Headaches

Headache is one of the most common ailments, affecting millions every day.  The symptoms and pain associated with the various types of headache can be difficult for a doctor to distinguish, making it hard to pinpoint exactly what the problem is, and the best treatment for it.

Dural Headaches are the most common type, resulting from autotoxicity or an excess of blood metabolites, such as from liver dysfunction or hangovers.

Almost everyone gets headaches, but not all headaches are the same.  Some are a mild twinge while others are so severe you cannot function.  There are different types of headache, each bought on by different causes and requiring a different treatment.

It is rare that a headache is the symptom of a severe disorder such as a brain tumor.  However, it does mean something is wrong, so it should not be ignored.  It is particularly important to seek medical help if your headaches are severe or keep coming back.

You don't have to just 'live with' headaches.  Effective treatment is available for all types of headache, even migraine.  By recording when and how your headaches occur, you can help your doctor diagnose and find the right treatment for them.

Incidence

Migraine (vascular) headaches affect one in eight adults in the developed world.  People of any age can suffer, although adults aged 25-34 are most commonly affected, and women two or three times as frequently as men.

Tension-type headache is the commonest form of headache with up to two-thirds of people experiencing it at some stage in their lives.

Temporal arteritis is not common, and often affects people over the age of 55.

Cluster headaches are rare, severe and mainly affect men.

Signs and Symptoms

Tension-type headaches are usually felt on both sides of the head; the pain is dull and persistent, varying in intensity.  It is often described as a feeling of pressure, heaviness or tightness in a band around the head.

Episodic tension type headaches can last from 30 minutes up to a week.  They usually occur infrequently, but can progress to what is known as a chronic condition, where headaches occur all the time, with sufferers enduring headaches of varying intensity all day, every day, and can be woken by them at night.

Generally, tension type headaches are diagnosed as being chronic when they are present for more than 15 days per month.  In this case, a sufferer will notice the headache at the start of the day, and it will remain as a dull ache throughout the course of the day.

Tension type headaches may be triggered by emotional or physical stress (eg.  an argument, fatigue, prolonged reading, dehydration or sitting for a long time with bad posture), or by environmental factors such as loud music.

A sinus headache usually occurs as a gnawing pain over or under both eyes.  It usually accompanies blocked sinuses caused by bad cold, flu or allergies and can be associated with a rise in temperature.  The affected area may be painful when touched.  The headache gets worse as the day goes on and increases in intensity if you bend forward.  Sinus headaches can occur at any time.

The sinuses are air-filled spaces in the facial bones around the nose, which are part of the respiratory system.  Sinus headaches are one symptom of sinusitis, where your sinuses become infected and inflamed.

The main migraine symptom is a moderate to severe throbbing pain, usually on just one side of the head.  This is often accompanied by nausea (feeling sick), cold hands, vomiting and sensitivity to light and sound.

A migraine where people suffer an 'aura' or warning, 10 to 30 minutes before the migraine begins, occurs in about 20% of cases.  The aura may take many forms: lines or spots before the eyes, total darkness, tingling or numbness in the limbs and speech impairment.  This can be a frightening experience.

Some 80% of migraines have no aura, although a few days beforehand you may feel irritable, lethargic and experience food cravings.  A migraine attack occurs on average once a month and usually lasts between 4 and 72 hours.

There is a wide range of possible triggers associated with migraine.  They include:

• bright or flashing lights irregular sleeping or eating patterns
• loud noises and strong smells sudden weather or altitude changes
• emotional factors, such as stress, fatigue or excitement.

Women may find fluctuating hormone levels (due to ovulation, menstruation, or birth control pills) are a contributing factor.  Your diet can also make you vulnerable to migraines: red wine, cheese, chocolate, nuts, soy sauce, citrus fruit, alcohol, excess caffeine (eg.  cola, tea, coffee) and some food additives (monosodium, glutamate, sodium nitrate) are all possible triggers.

The head pain caused by temporal arteritis is described as persistent, waxing and waning throughout the day, and may occur anywhere on the head, although it is often over the temples.  It may be severe, burning and throbbing in the early course of the disease and non-throbbing later.  Other symptoms are eyesight problems, mild fever, weight loss and jaw pain when chewing.  Temporal arteritis is caused by inflammation of the arteries which supply your head with blood.  See your doctor if you have these symptoms, or if you are over 50 years of age and develop a new, persistent headache as serious complications may develop and these can be avoided by prompt treatment.

