Understanding Headache - What should be done when you get a headache?

Headache is one of the commonest causes for visits to the out patient departments (OPD) of the hospitals and the primary care physicians accounting for 22 consultations per 1000 population per year in the UK. Tension headache, one of the commonest forms of headache is said to affect 86% of women and 63% of men every year.  It is often incapacitating but only rarely is it caused by a potentially serious illness. As it is so common, it is often ignored and reassured even when it is a symptom of a sinister disease. Therefore, it is important to know about headache and when to go to a doctor seeking treatment.

For the convenience of understanding headaches can be classified into several groups.

1.       Acute single headache

2.       Recurrent headaches

3.       Triggered headaches

4.       Dull aches increasing in severity

5.       Dull aches persisting for months

Acute single headaches are the commonest of all and most of the time, are benign. The commonest causes of a single episode of headache include benign (harmless) causes like tension headache, headache associated with fever, sinusitis and first attack of migraine and sinister (harmful) causes like injury to the head, intra-cranial haemorrhage, stroke and meningitis. The commonest cause of recurrent headaches is migraine. In addition, cluster headaches, episodic tension headaches and certain neuralgic syndromes (e.g. – trigeminal neuralgia and post herpetic neuralgia) can give rise to recurrent headaches. Triggered headaches are almost always due to migraine with the triggering factors being exertion, stress, relief from stress, certain items of food such as cheese and chocolate, travelling and sexual intercourse. Dull headaches increasing in severity are also benign most of the time and may be due to any cause of pain in the head and neck region (e.g. – neck pain, tooth aches) but can be due to sinister causes such as temporal arteritis which can lead to irreversible blindness and brain tumours. Dull aches not changing in severity are the chronic tension headache and the headaches associated with depression. How to recognize the sinister headaches is dealt with in a separate article by the author and here the readers are given glimpse of some common types of headaches seen in day to day life. Migraine being a disease that is common but difficult to treat is dealt-with in a separate article.

Tension-type headache

Most are seen to suffer from attacks of non-throbbing headache occurring simultaneously on either side of the head. Even though this is not as incapacitating as migraine, about 5% of those affected are seen to have a continuous, chronic headache. Most never seek medical advice and depend on over-the-counter analgesics. Investigations are almost always unnecessary. Many of the patients who present for medical care are taking analgesics (e.g. ergotamine, codeine, caffeine) on a daily basis, and it is now proven that their headaches often settle when theses drugs are withdrawn – suggesting that the analgesics are the cause for the headache. In some patients, headache may be due to the contraceptive pill or hormone replacement therapy (HRT). Others (particularly those with chronic headache) are overtly depressed, and are often cured completely with tri-cyclic antidepressants (e.g. – Amitriptylin). However, current practice is to minimize the use of medication as much as possible in chronic tension headache though analgesics like paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (e.g. – diclofenac sodium, aspirin) may be used. Reassurance of the patient is an important part of the management and advice to reduce the level of stress and avoidance of unhealthy postures may be important.

Sinusitis

Headache and facial pain are commonly seen in acute viral infections such as the infection with influenza. A single episode of severe headache following a common cold may be caused by secondary bacterial infection in the frontal or maxillary sinuses. Patients may experience pain and tenderness over the sinuses and a post-nasal drip and bad odor of breath may suggest the presence of the illness. This can be confirmed by skull radiography and usually resolves with oral antibiotic treatment.

Cluster headache

Cluster headache syndromes are less common than migraine. Being commoner among men unlike most other types of headaches, episodes of unbearably severe, steady pain, usually in the eye, cheek or temple on one side only, may be experienced lasting between 30 minutes and 3 hours, often several times daily. Patients are usually seen to wakeup from sleep, due to the severity of pain. The episodes are often accompanied by autonomic disturbances such as drooping of eyelids, excessive tearing from one eye, redness of one eye and watering or blockage of the nostril on that side. In most of the patients, the pain occurs daily for 6–12 weeks, after which there is a remission that may last from 3 months to 2 years before recurrence of a similar episode. Investigations are often unnecessary if the history is suggestive, although the syndrome is occasionally mimicked by structural disturbances in the pituitary gland or cavernous sinus.Therefore atypical patients should undergo CT or MRI of the brain.

Management of cluster headaches is difficult. Inhalation of 100% oxygen and subcutaneous sumatriptan, or sumatriptan or zolmitriptan administered by nasal spray may be effective. However, prophylactic treatment is the mainstay of management; verapamil is the drug of choice of choice, though patients also respond to lithium carbonate,  ethysergide and gabapentin. Corticosteroids (e.g. –prednisolone) are effective, but perhaps to be recommended only in patients in whom previous experience suggests that the cluster is likely to end within 2 or 3 weeks. Surgical destruction of the trigeminal nerve can be implemented in those who fail to respond to other modalities of trement.

