This article discusses the common symptoms of headaches and migraines and provides advice for anyone with repeated or severe headaches who is unsure whether this may be due to a more serious condition.
- Excluding a serious underlying condition
- Other causes of headache
- Primary headaches
- Key features of migraine headaches
- Treating headaches
Headaches occur frequently in people within the working population. Among young adults they affect approximately 5% of men and 20% of women. For some people headaches are just a minor inconvenience but for many they are a source of considerable distress and anxiety not least because they may herald serious illness.
It is important for anyone who does suffer from repeated headaches to receive an appropriate response from their doctor to include the following:
1. Rapid access to medical care when needed, to manage symptoms and reduce anxiety.
2. An accurate diagnosis. This is the process of determining which condition a patient may have; it is important to exclude significant disease.
3. Assistance to identify and address headache triggers, including lifestyle and in the workplace.
4. A treatment programme to include effective means of stopping a headache once it has started.
5.The offer of regular preventative therapies to patients experiencing severe and disabling headaches.
It is always necessary to rule out the possibility that headaches are being caused by a serious underlying condition.
The main things to bear in mind are that:
1. Whilst most sudden and severe headaches are not dangerous, the occurrence of a severe headache (thunderclap headache), often with exercise or intercourse may be due to a subarachnoid haemorrhage. This is bleeding into the subarachnoid, the area between the layers of meninges surrounding the brain and spinal cord.
2. Headache with fever, which may be accompanied by symptoms such as shivering, sweating and neck stiffness or signs of infection raises concerns of meningitis or encephalitis.
3. There is always the possibility that a headache is being caused by the presence of a tumour. The key features of intracranial hypertension are headaches which are worse at night or accompanied by personality or cognitive change, weakness or unsteadiness. New onset headaches in the elderly must also be taken seriously.
4. Recent onset headache in the elderly; fever, weight loss, unilateral pain with local tenderness could all be caused by temporal arteritis. An uncommon disease, usually affecting older people, in which the walls of the arteries in the scalp over the temples become inflamed.
5. Headaches felt on one side can be a symptom of carotid artery dissection, which is where the layers of the artery wall that supplies blood to the head separate.
The brain has no pain receptors and the pain-sensitive structures (such as meninges or large vessels) are supplied by nerves. The main symptom of sinus disease may be a frontal headache (and similarly primary headaches are often treated as sinusitis). Jaw grinding may also cause headaches.
The presence of cervical disease may result in pain felt in the occiput. Similarly headaches may result in protective cervical spasm and may trigger a cycle of pain. A close working relationship with a physiotherapist is often invaluable in treating all aspects of the pain syndrome.
These form the majority of cases of headache and although they are “unpleasant but not dangerous” they can still have a considerable impact on quality of life.
These headaches form a spectrum with intermittent severe migraines on one end, and daily tension-type headaches on the other. Many people suffer from a mixed pattern called a “transformed migraine” often caused by a combination of anxiety and over-use of non-prescription painkillers.
The key features of migraine headaches are an episodic, unilateral headache with accompanying nausea and vomiting and sensitivity to light, noise and movement. Only a quarter of patients will experience a migraine aura. Although obvious in people with previous auras, these may be mistaken for a stroke. Unusual migraine variants may include an isolated aura, vertigo, eye weakness or even loss of consciousness.
Common triggers for migraines are stress, sleep disturbances (both lack of sleep and excess), missing meals, excesses of caffeine and alcohol. Menstruation is a common trigger and some women with pure menstrual migraine may respond to hormonal treatment.
Patients who suffer from primary headaches require effective and well-tolerated therapy to control them. Suggested therapy starts with rest and if the headache does not ease after rest there is a progressive escalation of treatments starting with simple analgesics such as paracetamol and escalating to non-steroidal anti-inflammatory drugs (NSAIDs) and triptans. People who suffer from at least two attacks per month or whose headaches cause considerable disruption may benefit from regular medications. These include beta blockers, tricyclics and Topiramate, a novel anti-epileptic drug that is often effective in resistant cases. Botulinum toxin (Botox) has recently been licensed for use in patients with chronic migraine.
Non-steroidal anti-inflammatory drugs. A group of drugs that provide pain relief and reduce inflammation.Full medical glossary