Symptoms of cluster headaches include severe pain developing around or behind one eye, which usually occurs at nights and wakes the sufferer from sleep.  Congestion of the eye and nose on the affected side produces tears and nasal blockage and discharge on that side.

Cluster headache usually lasts between 15 and 90 minutes and can occur almost daily in groups or "clusters" for days or weeks at a time.  Then they may disappear for a year or more.  There is some evidence that excessive smoking and /or alcohol consumption can trigger an attack.

Treatment and Prevention

For tension-type headaches, useful lifestyle changes include combating stress by keeping fit, getting regular sleep and exercise and eating a balanced diet.  Some people find that learning specific relaxation techniques or posture improvement techniques such as yoga or meditation are effective because they tech you to relax your mind and your body, particularly during time of stress.

Episodic tension type headaches are best treated with mild, over-the-counter analgesics such as aspirin or paracetamol.  If the headache continues, you should take a shower or bath, apply a warm compress to your forehead and get some sleep.

If your headaches occur daily and are diagnosed as being chronic tension type headache, your doctor may prescribe tricyclic antidepressants which have been shown to be useful in this condition and which may also be useful for any associated depression.

For sinus headaches, lifestyle change include: If possible stay indoors in a room with an even temperature, as a dry overheated environment could make your high temperature and nasal congestion symptoms worse.  Steam inhalation may be useful to try and clear the sinuses.

Medication: Take aspirin or paracetamol to relieve the headache.  If your symptoms persist, you may need to see your doctor to be prescribed a broad spectrum antibiotic to combat the sinus infection and possibly a nasal decongestant to unclog your nose.  If your sinusitis does not clear up, you may need to undergo a minor operation to remove any obstruction from your sinuses.

For migraines, lifestyle changes include: Learn to recognize if there are 'triggers', so they can be avoided.  Keeping a diary will help by highlighting suspect events, moods or foods.  Given that stress is one of the most common triggers for migraines, relaxation such as yoga or meditation may be helpful.

However, only a minority of people with migraine can clearly identify what triggers their attacks and even if triggers can be identified, they can not always be avoided.  Support organizations such as the Migraine Foundation of Australia that will provide further information about lifestyle changes you can make to help manage migraine.

Medication: Until recently, doctors were relatively limited in managing migraine.  However, modern medicines are now available that can help minimize the disruption migraine makes to your everyday life.

Mild migraine pain can be treated with analgesics (eg.  aspirin, paracetamol), antihistamines and anti-emetics (to combat nausea).

If you suffer two or more migraines a month, your doctor may prescribe preventative medication, which is used when migraines are severe or frequent enough to disrupt your life.  This continuous, daily medication should help you to reduce the number of migraines and may eliminate them altogether.

For moderate or severe attacks which are not too frequent, you may prefer effective, on-the-spot acute treatment rather than daily preventatives.  In this case, medications such as sumatriptan or ergotamine can effectively reduce the severity and the duration of migraine pain and its associated symptoms.

Once diagnosed, long-term management of temporal arteritis can prevent recurrences.  If your symptoms are suggestive your doctor will perform a blood test and possibly a biopsy (the removal of a small piece of tissue under local anaesthetic for testing).  Prompt and appropriate anti-inflammatory medication is essential to reduce the inflammation of the affected arteries and protect eyesight.

The migraine medication sumatriptan has proven effective in injection form for treating cluster headache.  Pure oxygen inhalation is also used to alleviate an attack.

Seek medical attention if...

Some migraine sufferers (about 10%) also sufferer from tension headaches.  It is important to keep an accurate record of the exact symptoms and triggers for all your headaches so that your doctor can see if you fall into this category and treat you accordingly.  See you doctor if:

• your headache lasts more than 24 hours or they occur more than three times a week
• you are woken by headaches, or they are worse in the mornings
• your headache starts when you exercise, strain or cough
• your headache gets progressively worse over several days.

See your doctor if sinus headache symptoms persist for more than a couple of days.

See your doctor if you think you might be suffering from migraine or if you are not satisfied with your current migraine treatment.  If you have been suffering from migraine for years, there may now be more effective treatments available.