Understand Your Headache

There can’t be a person alive who has never had a headache and for some of us it’s more common than for others.  There is a lot written about headache and many thick medical books dedicated to it.

Chronic daily headache

Chronic daily headache affects about 4% of people and, while it may not occur every day as the name suggests, it is defined as a headache that occurs on more than 15 days each month.  There may be different types of headache – see below for descriptions – and there may be attacks of migraine as well.

Tension headache

Tension headache affects both sides of the head and gives a feeling of pressure or a band around the head.  It may occur with increased stress levels.

Medication overuse headache

Medication overuse headache.  If pain relief is taken every day for headache the body can get used to it and lower your tolerance to pain and causing rebound headaches when it’s not taken.  So the headache doesn’t have a physiological cause but a pharmacological one –with the treatment causing the problem.  If you need to take pain killers for headaches on more than 2 days in a week for 3 months or more, then ask your doctor for advice.

Migraine

Migraines come in 2 varieties – those with an aura and those without.

Common migraine (without an aura) is an intense, throbbing pain, commonly only to one side of the head and is often combined with one of more of these symptoms:

  • Nausea/vomiting
  • Increased sensitivity to light
  • Increased sensitivity to smell
  • Increased sensitivity to sound.

 

Classical migraine (with an aura) follows the same symptoms as above but the aura that precedes it is usually comprised of visual disturbances such as flashing lights, blind spots or zigzag patterns.  This lasts for 5 minutes to an hour and resolves before the headache starts.  There may also be tingling or numbness in the arms and legs or problems with coordination.

Migraine without headache occurs in about 1% of migraine sufferers and some may just have a mild headache after the aura. Children’s migraine is often characterised by stomach ache rather than headache, but has the nausea/vomiting that accompanies other types of migraine.  Stomach ache in adults is common too and is caused by gastric stasis – the stomach sits ‘still’ rather than moving its contents along the digestive tract – and is why it’s a good idea to take painkillers as soon as an attack starts.

Ophthalmic migraine is also rare and the pain is centred around the eye area, causing it to redden and water excessively.  There may also be a drooping of the lid, double vision, nausea and vomiting.

Hemiplegic migraine is rare and possibly has a genetic genetic.  There is temporary paralysis down one side of the body which can last for several days.  It may also involve vertigo or difficulty walking, blindness or double vision, hearing loss and difficulty speaking/swallowing.  All these symptoms mimic a stroke and can be very frightening for the patient.  In this hemiplegic migraine symptoms are all fully reversible.

Basilar artery migraine is caused by the spasm of the basilar artery at the base of the brain, affecting the blood supply.  It occurs in 1 in 400 migraineurs and can cause dizziness, double vision, fainting or even loss of consciousness.  Again, this is worrying for the patient but diagnosis and specific managements are available.

Cluster headache

Cluster headache affects less than 1% of the population but can occur in all age groups although it’s more common in men in the middle years of life.  Pain is intense and centred around the eye.  Attacks may be short-lived – lasting 10 minutes to 2-3 hours – but can occur frequently in a day and over a number of weeks.

Headache Treatments:

There are plenty of headache treatments that can be bought over the counter at the chemist. These include:

Aspirin: one of the family of non-steroidal anti-inflammatory drugs (NSAIDs) that relieve pain by reducing inflammation. Avoid them if you have a peptic ulcer, asthma or if the sufferer is under 12 years. And take them after food.

Ibuprofen is in the same NSAID family and should be avoided by the above groups as well as anyone with liver or kidney problems.

Paracetamol is a painkiller and also helps reduce fever. Avoid if you have liver or kidney problems.

Caffeine can help the painkiller absorption and some medications come in a combination with caffeine. Avoid if caffeine is a trigger or if you plan to sleep.

Codeine is an opiate drug (related to morphine) and used in small amounts in over the counter medicines. It can cause constipation and can be addictive.

Sumatripan is a drug specifically designed for migraine and aims to control the serotonin imbalance which causes it. It’s not suitable for everyone though, and shouldn’t be taken by anyone with uncontrolled high blood pressure, kidney problems, heart disease, under 18s or over 65s. If you’re pregnant or taking certain antidepressant drugs then talk to your pharmacist.

Take tablets with plenty of fluid and dissolving tablets (only dissolve them if they are formulated for this) work faster than non-dissolving ones.

The earlier the pain meds can be taken during an attack the better, not least because research has shown that a condition called ‘gastric stasis’ means that the stomach’s normal activity is slowed. This in turn slows the rate at which any painkillers are absorbed.

If over the counter painkillers or nausea meds aren’t working well enough then consult your doctor. Stronger NSAIDs are available on prescription as well as painkillers combined with anti-emetics.

In the UK http://www.bash.org.uk has more advice and in the US have a look at the headache pages at www.ninds.nih.gov.

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