Trigeminal neuralgia

Trigeminal neuralgia is commonly seen in old age. The pain is thought to be caused by compression of the trigeminal nerve by an abnormally placed artery at the point the nerve leaves the brainstem. The compression may also be due to a plaque of multiple sclerosis or an aneurysm in the arteries. The pain is described as severe, knife-like, lasting only 1 or 2 seconds, and being confined to the distribution of the trigeminal nerve on one side, especially over the cheeks (maxilla) and the mandible. Attacks are often triggered by chewing, eating, speaking or touching the face, or even by the wind. Carbamazepine and gabapentin are often effective in most of the patients though ablation of the nerve or corrective neurosurgical procedures to wrap the artery or an aneurysm if present may be necessary.

Atypical facial pain

Atypical facial pain is less well localized in the face unlike trigeminal neuralgia which is well localized. The pain often lasts longer and may be continuous. All other causes of headache and facial pain should be excluded before arrival at the diagnosis and it is important for the patient to be screened by a dental surgeon, ENT surgeon and ophthalmologist. Many patients with atypical facial pain are depressed, and therefore tri-cyclic antidepressants are effective in the treatment.

Other causes of headache

Paget’s disease of the skull is an uncommon cause of headache in older patients. Although chronic hypertension can give rise to headache, especially when diastolic blood pressure exceeds 140 mm Hg, it is a rare cause of headache. In contrast, paroxysmal hypertension, which may be caused by phaeochromocytoma, and severe hypertension may present with a severe headache associated with vertigo.

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Comments 28 comments

maxravi profile image

maxravi 5 years ago from India

Thanks for your hub, got to know lot of new things.well when I had headache, i used to take medicine and sleep :)


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Thank you for your comment maxravi!! Glad to hear that it was useful.


bwhite062007 profile image

bwhite062007 5 years ago from East Coast

Useful hub! I am suffering from a tension headache as I read this and do often look to OTC medication and caffeine to help. I do notice sometimes when I do not have caffeine...boom, another headache.


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Dear bwhite06007,

Your headache might be precipitated by some cause like stress at work, disturbances in eye sight or a neck pain due to poor posture. Try to find out the cause and avoid that. Hope that would save you from excessive use of caffeine and OTC meds.

Thank you for you comments and you are always welcome!


PenMePretty 5 years ago from Franklin

Is there a doctor in the house? Yep, and a very good one!

Thank you for all the helpful/useful information. I think

I have had all of these headaches at one time or another.

On occasion, maybe all of them at once. LOL Right now I am living in Sinus Valley (Miami Valley, Franklin, OH). Thanks for taking the time to write this hub for us. I bet everyone can relate. Looking forward to following

you. I voted useful/interesting. Best wishes!


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Thank you for your comments and votes PenMePretty!! Glad to hear that this was useful.


Ramzeed profile image

Ramzeed 5 years ago from Maryland

Thanks for the helpful information


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Thanx Ramzeed!! I'm so glad to hear that the article was useful!


Rosemay50 profile image

Rosemay50 5 years ago from Hawkes Bay - NewZealand

A very good hub. One I can relate to as I suffer a lot with Sinusitis. nothing seems to do any good except for antibiotics


Apostle Jack profile image

Apostle Jack 5 years ago from Atlanta Ga

You brought a good message.Very informative.


Injured lamb profile image

Injured lamb 5 years ago

Informative hub. Headache does attack me almost everyday if not four to five times in a week...terrible huh? Yup, I am under tension and migraine type due to too much invisible stress and not enough sleep may be...always "saved" by the pain-killer, but it improves a lot after I have "thrown" myself to do exercise...


mslizzee profile image

mslizzee 5 years ago from Buncombe County, NC

Good article. I had severe headaches for 30 years until one day, just by circumstance I discovered I was severely allergic to SOY. This started some research on my part and I discovered that there are very few items in the market that do not contain SOY, even recently I discovered it was in Bumblebee and Starkist Tuna. Why on earth would they put Soy in tuna fish cans? Well because there is a very large, very evil company called MONSANTO, The creators of such things as Agent Orange, and Roundup Insect killer, that makes GENETICALLY MODIFIED SOY. Around 90% of the soy in our food is Genetically modified. The process involves the use Hexane, which is a neurotoxic petrochemical solvent that is listed as a hazardous air pollutant with the Environmental Protection Agency (EPA). YET THE FDA ALLOWS IT TO APPEAR IN ALMOST EVERY SINGLE FOOD PRODUCT IN THE STORE. CHECK THE LABELS

Over the years I've concluded that our doctors are unbelievably uneducated in the matter of nutrition. All I had to do was avoid SOY and the headaches went away. I did not need medicine, drugs or anything else, just a doctor with the God given sense to suspect FOOD ALLERGY.

