Types Of Headaches

Introduction

Headaches are incredibly common, and chances are you have suffered from them many times. This article will explore different types of headaches, their potential causes as well as available treatments. 

Primary headaches

When a headache is not a result of an illness or an underlying condition, it is referred to as a primary headache. Primary headaches can be episodic, meaning that they occur less than 15 days each month, lasting between 30 minutes to several hours, or chronic. Chronic headaches are more consistent, as they happen daily for more than 15 days a month. 

Migraine headaches 

Migraine headaches are characterised by an intense pulsating pain that most frequently comes from one side of the head. Migraines can last from hours to days and can have a very debilitating effect on your everyday life. 

Symptoms and triggers

The main symptom of a migraine is a one-sided throbbing pain that can be moderate or severe. However, while most people think that migraines can only be one-sided, around 40% of cases are bilateral, especially in elderly patients. Migraines are often triggered by routine physical activity. During a migraine, you can experience nausea and/ or vomiting, as well as light and sound sensitivity. ¹ In some cases, before the symptoms start, people experience visual disturbances also known as migraine auras. These can include; flashing or shimmering lights, starts/ sparkles, zig-zag lines and blind spots. The aura stage can also include speech difficulties, feelings of confusion, numbness and a tingling sensation on the face or one arm.

Treatment options 

While there is no specific treatment for migraines, there are several ways to help alleviate the symptoms. It can take some time to figure out which treatment option works best for you, and sometimes a combination of these options can be proven the most effective. The first thing you might find helpful is lying down or sleeping in a dark room. 

Painkillers: Most people lean towards the use of over-the-counter painkillers, such as ibuprofen and paracetamol. It is suggested to take the medicine when the migraine symptoms start, as the effect of painkillers can kick in before the symptoms worsen. Waiting until the pain gets intense should be avoided, as it may be too late for the painkillers to work effectively. If you have trouble swallowing pills, both ibuprofen and paracetamol come in soluble forms that can be dissolved in water. Soluble painkillers are a great alternative and they usually work faster as they get absorbed quicker. If you experience vomiting, you may opt for suppositories that are inserted into the bottom. 

Triptans: If over-the-counter medicine does not seem to work, a doctor might prescribe you triptans. It is suggested that migraines cause the widening of the blood vessels, and triptan medications work by reversing this process. Triptans come in tablets, nasal sprays and injections. Side effects are mild and improve overtime, and include tingling, flushing, warm sensations on chest or face, feeling sick and drowsy.² 

Antiemetics: Another anti-sick medication. While these can be very helpful if you are experiencing vomiting, they can be quite effective in treating the migraine itself, even if you are not feeling sick. These are prescribed by a doctor and should be taken as soon as the symptoms start. 

Tension headaches

Tension headaches are the most common type of headaches. They are characterised by pressure and tightness around the forehead. Most frequently, tension headaches are episodic, occurring once or twice a month on average, but in some cases they can be chronic. 

Symptoms and triggers

Tension headaches cause pain in the neck, head and forehead area, specifically behind the eyes. The pain can be mild, moderate or severe, and is often associated with bad posture or muscle strain/ tension in the neck. Symptoms also include head pain, pressure and tenderness around the forehead, fatigue and trouble concentrating. Tension headaches can be triggered by multiple factors such as: 

• stress
• cold/ flu
• sinus infection
• overconsumption of caffeine 
• lack of sleep 
• consumption of alcohol
• smoking
• dehydration
• clenching your jaw (typically during sleep) 

Treatment options

Dehydration and hunger can cause tension headaches and making sure you are drinking enough water and not skipping meals during the day is important. Lack of sleep is a common trigger as well, so make sure you are sleeping enough. If your headache is not helped by any of these, you may opt for over-the-counter painkillers such as ibuprofen or aspirin. Aspirin is not recommended for children under 16 without a doctor's advice. Make sure that you do not combine ibuprofen and aspirin and that you take these painkillers in moderation. Finally, as tension headaches can be caused by muscle strain in the neck, it is worth considering a massage or a hot shower to help your muscles relax. 

Cluster headaches

Cluster headaches are characterised by severe pain that comes in clusters. Cluster headaches are more common in teenagers and middle-aged individuals, and are more often reported in males. Cluster headaches can be both episodic and chronic.

Symptoms and triggers

Cluster headaches are very sudden and severe. In many cases, cluster headache attacks start during sleep and the severity of the pain can be enough to wake you up. The pain is most frequently one-sided and can last between 15 minutes and 3 hours. Cluster attacks have been described as a burning or piercing pain focused in the area behind the eye. The pain can also spread to the teeth, nose and forehead. Sometimes, the painful side can exhibit other symptoms such as; a droopy eyelid, excessive tearing, eye swelling and redness, nausea, facial flushing and sensitivity to light.³

Treatment options

There is no cure for cluster headaches but attacks can be helped in a few ways, both in terms of pain relief and prevention.

Oxygen: Inhaling pure oxygen during the attack can help terminate the symptoms. It is recommended that oxygen is administered as soon as the attack begins. Oxygen is usually the first option for cluster headaches, as it has good response rates and no adverse side effects. Over 70% of patients reported significant pain reduction within 30 minutes.⁴

Triptans: Triptan medications come in several forms such as nasal sprays and injections. They are generally effective in reducing pain by constricting blood vessels in the brain. 

Prevention 

These medications cannot treat cluster headaches or relieve pain but can decrease the frequency. 

