Life Can Be A Headache

"Primary headache disorders are those where the headache is the problem and there's nothing else going on."

"While secondary headache disorders are when the headache is caused by something like a brain tumour or meningitis, or if you've banged your head."

Dr. Peeter Goadsby, professor of neurology, director of National Institute for Health Research, Wellcome Trust King's Clinical Research Facility, King's College London

"Like a migraine, a tension-type headache can be caused by missed meals, lack of sleep, dehydration, anxiety and stress. But unlike migraine, it can quickly be resolved with food, hydration, sleep or taking time out to decompress."

"Migraines occur in attacks, sometimes several times a month or they may occur just once or twice a year, and they can last anything from a few hours to a few days. The key features are episodes of headache on one side or both sides of your head, accompanied by nausea [2/3s of sufferers have this] and sensitivity to light and sound. The pain is so bad that sufferers often find it difficult to continue their usual daily activities and may have to stay in bed. A healthy brain needs regular food, water, sleep and exercise, so aim for consistency in these areas."

"In the early part of a migraine attack, blood vessels on the surface of the brain dilate and trigger a cascade of chemical changes. These are processed by the brain and ultimately perceived as pain and all the other typical migraine symptoms of nausea, light sensitivity and so on. Triptans constrict these blood vessels and prevent the headache developing into a full-blown migraine attack."

Professor Anne MacGregor, specialist in headache and sexual and reproductive health care, Barts Health NHS Trust

 

A 2022 study published in The Journal of Headache and Pain states that 52 percent of the global population experienced some kind of 'primary' headache during the year just past. Tension headaches are normal, everyday headaches, typically TTH feel like a tight band exerting pressure around the head, pain is felt on both sides, but these tension-type headaches normally do not stop anyone from carrying on with their usual activities. 

Muscle tension is a common trigger for tension headaches; sitting hunched over a computer, lifting a heavy object or even wearing too-tight sunglasses. Simple things like insufficient sleep, missing meals, failure to absorb enough liquid, or allowing tension to build rather than decompress are also triggers for tension headaches. This is where over-the-counter painkillers like ibuprofen, paracetamol and Aspirin taken as prescribed, usually resolve a TTH within twenty minutes.

On the other hand, a predisposition to the more serious type of headache, migraines, can be familial, handed down through families. For migraines, triggers include skipped meals, dehydration, sleep deprivation and lack of exercise. A single dose of 900 mg Aspirin, according to studies, is as effective as 50mg-100mg of sumatriptan, a migraine prescription medication. Many people find a cold compress and a dark, quiet room can achieve a similar effect. And then there is a new type of treatment known as CGRP mAbs; the first preventive medicine to be prescribed for migraine, administered by injection.

The absolute worst type of headaches are those occasionally referred to as 'suicide headaches'; cluster headaches which affect roughly two in a thousand people where attacks are characterized by severe pain on one side of the head; agitation and restlessness accompanying the pain. "Such headaches typically occur at night, in clusters lasting six to eight weeks, often at the same time of year, with periods of remission between. Attacks tend to come on quickly, last between 30 to 90 minutes, and can occur several times a day; so painful that sufferers cannot keep still, sometimes banging their heads as a result of the pain. The intensity is often centred around one eye, which can become red and watery, while the other side of the face is completely unaffected", notes Dr. MacGregor.

These attacks can be triggered by alcohol and spicy foods, often wakening the sufferer within an hour of falling asleep. "The cause of cluster headaches is unknown, but research has highlighted changes in a part of the brain known as the hypothalamus, the area that controls the body clock, which might explain why clusters often occur at the same time of year and the same time of day or night", explains Dr. MacGregor.

Effective treatments include sumatriptan injections and nasal sprays, to constrict blood vessels. Pain signals are stopped from being sent to the brain, thus blocking the release of certain natural substances causing pain, nausea and other symptoms. A psychoactive compound found in magic mushrooms is being studied through new research looking at their potential cluster-relieving effects of psilocybin.

Over half of women who suffer from migraines notice a link with their menstruation, according to the National Migraine Centre. "Treatment to prevent attacks can range from standard migraine prevention to hormonal contraceptives", advises Dr. MacGregor. During perimenopause, due to hormone fluctuations, hormone headaches may also increase in prevalence. Doctors may advise a patch or gel with continuous progesterone as helpful. However, menopause onset has a tendency to rid sufferers of hormone headaches altogether.