Headache

What Is Headache?

  • Headaches are one of the commonest presenting complaints in health care facilities. It is estimated that about 90% percent of the population will experience a headache at some point in their lives.
  • The causes of headaches are numerous, and most often not a cause for concern. However, certain warning signs may indicate possible sinister causes.
  • Headaches are classified as either primary or secondary.
  • Primary headaches include Tension headaches, Migraines, Cluster Headaches.
  • Secondary headaches include headaches due any other reasons (see causes below)
  • Investigations done for headaches depend on the suspected cause of a headache. On physical examination, there may be tender neck and shoulder muscles in a tension headache or neck stiffness (meningism in meningitis. There may be features of neurological fall-out, such of loss of power or sensation in one hand, that may suggest bleeding in the brain or a mass or tumour pressing on nerve fibres.
  • Special investigations done include radiological investigations and laboratory tests, depending on the suspected causative factor of a headache.
  • Blood test for infective markers as well as a lumbar puncture will be done in suspected meningitis. CT scans or MRIs (Magnetic Resonance Imaging) are done in suspected intracranial masses(tumours), aneurysms (abnormal outpouchings formed in blood vessel linings) or bleeding.

What Is Headache?

  • Headaches are one of the commonest presenting complaints in health care facilities. It is estimated that about 90% percent of the population will experience a headache at some point in their lives.
  • The causes of headaches are numerous, and most often not a cause for concern. However, certain warning signs may indicate possible sinister causes.
  • Headaches are classified as either primary or secondary.
  • Primary headaches include Tension headaches, Migraines, Cluster Headaches.
  • Secondary headaches include headaches due any other reasons (see causes below)
  • Investigations done for headaches depend on the suspected cause of a headache. On physical examination, there may be tender neck and shoulder muscles in a tension headache or neck stiffness (meningism in meningitis. There may be features of neurological fall-out, such of loss of power or sensation in one hand, that may suggest bleeding in the brain or a mass or tumour pressing on nerve fibres.
  • Special investigations done include radiological investigations and laboratory tests, depending on the suspected causative factor of a headache.
  • Blood test for infective markers as well as a lumbar puncture will be done in suspected meningitis. CT scans or MRIs (Magnetic Resonance Imaging) are done in suspected intracranial masses(tumours), aneurysms (abnormal outpouchings formed in blood vessel linings) or bleeding.

What Are The Symptoms Of Headache?

  • Symptoms usually differ depending on the cause of a headache.:
  • Tension headaches can present with tender neck and shoulder muscles, jaw clenching at night or a feeling of a tight compression around the head (a band-like headache).
  • Migraines are usually severe headaches, with associated nausea or vomiting. Sensitivity to light or sound may be present. A headache is usually pulsating and on one side of the face/head. Migraines can present with or without aura. Auras are symptoms that typically precede the onset of migraine headaches. These symptoms include blurred vision, seeing flashes or stars.
  • Cluster headaches mostly affect males. These headaches are usually severe, on one side of the head around the orbital area. It may include redness, tearing and drooping of the eye.
  • Possible sinister headaches may present with following:
  • Headaches due to raised intracranial pressure (possible tumour or brain mass) can have an early morning headache that improves during the day, projectile vomiting, neurological symptoms such as weakness or loss of sensation, as well as new onset seizures.
  • A thunderclap headache- sudden, severe onset of a headache, often described as "the worst headache of my life"- may indicate subarachnoid haemorrhage (bleeding under one of the meninges/linings of the brain).
  • Meningitis or encephalitis can present with neck stiffness, fever, sensitivity to light, decreased the level of consciousness or seizures. 

What Are The Causes Of Headache?

Headaches can have a myriad of causes.

The commonest headaches are:

  • Tension headaches- often multifactorial, with stress, poor posture, muscle weakness, sleep deprivation and jaw clenching as related causes.
  • Migraines- Usually a genetic component, with certain individualised, specific triggers such as chocolate, caffeine, exercise, menstruation, and alcohol. Migraines are more common in females due to the hormonal changes associated with normal menstrual cycles.
  • Headaches from fatigue or dehydration
  • Caffeine withdrawal headaches
  • Cluster headaches
  • Other rarer headaches include:
  • Post-coital headache
  • Sinus headaches

Life-threatening headaches:

  • Meningitis
  • Encephalitis
  • Brain tumours or other space occupying lesions
  • Bleeding on the brain

Side effects of certain medications can also cause headaches. These include antidepressants, treatments for erectile dysfunction or withdrawal headaches from chronic analgesic-overuse that contains opioids or caffeine.  

What Are The Things One Should Do To Manage Headache?

  • If you are prone to develop tension headaches, maintaining a healthy lifestyle is necessary.
  • Exercise and healthy diet help with stress reduction and elimination of toxins from your body.
  • Be sure to eat right and drink plenty of fluids
  • If you suffer from migraines, keep a migraine diary and try to determine what the specific triggers are.    

What Are The Things One Should Avoid To Manage Headache?

  • Leave headaches untreated or uninvestigated.
  • If any possible danger or red flags symptoms are present, seek medical advice
  • Overuse of over the counter drugs painkillers. These may cause rebound headaches if used too often    

What Are The Best Foods For Headache?

  • Nutrients such as magnesium, vitamin B2, Omega 3 fatty acids, and Coenzyme Q10 have been shown to decrease the incidence of particular types of vascular headaches such as migraines.    

What Are The Worst Foods For Headache?

