Overall there are more than 100 different clinical categories of headaches. Photo / Christian Erfurt, Unsplash
Overall there are more than 100 different clinical categories of headaches. Photo / Christian Erfurt, Unsplash
If you woke up with a headache this morning, you are far from alone. A new study in the Journal of Headache and Pain has illustrated the sheer prevalence of headaches, finding that around one in six people worldwide will experience some form of pounding head pain today. In particular, the authors found that seven per cent of people suffer from migraine, with nine per cent experiencing a tension headache.
Migraine is known to have a crippling economic effect in the UK, costing the country approximately £2.3 billion (NZ$4.3b) every year in lost work days. "Migraines are the commonest cause of disabling headache in the world," says Peter Goadsby, professor of neurology at Kings College London. "The WHO describe it as the most disabling problem for under 50s."
Overall there are more than 100 different clinical categories of headaches, ranging from temporary twinges which pass within a few hours to severe and even life-threatening ones. Below is a guide to some of them and their causes, as well as ways of preventing and treating them.
Migraines
This is characterised as a severe throbbing headache on one side of the head, which can be accompanied by blurred vision, nausea and acute sensitivity to light and sound. Women are far more vulnerable to migraines – the latest figures suggest that 17 per cent are affected by migraine in a given year, compared to 8.6 per cent of men – for reasons which scientists believe are linked to fluctuating ovarian steroid hormones, such as the drop in oestrogen during the menstrual cycle.
Common migraine triggers include stress, skipping meals and inadequate sleep, which is why consistency in your daily routine can help reduce the likelihood of attacks. They can also occur as a reaction to certain elements of your diet such as artificial sweeteners, processed meats, aged cheeses and alcohol.
Women are far more vulnerable to migraines - the latest figures suggest that 17 per cent are affected by migraine in a given year, compared to 8.6 per cent of men. Photo / Anh Nguyen, Unsplash
"If you have migraines, you can help yourself somewhat by adding some stability to the physiological variations of your day," says Goadsby. "Regular sleep, regular meals and regular exercise will help. The advice we give to people experiencing persistent migraines is to have a solid 'vanilla' life, to get things under control."
While triptans have long been the drug of choice for treating migraine attacks, they do not work for all patients and come with side effects. However, in the last few years a number of breakthroughs have been made in developing newer, more effective therapies.
Two classes of drugs known as gepants and ditans have been approved for use in the US and will soon be considered for use in the UK. They are thought to be safer in patients with heart problems than triptans as they bind to blood vessels involved in migraine attacks, without constricting or tightening the vessels.
These are by far the most common type. Unlike migraine, they cause a steady, mild to moderate ache rather than a throbbing one and do not tend to come with nausea or sensitivity to light and sound.
While they can be treated with common painkillers such as aspirin or paracetamol, tension headaches are often a sign that something else is awry within the body. They can be an indication of dehydration, lack of sleep, emotional stress, dental problems such as jaw clenching or teeth grinding, or too much caffeine.
As indicated by the name, tension headaches can also be a sign of poor posture and stiffness in the neck muscles, and there is some evidence that physiotherapy or acupuncture can prevent their onset.
"Tension type headache can come with abnormalities of muscle contractions in the head, as well as the neck and shoulders," says Todd Schwedt, professor of neurology at the Mayo Clinic. "Using heat on the muscles, as well as massage and gentle stretching, can be useful."
Covid headaches
The data from the Covid Symptoms Study states that headaches are now one of the earliest signs of Covid-19, typically coming on at the start of the illness and lasting for three to five days. Covid headaches tend to be a pulsing, pressing or stabbing pain, occurring across both sides of the head rather than just one area.
Covid headaches tend to be a pulsing, pressing or stabbing pain, occurring across both sides of the head rather than just one area. Photo / CDC, Unsplash
Goadsby says that headaches can occur with many respiratory infections such as influenza, but it seems to be especially pronounced with Omicron and other more infectious variants. This is thought to be because a higher amount of virus gets into the body's cells, inducing inflammation, and the brain responds to this by creating a migraine-like pain.
Some data suggests that Covid headaches tend to be more resistant to regular painkillers, with one alternative option being to take over-the-counter decongestants to relieve any sinus pressure that may be contributing to the pain.
