-related headaches are not usually a sign of serious underlying problems. Very occasionally they can be a sign that there is a leaky blood vessel on the surface of the brain. Therefore, if they are marked and repeated, it is sensible to discuss them with your doctor.
Other common causes of headaches are dehydration, drinking too much alcohol or caffeine, carbon monoxide poisoning, sinusitis (infection of the air spaces in the skull), Glaucoma (In this condition the pressure inside the eyes goes up suddenly and this causes a sudden very severe headache behind the eye. The eyeball can feel very hard to touch, the eye is red, the front of the eye (cornea) can look cloudy and the vision is usually blurred.
Generally, simple painkillers like paracetamol and ibuprofen when safe to do so helps settle most headaches. But for specific headaches, there are other specific preventative and relieving medications that work even better to reduce the impact of these, on everyday living.
Consult your doctor for specific medications tailored to the type of headache you may have – especially if recurrent.
When should I be worried about a headache?
- You have had a significant head injury in the previous three months.
- Your headaches are worsening and accompanied by high temperature (fever).
- Your headaches start extremely suddenly or you have stiff neck with it.
- You have developed problems with speech and balance as well as headache.
- You have developed problems with your memory or changes in your behaviour or personality as well as headache.
- You are confused or muddled with your headache.
- Your headache started when you coughed, sneezed or strained.
- Your headache is worse when you sit or stand and /or present when you wake up in the morning.
- Your headache is associated with red or painful eyes.
- Your headaches are not like anything you have ever experienced before.
- You have unexplained vomiting with the headache.
- You have low immunity – for example, if you have HIV, or are on oral steroid medication or immune suppressing drugs.
- You have or have had a type of cancer that can spread through the body.
- Your headache is often associated with pain in the scalp as you comb your hair and often associated with pain on chewing
The above may be a symptom of an underlying serious and dangerous causes of headache such as Subarachnoid haemorrhage (bleeding around the brain), Meningitis and brain infections, Temporal arteritis. (inflammation of blood vessels in the skull and behind the eye) and Brain tumors amongst others so these symptoms should prompt an urgent visit to the doctor.
If you have a headache which is unusual for you then you should discuss it with your doctor. You should also talk to your doctor about headaches which are particularly severe or that stop your regular activities, those which are associated with other symptoms like weakness or tingling, and those which make your scalp sore (especially if you are over 50 years of age). Finally, always talk to your doctor if you have an unremitting morning headache which is present for more than three days or is getting gradually worse.
Remember that headaches are less likely to occur in those who:
- Manage their stress levels well.
- Eat a balanced, regular diet.
- Take balanced regular exercise.
- Pay attention to posture and core muscles.
- Sleep on two pillows or fewer.
- Drink plenty of water.
- Have plenty of sleep.
Anything that you can do to improve any of these areas of your life will improve your health and well-being and reduce the number of headaches you experience.
Remember if in doubt consult your doctor.
References: patient.co.uk, International headache society (IHS). GP notebook.