  • Migraines: Caffeine(can either be a trigger or treatment), dairy, alcohol, chocolates
  • Tension headaches: Caffeine overuse    

What Are The Medicines For Headache?

  • The treatment of headaches depends on the type of a headache
  • A tension headache is usually treated with physiotherapy, short course anti-inflammatories, and muscle relaxants. Addressing underlying stressors through psychotherapy and counselling may be considered. If the patient shows signs of depression or severe anxiety, anti-depressants can be considered.
  • Migraines treatment depends on the acute episode or on chronic preventative therapy. Preventative therapy includes an elimination of triggers. Medications such as alpha-blockers calcium channel blockers or antidepressants can be used.
  • Acute episodes of cluster headaches are treated with high flow oxygen, medications called triptans (sumatriptan most often used), high dose cortisone for a few days and opioids. Preventative treatments include antidepressants (tricyclic antidepressants), anti-epileptic drugs and calcium channel blockers.
  • Secondary headaches are treated by the specific cause of a headache and usually require admission to hospital for investigations and management. Intracranial masses or bleeding may require neurosurgery. Meningitis and encephalitis will need intravenous antibiotics.    

What Are The Tips To Manage Headache?

What Are The Symptoms Of Headache?

  • Symptoms usually differ depending on the cause of a headache.:
  • Tension headaches can present with tender neck and shoulder muscles, jaw clenching at night or a feeling of a tight compression around the head (a band-like headache).
  • Migraines are usually severe headaches, with associated nausea or vomiting. Sensitivity to light or sound may be present. A headache is usually pulsating and on one side of the face/head. Migraines can present with or without aura. Auras are symptoms that typically precede the onset of migraine headaches. These symptoms include blurred vision, seeing flashes or stars.
  • Cluster headaches mostly affect males. These headaches are usually severe, on one side of the head around the orbital area. It may include redness, tearing and drooping of the eye.
  • Possible sinister headaches may present with following:
  • Headaches due to raised intracranial pressure (possible tumour or brain mass) can have an early morning headache that improves during the day, projectile vomiting, neurological symptoms such as weakness or loss of sensation, as well as new onset seizures.
  • A thunderclap headache- sudden, severe onset of a headache, often described as "the worst headache of my life"- may indicate subarachnoid haemorrhage (bleeding under one of the meninges/linings of the brain).
  • Meningitis or encephalitis can present with neck stiffness, fever, sensitivity to light, decreased the level of consciousness or seizures. 

What Are The Causes Of Headache?

Headaches can have a myriad of causes.

The commonest headaches are:

  • Tension headaches- often multifactorial, with stress, poor posture, muscle weakness, sleep deprivation and jaw clenching as related causes.
  • Migraines- Usually a genetic component, with certain individualised, specific triggers such as chocolate, caffeine, exercise, menstruation, and alcohol. Migraines are more common in females due to the hormonal changes associated with normal menstrual cycles.
  • Headaches from fatigue or dehydration
  • Caffeine withdrawal headaches
  • Cluster headaches
  • Other rarer headaches include:
  • Post-coital headache
  • Sinus headaches

Life-threatening headaches:

  • Meningitis
  • Encephalitis
  • Brain tumours or other space occupying lesions
  • Bleeding on the brain

Side effects of certain medications can also cause headaches. These include antidepressants, treatments for erectile dysfunction or withdrawal headaches from chronic analgesic-overuse that contains opioids or caffeine.  

What Are The Things One Should Do To Manage Headache?

  • If you are prone to develop tension headaches, maintaining a healthy lifestyle is necessary.
  • Exercise and healthy diet help with stress reduction and elimination of toxins from your body.
  • Be sure to eat right and drink plenty of fluids
  • If you suffer from migraines, keep a migraine diary and try to determine what the specific triggers are.    

What Are The Things One Should Avoid To Manage Headache?

  • Leave headaches untreated or uninvestigated.
  • If any possible danger or red flags symptoms are present, seek medical advice
  • Overuse of over the counter drugs painkillers. These may cause rebound headaches if used too often    

What Are The Best Foods For Headache?

  • Nutrients such as magnesium, vitamin B2, Omega 3 fatty acids, and Coenzyme Q10 have been shown to decrease the incidence of particular types of vascular headaches such as migraines.    

What Are The Worst Foods For Headache?

  • Migraines: Caffeine(can either be a trigger or treatment), dairy, alcohol, chocolates
  • Tension headaches: Caffeine overuse    

What Are The Medicines For Headache?

  • The treatment of headaches depends on the type of a headache
  • A tension headache is usually treated with physiotherapy, short course anti-inflammatories, and muscle relaxants. Addressing underlying stressors through psychotherapy and counselling may be considered. If the patient shows signs of depression or severe anxiety, anti-depressants can be considered.
  • Migraines treatment depends on the acute episode or on chronic preventative therapy. Preventative therapy includes an elimination of triggers. Medications such as alpha-blockers calcium channel blockers or antidepressants can be used.
  • Acute episodes of cluster headaches are treated with high flow oxygen, medications called triptans (sumatriptan most often used), high dose cortisone for a few days and opioids. Preventative treatments include antidepressants (tricyclic antidepressants), anti-epileptic drugs and calcium channel blockers.
  • Secondary headaches are treated by the specific cause of a headache and usually require admission to hospital for investigations and management. Intracranial masses or bleeding may require neurosurgery. Meningitis and encephalitis will need intravenous antibiotics.    

What Are The Tips To Manage Headache?