Cluster headaches
A rare type of severe headache, characterised by excruciating pain on one side of the head, often around the eyes. "A cluster headache is considered to be one of the most painful conditions known to humans," says Schwedt. "There can be tearing from the eye, reddening of the white of the eye, and usually people feel very agitated during an attack, so they pace or rock their body constantly."
Far more common in men, this type of headache tends to occur in a rhythmical fashion at the same time each day. They require specialist treatments to relieve the pain, such as oxygen therapy, sumatriptan injections or nasal spray.
A drug called verapamil, which is taken as a tablet several times a day, is the main treatment for preventing cluster headaches. However it can cause heart problems in some individuals, so it requires regular monitoring with an electrocardiagram.
Rebound headaches are the bane of many regular headache sufferers' lives, as they occur when someone frequently uses painkillers such as paracetamol, ibuprofen, triptans or opiates for at least three months.
These drugs can be a vital way of relieving pain, but if you consistently take them more than twice a week, they can cause more headaches to occur. Research has shown that people who suffer from chronic migraine or experience more than 15 headache days per month are particularly vulnerable to developing medication overuse headaches.
Doctors say that in these instances it is most important to try to identify the root causes of the headache attacks and focus on avoiding certain triggers, as well as looking into preventative therapies rather than attempting to just mask the pain.
Medication overuse headaches can occur when someone frequently uses painkillers for at least three months. Photo / Towfiqu barbhuiya, Unsplash
"If someone is already having high frequency headaches, or they notice that their frequency is increasing over time, they need to see a clinician and talk about prevention," says Schwedt. "That can involve a combination of lifestyle measures, vitamin supplements, dietary changes, and other medications to prevent the attacks."
Schwedt has just completed a large study looking at ways of addressing medication overuse headaches. One strategy is to find an effective preventative medicine so they do not immediately have to cut out painkillers. "Then because they're having fewer migraine attacks, they will naturally need less medication," he says.
Eye strain headaches
Eye strain can trigger both a tension headache and a migraine, but it can also be a form of headache in its own right. Eye strain headaches typically appear when you focus on something for a long period of time, typically a screen, and the pain is usually located behind or around your eyes. It tends to subside once you rest your eyes for a little while.
It occurs because when you focus on a screen at close range, the muscles in and around your eyes need to work harder, and become sore and tired over time. Repeatedly squinting at something can also trigger facial muscle spasms which can then result in eye strain headaches.
Schwedt suggests going for an eye exam if you are experiencing these problems. Other solutions include trying to reduce the glare from your screen, avoiding staring at a screen for two or more hours without a break, placing your screen at least 25 inches away from your eyes, and blinking often to moisten your eyes.
"Sometimes just lowering the intensity of the screen can reduce the chance of a headache being triggered," he adds.
Morning headaches
This is a common form of tension headache and can be linked to a variety of triggers such as poor sleep posture, resulting in strained or tense muscles. Experts recommend speaking to a doctor if you experience persistent morning headaches as this can also be a sign of sleep apnea where the throat muscles partially collapse during sleep and interrupt breathing.
Morning headaches can also be linked to insomnia, teeth grinding during sleep or caffeine withdrawal. Because regular caffeine consumption causes the blood vessels to narrow, suddenly reducing or stopping intake allows blood vessels to open up and increases blood flow to the brain. This can cause painful headaches as the brain adjusts to the increase in blood.
Alternatively, it could just be a symptom of a hangover.
These are rare, but occur in around one per cent of the population, typically in your 30s or 40s. Goadsby explains that there are two main forms of headache associated with sex. The first begins as a dull pain during foreplay and is persistent throughout sexual activity, before worsening after climaxing, but the second is specifically initiated by orgasm.
Goadsby describes orgasmic headaches as feeling like "you've been hit with a cricket bat at the back of the head" and, if this occurs, it is important to call an ambulance. This is because while an orgasmic headache can be benign, it can also be caused by a brain aneurysm, which can lead to bleeding on the brain.
"That's one of the few headaches where you go to the emergency room," Goadsby says. "It can happen on its own without the bleed, and it can happen with a bleed. You can't tell the difference so you have to investigate everyone, because the bleeds are life threatening."
