Headaches are incredibly common, affecting millions of people worldwide. While most headaches are mild and temporary, others can be severe and debilitating, significantly impacting daily life.
Understanding the types, causes, and treatments of headaches can help you to manage your symptoms effectively.
Here, Dr Salwa Kamourieh, a consultant neurologist, discusses common headaches, self-management strategies, and when to seek medical advice.
What is a headache?
A headache is a head or face pain lasting from a few minutes to several hours and is often described as a throbbing pain, an ache, a feeling of pressure, or sharp pain. Knowing your headache type can help you determine the best course of action.
Most headaches are known as primary headaches, which occur independently, without being linked to another underlying condition. However, headaches can sometimes be classified as secondary headaches, meaning they are associated with another health issue.
“Tension headaches”: The everyday headache
“Tension headaches” as they are often known, are very common and are often linked to stress or dehydration. These can last from 30 minutes to several days. They are described as feeling like a tight band around your head. The pain is mild to moderate around the forehead, temples, or the back of the head and not aggravated by movement. They don’t tend to impact everyday activity; however they can become chronic in rare cases, which can be disabling.
There are self-management strategies suitable for tension headaches. You could try to:
- Take breaks from screens and avoid eye strain
- Drink more water
- Use relaxation techniques like deep breathing or meditation and mindfulness
- Apply a warm or cold compress to your neck and shoulders
- Take over-the-counter medication (it is essential to discuss this with your doctor)
However, it is worth noting that taking painkillers more than twice a week can increase the risk of developing daily headaches.
Migraine
Migraine is among the most common reasons people seek medical help for headaches. If severe or frequent they can significantly impact daily life, preventing the person experiencing migraine from working, socialising, or carrying out routine activities. It usually lasts between 4 and 72 hours. Some symptoms can start 24 hours before the headache and 24 hours after it settles.
Typical migraine symptoms include:
- Moderate to severe throbbing pain (often on one side of the head)
- Nausea or vomiting
- Sensitivity to light and sound
- Visual disturbances
- Worsening pain with movement
Self-management strategies for migraine can include:
- Resting in a dark, quiet room
- Applying a cold/warm compress to your forehead
- Staying hydrated and maintaining a regular sleep routine
- Regular, moderate exercise (approximately 150 mins of exercise a week)
- Avoiding known triggers like caffeine or alcohol.
You can also take over-the-counter painkillers but remember to take them no more than two days a week to avoid worsening your headaches. If these simple measures are insufficient, you can speak to your doctor about other preventative treatments to stop headaches from occurring.
Cluster headaches: The most intense pain
Cluster headache, also known as ‘suicide headache’, due to their severity, is considered one of the most painful headache conditions a person can experience. It is rare, occurring in around 1 in 1000 people.
The main symptom of cluster headache is an excruciating headache on one side of the head, mainly around the eye. It can occur in clusters or cycles lasting weeks to months. The pain comes on quickly and is described as a burning sensation or as if something is boring into your head. People can also experience watery, red eyes, a blocked or runny nose, restlessness, or agitation. The attacks can last from 15 minutes up to three hours. Some people can have multiple attacks in the day. They tend to occur at night, often at the same time.
During a bout, avoiding alcohol and smoking can reduce cluster headaches. There are specific prescribed painkillers that can be used called sumatriptan injection, which you can inject from home at the start of an attack. Alternatively, some patients have a portable oxygen cannister which can be used when an attack starts. These options should be discussed with your doctor. Other treatments can be used to decrease the severity and prevent attacks.
When to seek help for your headaches
If your headaches start to interfere with your daily life or the self-management strategies no longer seem to work, you may want to seek the support of your GP.
It is advisable to keep a headache diary for at least a month before your visit to see if you can spot patterns (for example, if they seem linked to certain foods or hormonal changes in women). Record the length of each episode and score your pain from 1 to 10 so that your GP can get an overall sense of the problem. If you suspect your headaches are linked to your menstrual cycle, a three-month diary is recommended.
You should also send your GP a complete list of all medications that you are currently taking.
Your GP may suggest some modifications or offer you different medications. However, if these changes don’t help, you may be redirected to a neurologist.
At The National Hospital for Neurology and Neurosurgery, we can provide some of the most advanced treatment options for headaches and migraine, including:
- Medication, including new CGRP inhibitors and gepants for migraine relief
- Botox injections for chronic migraine
- Nerve blocks for headache
- Surgical procedures for specific conditions like trigeminal neuralgia, including microvascular decompression, Gamma knife radiosurgery and radiofrequency ablation.
Secondary headaches: When a headache signals something more serious
Most headaches are primary headaches, meaning they are not caused by an underlying condition. However, less frequently, secondary headaches occur due to other causes.
These could potentially be caused by:
- Severe high blood pressure
- Neurological conditions affecting the brain or its surroundings, e.g. meningitis
- Infections of the head and neck, e.g. sinusitis
- Head trauma – even a mild knock to the head can lead to headaches
- Brain tumour - Although rare, this is often accompanied by neurological symptoms, like changes to vision or speech.
- Blood vessel problems (aneurysms or bleeds) – If you have a sudden onset of a severe headache (often called "thunderclap headaches"), then there could be something else going on.
- Fluid imbalances around the brain causing pressure problems. Headaches can change depending on head position.
If you get any of these types of headaches, it is worth seeking immediate medical attention:
- A sudden, severe headache ("thunderclap headache")
- A change in headache that is significantly more severe than any before
- New headaches after the age of 50 years old
- Headache triggered by activity or sex
- Headache associated with seizures
- Headache in the presence of HIV or active cancer
- A headache after a head injury
- New or severe headaches in pregnancy
- A headache with vision loss, confusion, or difficulty speaking
- Headache associated with rash, weight loss, fever, neck stiffness.
You will need to make a personal judgement call whether you should seek help from your GP or go to the emergency department, based on a number of factors, including severity and regularity However, as a very broad rule of thumb, if your severe headache has come on suddenly, if you have any accompanying symptoms (e.g. blurred vision or loss of mobility) or if it is triggered by activity, then it is probably worth going directly to an emergency department.
Most headaches are treatable, and with the proper diagnosis, relief is possible. If you're experiencing persistent or severe headaches, don’t hesitate to seek help.