How many kids do you suppose are allergic to Soy that is in Peanut Butter? Well, if they were aware they would switch to a peanut butter that is natural and stay away from Skippy and those with the dreaded Hexane in it.

See what a rant I go on when the subject of food comes up. I can't help myself.

People, please, check the labels on your food. SOY IS NOT THE ONLY DEVIL. ALL SWEETENERS ARE POISON.Splenda, Sweet and Low, Aspartame, ALL OF THEM.. . . .Try Stevia. It is make from a leaf and no evil processing, NO chemicals.

Americans are poisoning themselves with their food. The incidence of disease in our children is increasing. ADD, diabetes, etc, etc, etc IT'S THE FOOD.

Lizzee

INJURED LAMB, ARE YOU LISTENING?>???


SubRon7 profile image

SubRon7 5 years ago from eastern North Dakota

Good hub, Nadeeshan. I used to get "hangover" headaches far back in my drinking days. Now sometimes I get a short term headache from maybe sleeping wrong. Good hub, and thanks for the follow.


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Dear Rosemay50,

If you suffer from sinusitis very frequently, there might be a structural problem in your nasal cavity which is easily correctable these days and which makes you free from sinusitis once corrected.

Thank you for the comment and I'm very glad that this hub was useful to you!!


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Thank you Apostle Jack!!


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Dear Injured lamb,

Your headaches are too frequent to be migrainous attacks alone. Seems like you are suffering from a tension type of headache.

I advice you to revise the posture you are maintaining while at work and while being online. The upper limbs should be allowed to drop free and bent at 90 degrees at the elbow to reach the keyboard of the laptop or your PC.

At the same time check your eye-sight. These are the commonest causes of tension headaches occurring quite frequently.

Thank you for your comments and you are most welcome for future comments and questions!!


jill of alltrades profile image

jill of alltrades 5 years ago from Philippines

Very useful hub! Thanks for sharing!


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Dear mslizzee,

Soya is a well known precipitant of migraine in susceptible individuals and I guess unluckily you are one of them. For such individuals there is no option other than to avoid consumption of any products containing soya. However, up to date there is no scientific evidence to suggest genetically modified food substances are adversely affecting health. FDA has given the approval to such food items after a thorough review of hundreds of scientific research carried out on the subject.

Anyway, only a couple of decades have passed after the introduction of genetically modified food in large quantities to the market. Scientific community is not yet aware of long term effects of genetically modified food. So, the decision to consume such products or not is up to each individual.

Thank you for your comment and compliments! You are always welcome for future comments and questions!


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Dear SubRon7,

Thank you for the comment and your compliments!!


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Thank you jill of alltrades!! Glad that the hub was useful!!


dilipchandra12 profile image

dilipchandra12 5 years ago from India

Amazing hub, really very good information you have provided. I really appreciate your work, I've learnt many things from the above. Thanks you, Voted Up...


Brett.Tesol profile image

Brett.Tesol 5 years ago from Somewhere in Asia

Good and informative hub, voted up and useful.

My main causes of headaches are from using the computer (should muscles causing the headache), or sometimes the classic office stress headache.

Thanks for sharing.


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Thank you dilipchandra12, glad to hear this hub was informative to you!


Nadeeshan301 profile image

Nadeeshan301 5 years ago from Kandy - Sri Lanka Author

Thank you Brett.Tesol, glad that this was useful. The muscle pains you have can be easily reduced by maintaining a proper posture while using the computer.

You should be seated in a chair with the spine straight and the monitor should be placed slightly low to your eye level with a 10 degree upward inclination. The arms should be bent at 90 degrees at the elbow with the support of a rest and the hands should be easily reaching the keyboard and the mouse in that position. This position is described to minimize excessive strain to muscle while using the computer. Hope this would be helpful to other readers of this hub as well.

Thank you once again for your comments and you are always welcome for future comments!


Emma Harvey profile image

Emma Harvey 5 years ago from Berkshire, UK

Good info. I rarely suffer with headaches, but when I do they are usually tension headaches when I feel stressed. I used to work in neurology and saw patients who suffered with headaches and they lead to more serious conditions. We try not to scare ourselves, but at the same time, it's good to be aware of what to look out for.


johncimble profile image

johncimble 5 years ago from Bangkok

thanks for sharing such a good content :) vote up!!


Suzy 23 months ago

I'd venrute that this article has saved me more time than any other.


Vinzkie 23 months ago

As last resort went into to see Debbie for teetamrnt of left hip. At this time I could not walk without discomfort. Explained my problem to Debbie who also then explained Bowen Therapy. I thought well if this works I will be surprised but I was ready to try anything other then surgery. After the 1st teetamrnt I felt much better, still uncomfortable but much improved. After several teetamrnts/sessions I can now walk up stairs without pian, walk for 2-3 miles and keep going.Thank you Debbie for a new me!Kathy

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