Have a reoccurring headache? Here's what could be causing the problem
From mild tension headaches which don't usually disturb daily life to severe migraines which can be debilitating, Dr Muhammad Rizwan UdDin sheds some light on this common problem
1. Is your headache dull and achy?
Tension headaches are the most common type of headache and are what we think of as normal, "everyday" headaches. They feel like a constant ache that affects both sides of the head, as though a tight band is stretched around it.
A tension headache normally won't be severe enough to prevent you from doing everyday activities. They vary widely in frequency, usually lasting from between 30 minutes and several hours, but they can last for more than 15 days a month (chronic).
Tension headaches can usually be treated with ordinary painkillers such as paracetamol and ibuprofen. Lifestyle changes, such as getting regular sleep, reducing stress and staying well hydrated, may also help. Daily prescription medications, including tricyclic antidepressants, may manage tension-type headaches.
2. Is your headache throbbing and severe?
Migraines are defined as headaches that are moderate to severe in intensity, often on one side of head, and typically associated with other symptoms such as light sensitivity, nausea, or vomiting. They affect three times more women than men. Migraines are generally more severe and can be debilitating.
Many people with sinus headaches actually have migraine headaches. They can occur after a bout of upper respiratory infection, such as a cold. Along with the headache, people often have a runny or stuffy nose. Sinus headaches occur when bacteria invade and infect the nasal sinuses.
The cause of migraine is not known, but many trigger factors are recognised. These include hormonal changes, certain foods, beverages, strong odours, lack of sleep, and even stress. It is not uncommon to experience mixed tension-migraine headaches. Migraines are less common than tension headaches, and are divided into two categories: migraine with aura and migraine without aura. More often than not, no aura occurs before the headache.
3. Do your headaches recur for weeks at a time?
Cluster headaches occur in "clusters" or groups, with pain lasting from about 20 to 90 minutes at a time and continue for weeks. These headaches are rare, but most often affect men and smokers, and are characterised by redness or tearing of the eye on the affected side - or a drooping of the eyelid on the affected side - and a blocked or runny nose. Many people who are susceptible to migraines will also report eye strain, bad lighting, or flicker from a computer as triggers for these headaches.
Treatment options include injectable medications such as sumatriptan for quick relief during an attack; prescription triptan nasal sprays such as zolmitriptan or sumatriptan; oxygen therapy; and preventive medications such as verapamil.
5. Do you take pain medication on more than two or three days a week?
Medication-overuse headaches occur from overuse of pain-relieving medications for headaches for at least three months. They develop at least 15 days out of the month, and often occur along with chronic daily headaches. Taking pain medication several times per month can increase the risk of developing medication-overuse headaches.
A medication-overuse headache will usually get better within a few weeks once you stop taking the painkillers that are causing it, although your pain may get worse for a few days before it starts to improve.
9. Does your headache wake you from sleep?
Rare chronic daily headaches - including hypnic headaches - generally occur after the age of 50 and can wake you from sleep, earning the nickname the "alarm clock headache". Treating an underlying disease or condition often stops chronic daily headaches. If headaches aren't caused by another health problem, treatment focuses on preventive medication.
10. Are you suffering from caffeine withdrawal?
Caffeine headaches often happen in the morning because night time is the longest period that people go without caffeine, at least in the case of those who are really overdoing it. It's not a bad thing to try a cup of coffee to get rid of an occasional headache, if that works well for you, but if you have to do that very frequently (more than twice a week) you may want to seek additional advice or treatments.
When used too frequently, caffeine can become a cause rather than a treatment of headaches.
11. Does exercise bring on your headache?
Exercise or physical exertion can trigger a headache, resulting in a what is known as an exertional headache. Being in high altitude or exercising for quite a while may make these headaches more likely to occur. Some people who experience migraine also find that physical exertion can trigger a migraine attack.
One way to relieve pain might be to modify or switch the type of activity you're doing. Some people also benefit from taking anti-inflammatory medication about an hour before exercise. Most people who have occasionally had this type of headache recognise that they didn't warm up properly or engaged in a particularly hard workout.
12. Is it your hormones?
Headaches in women are often caused by hormones, and many women notice a link with their periods. The combined contraceptive pill, the menopause and pregnancy are also potential triggers. Reducing your stress levels, having a regular sleeping pattern, and ensuring you don't miss meals may help to reduce headaches associated with your menstrual cycle.
14. Other possible causes of headaches
Headaches can also have a number of other causes, including drinking too much alcohol, a head injury or concussion, and cold or flu.
Temporomandibular disorders, which are problems affecting the "chewing" muscles and the joints between the lower jaw and the base of the skull, are also triggers. Sinusitis - the inflammation of the lining of the sinuses - is another cause, along with carbon-monoxide poisoning and sleep apnoea, a condition where the walls of the throat relax and narrow during sleep, interrupting your normal breathing.
15. When you should seek medical help
Seek emergency evaluation if you experience a very severe headache, a sudden headache; a headache after a head injury or fall; fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking; or pain that worsens despite treatment. These symptoms suggest a more serious underlying condition, so it's important to get a prompt diagnosis and treatment.
* Dr Muhammad Rizwan UdDin is an Internal Medicine Physician at Beacon Hospital. He has broad range of expertise in the areas such as Migraine, Chronic Fatigue Syndrome/ME, and Pain Management. He also has special interest in Rheumatology
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