• Blood pressure medication
• Antidepressants
• Anti-seizure medication
• Steroid medication 
• Muscle relaxants 

The last resort is surgical intervention. This procedure disables the trigeminal nerve, offering pain relief to some patients. 

Secondary headaches

A headache is referred to as secondary when it is a symptom of a separate disease or illness. 

Sinus headaches

When you experience sinusitis (sinus inflammation or infection), the sinus passages behind your nose and eyes are blocked. This can lead to pressure and subsequently a headache known as a sinus headache. 

Symptoms and causes

During a sinus headache, you may experience pressure around your eyes, nose or cheeks. Sinus headaches are caused by the inflammation of the sinuses, therefore, during a sinus headache you will experience additional symptoms such as; 

• Rhinorrhea (runny nose)
• Nasal obstruction or congestion 
• Nasal discharge, usually yellow/ green
• Pressure behind the eyes and forehead
• Fever
• Pain that worsens when you lean forward

Around 90% of sinus headaches are linked to viral infections causing the common cold. ⁵ Viral infections are sometimes followed by bacterial infections which can exacerbate or prolong symptoms. Seasonal allergies are also a common causal factor for sinus headaches, as they cause sinus inflammations known as rhinitis. 

Treatment options

It is generally suggested that you allow sinus headaches to subside on their own. Unless you experience symptoms such as fever, medical interventions are not encouraged. However, the use of a saline spray/ drops can help cleanse your sinuses. 

Analgesics such as ibuprofen and paracetamol can help decrease the pain but will not treat blocked sinuses. If the pain persists for more than a few days, speak to your doctor.  Your doctor may prescribe ith antihistamine medication, decongestants or mucolytics, to help clear your sinuses and decrease pain. If the sinus headache is caused by allergies your doctor might prescribe you with antihistamines or corticosteroid shots. 

Rebound headaches

Rebound headaches are also referred to as medication overuse headaches. Medications used to treat migraines most commonly cause that rebound effect. 

Symptoms and causes

If you experience headaches regularly, especially migraines, and opt for medication to treat them, your brain may become used to the medication and become more sensitive to headaches. Medications that can cause rebound headaches - if they are overused- are; paracetamol, ibuprofen, triptans, ergotamines (especially mixed with coffee) and opioid pain relievers.

Treatment options

If you think you are experiencing rebound headaches, speak to your doctor. They might help you create a plan to reduce the overused medication without experiencing adverse effects, such as withdrawals. In terms of prevention, your doctor may prescribe you antidepressants, anti-seizure medications or Botox injections.  

Thunderclap headaches

Thunderclap headaches are extremely severe and come suddenly. They are considered the most intense headaches and can be a sign of serious underlying health conditions.⁶

Symptoms and causes

The intense pain usually lasts for up to 1 minute but the pain may linger for longer. 

Regardless of the cause, thunderclap headache symptoms include; 

• Sudden severe pain
• Nausea or vomiting 
• Fainting

The most frequent cause is subarachnoid haemorrhage or a ruptured aneurysm that causes internal bleeding in the brain.  These conditions are life-threatening and should be treated immediately. Other causes include stroke or head injury. Physical or sexual activity can be triggers. 

Treatment options

You should seek medical help if you think you are experiencing a thunderclap headache. To treat it, the cause should be determined with one of the following tests; MRI or lumbar puncture. Depending on the cause of your headache, treatment can include pain or blood pressure medication, or surgery.  

Other types of headaches

Hormone related headaches

Symptoms and triggers

Hormonal headaches are comparable to migraines and can be accompanied by nausea, vomiting, loss of appetite, acne, fatigue, cravings and constipation. 

The female hormone estrogen is linked to hormonal headaches. Hormonal changes and a decrease in oestrogen levels can cause headaches. These changes can be attributed to: 

• Menstrual Cycle 
• Pregnancy 
• Menopause
• Contraceptive pill 
• Skipping meals 
• Sleep disturbances 
• Alcohol and caffeine 
• Stress

Treatment options

Home remedies such as keeping hydrated, lying or sleeping in a dark room and breathing exercises are suggested as the first option. Magnesium supplements are often recommended by doctors. If the pain persists you may opt for NSAIDs like ibuprofen. A doctor may also prescribe you some form of hormonal therapy. 

Hypertension headaches

Symptoms and causes

Hypertension headaches are bilateral and are described as throbbing. They occur during a hypertensive crisis. If your blood pressure is 180/120 mm Hg or higher and you are experiencing blurred vision, vomiting, chest pain, trouble breathing or seizures, seek medical help immediately. 

Treatment options

If you are on medication for high blood pressure, be diligent with the type of treatment you choose. If you choose to take over-the-counter medication (mainly aspirin) contact a doctor first. These are some natural ways you can help your symptoms. 

• Anti-inflammatory diet (celery, berries etc.) 
• Reduce caffeine

Exercise headaches

Headaches after exercising are common and usually easy to treat. 

Symptoms and triggers

You may experience throbbing pain that can develop after working out, especially in warm weather. These headaches can be primary or secondary. 

Treatment options

If you get headaches after working out frequently, speak to a doctor as there may be an underlying condition. 

You can improve symptoms with NSAIDs such as ibuprofen. Make sure you keep yourself hydrated, as it can help prevent symptoms. 

Summary

Headaches are one of the most common issues people experience daily. While in most cases they are not a medical emergency and can be treated easily, pay attention to your symptoms as these headaches may be a sign of underlying conditions.