Headaches are among the most annoying health problems out there. But apart from being a nuisance, they could point to something more sinister. When should you worry about headaches?

There’s nothing quite like a throbbing headache to ruin your day. The pain makes concentrating on that spreadsheet (or your date!) a nightmare, and the pills you’ve been popping only vaguely dull the skull-crushing pressure... Bluh.

A staggering three quarters of the world’s adults experience some form of headache during their lifetime. While most people will only get minor headaches from time to time, sudden headaches could be a sign of more serious trouble, such as stroke, a tumour or a blood clot. Other headaches could point to a specific headache disorder, which means they have to be treated in a very specific way.

Three common headache disorders
If you get headaches repeatedly, or to such an extent that they have a significant impact on your quality of life, you may have a headache disorder, says Dr Elliot Shevel, a maxillofacial surgeon, and founder and chairman of the International Headache Society’s South African branch.

Luckily, we live in an age where much research has been done on headaches. New treatment approaches also mean there’s much hope for those of us who need to keep sharp throughout the day.

“Growing scientific interest has helped people better understand the different types of headaches.

This is always a good starting point in identifying the underlying cause of the pain,” Dr Shevel says.

According to him, there are three main types of headache disorders:

    • Tension - type headaches (most common)

    • Migraines (second most common, very painful)

    • Cluster headaches (third most common, very severe)

Knowing which type of headache you have can remarkably increase your chances of successful treatment.

1. Tension headaches
Tension headache is the most common type of headache, and yet its causes aren’t well understood. These headaches generally present with mild to moderate pain, and it may feel like you have a tight band wrapped around your head.

“These types of headaches can last from 30 minutes to a week,” says Dr Shevel, adding they can become chronic once they start occurring 15 or more days a month for at least three months. “They are also sometimes hard to distinguish from migraines since patients with chronic tension headaches are very likely to also experience migraines.”

In developed countries, such as Australia, tension-type headaches affect over one third of men and over a half of women, according to the World Health Organization (WHO).

Signs and symptoms of this type of headache include, but are not limited to:

    • A feeling of tight pressure across the forehead, back of and sides of the head.

    • A tender scalp, as well as tender neck and shoulder muscles.

    • A dull, aching head pain.

These headaches are often treated with a balance of healthy habits, finding effective non-drug treatments (such as acupuncture or relaxation techniques) and using prescribed medication appropriately by reading labels and following your doctor’s instructions.

2. Migraines (with and without an aura)
Second-most common among the three types of headaches, migraines cause severe pain that can range from a few hours to a few days. Some people may experience a sensory warning (aura) just before a migraine hits.

The intense throbbing or a pulsing sensation of migraines in one area of the head is commonly accompanied by nausea, vomiting and high sensitivity to light and sound.

Other signs and symptoms of this type of headache include, but are not limited to:

    • Irritability (before the migraine)

    • Hyperactivity (before)

    • Food cravings (before)

    • Stiff neck (before)

    • Speech or language problems (during a migraine)

    • Seeing shapes, spots or flashes of light (during)

    • Vision loss (during)

    • Pins and needles in arms or legs (during)

Although migraines can’t be cured, your specialist can help you manage your condition with medication specifically designed to treat these headaches. These drugs fall into two categories:

    • Pain-relieving medication – these can help stop symptoms and should be taken during attacks.

    • Preventive medication – these should be taken regularly, as prescribed, and can help to reduce severity and frequency of migraines.

3. Cluster headaches
Cluster headaches can be incredibly severe and painful, and typically occur in cyclical patterns or clusters, hence the name. “The pain is so debilitating that this headache is also known as ‘suicide headache’,” says Dr Shevel, noting that an estimated 10,000 suicide attempts in the USA have been linked to cluster headaches.

Fortunately, they’re also rare and not life-threatening.

As clusters start suddenly and seldom last long, they’re difficult to treat and tend to respond poorly to medication. Since they can’t be cured, treatment focuses on reducing how often they occur, how severe the pain is, and how long the headaches last.

Some of the classic symptoms of a cluster headache may include:

    • Stuffy nose (nasal congestion) followed by runny nose.

    • Reddening of the eye with tears – on the same side as the pain.

    • Widening or enlargement of the artery in the temple on the affected side, which can be seen or felt.

    • A droopy eyelid and constriction of the pupil (pupil gets smaller).

    • Extreme sensitivity to light.

    • A red or flushed face.

If headaches do occur, the following may help:

    • Use the medication or treatment your doctor has recommended as early as possible. The sooner you can treat the headache, the less painful it will be.

    • Try to focus on the end of the attack. Cluster headaches are extremely painful but generally don’t last long.

    • Pacing the floor or rocking in a chair provides temporary relief.

Common headache causes and triggers
There a wide range of triggers and causes of headaches. Importantly, the two shouldn't be confused. According to Headaches.com.au, pre-existing conditions that can cause headaches include:

    • Ear problems

    • Dental and jaw conditions

    • Nose and throat conditions

    • Conditions of the nerves and brain

    • Eye problems

    • Poor diet

    • Injury or strain to the neck or back

    • Eye problems

Triggers, on the other hand, are factors that may kick-start a headache in susceptible people. A few examples of triggers include:

    • Foods such as chocolate, wine or cheese

    • Environmental factors such as bright light, noise or heat

    • Stress

    • Hormonal fluctuations (e.g. during menstruation)

    • Dehydration, especially during a hangover

When to see a doctor
Headaches sometimes point to serious disease or a chronic problem. Dr Shevel, along with experts from the Harvard Medical School, says it’s best to seek medical care if your headaches:

    • Occur more frequently than usual.

    • Are more severe than usual.

    • Worsens or don’t improve with over-the-counter drugs.

    • Impact your quality of life and causes distress.

    • Prevents participating in normal activities.

    • First develop after age 50.

    • Get worse if you move or cough.

    • Are accompanied by changes in personality or mental function.

    • Are accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness or seizures.

    • Are accompanied by a painful red eye.

    • Are accompanied by pain and tenderness near the temples.

    • Follow a blow to the head.



- Harvard Health Publications http://www.health.harvard.edu/pain/headache-when-to-worry-what-to-do
- Dr Elliot Shevel: maxillofacial surgeon, founder and chairman of The Headache Clinic www.theheadacheclinic.net
- WHO Headache Disorders http://www.who.int/mediacentre/factsheets/fs277/en/


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