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Medicare / Health Articles / Articles
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Dealing with Headaches and Migraines
Headaches are one of the most common complaints healthcare professionals see regularly. Affecting more females than males on the whole (85% vs 80%) in a lifetime, based on a study conducted in Singaporean adults, headaches may interfere with daily activity. One-half of headache sufferers in a US study reported that their activity was limited to more than 50% of normal by headache.
The International Headache Society has identified and classified nearly 130 different types of headaches. They can be mild, moderate, or extremely severe and incapacitating. Headaches also vary in intensity, frequency and duration depending upon the headache type and your sensitivity to them. The commonest cause of headache is lack of sleep and mental stress. Both these factors, together with physical over-exertion and weather are frequent triggers of migraine and tension headaches. However, menstruation, alcohol and dietary triggers like foods and drinks that contain alcohol, spicy food, caffeine, aspartame, mono sodium glutamate, nitrate and nitrites, ice-cream and chocolate are frequent causes of migraine. Rather than tension headaches. Other possible causes include changes from normal routines or patterns (e.g. dieting or travelling, alterations in altitude, seasons, sleep patterns); dehydration; high blood pressure; certain medications, or even poor posture. With so many different causes and symptoms of a headache, how do we identify and manage the pain effectively?
Different headache patterns
Headaches can be grouped into primary (benign) headaches and secondary (organic) headaches. Primary headaches are those in which the headache represents the primary symptom of a physiological, or bodily, disorder. No consistently organic cause can be determined for these headaches. Primary headache types include chronic daily headache, tension headache, cluster headache and migraines. Secondary (organic) headaches arise as a symptom of another disorder. More than 300 organic causes of such headaches exist. Some of the more common secondary headache types are post-traumatic headache that occurs as a result of head injury and sinus headache due to infection of the sinuses.
Chronic daily headache may actually be an extremely mild form of migraine. It may be mild to moderate most of the time but sometimes it may be severe enough to affect daily activities. Nausea or vomiting and sensitivity to light may occur with the headache. Tension headache is the most common headache worldwide, but less so in Singapore. Affecting patients of all ages, the headache consists of band-like tightness, pressure, or constriction around the forehead and temples that often radiates to or from the neck and may last up to half an hour. Cluster headache usually exhibits as severe, excruciating one sided pain behind the eye and it occurs in 'clusters' two to six times daily for 1 to 2 weeks to a few months. It may be accompanied by blocked nose and excessive tearing. It usually occurs at night.
Migraine is a moderate to severe headache that can occur on one side or both sides of the head. The pain is usually aching or throbbing and can worsen with normal movements like bending or climbing stairs. Sensitivity to light and sound, nausea or vomiting may accompany the pain. There are two major types of migraines — migraine with aura (classic migraine), and migraine without aura (common migraine). Classic migraines start with a warning sign, called an aura. The aura often involves changes in the way you see objects. The aura may include flashing lights and colours and temporary loss of vision, burning or prickling sensation of pins-and-needles, muscle weakness or numbness, speech difficulty or even irritability may accompany the aura. Auras last about 15 to 30 minutes and may occur either before or after the headache. The headache of classic migraines may occur on one side of the head or on both sides. In contrast, common migraines don't start with an aura. They may start more slowly than classic migraines, last longer and interfere more with daily activities. The pain of common migraines may be on only one side of the head.
Treatment of Headaches and Migraines
Primary headaches may be treated with over-the-counter painkillers, such as aspirin and paracetamol (Panadol, Biogesic etc). Formulations containing a mixture of codeine and paracetamol may sometimes be used for more effective pain relief. However, codeine may cause constipation and drowsiness, whilst aspirin should be avoided in children less than 16 years old to prevent Reye's Syndrome – a rare but serious illness that can affect the blood, liver and brain of children. It is useful to note that an adult should not exceed the total intake of 4 grams of paracetamol in a day.
If even stronger pain relief is required, you may wish to consider NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Nurofen), naproxen (Synflex, Aleve) and mefenamic acid (Ponstan). Although many NSAIDS are available only on prescription from a doctor, Nurofen and Aleve can be obtained from a pharmacist. However, NSAIDs and aspirin may cause unpleasant side effects. As such, if you have a history or are suffering from stomach ulcers, kidney, heart or liver abnormalities, consult your pharmacist or doctor before self-treatment. To treat headaches that are unresponsive to standard pain relievers in cluster headaches and acute migraine, doctors often prescribe 5HT1 agonists, e.g. ergot alkaloids. However, its use is limited by poor absoprtion and unpleasant side-effects e.g. muscular cramps, nausea, vomitting and abdominal pain. Some anti-emetics e.g. domperidone or metoclopramide may be added if nausea and vomitting symptoms are uncontrolled.
Besides medication, resting in a quiet, dark room with an ice pack on the head and massaging the scalp or temples with firm pressure may help to relieve the headache.
However, prompt medical attention must be sought if any of the following is experienced:
- Headache is sudden and very severe and different from any other headache previously experienced.
- Headache worsens steadily instead of getting better with time.
- Intercranial hemorrhage (internal bleeding of the brain) and meningitis (infection and inflammation of brain tissues). Seen as headache accompanied with fever, stiff neck, sensitivity to light, nausea, vomitting, loss of consciousness or coma.
- Headache that lasts for more than a week following a head injury or brought about by exertion or exercise.
- Patients with glaucoma experiencing pain around the eye. May be indicative of an acute glaucoma. When left untreated, will lead to blindness.
- Headache in children younger than 7.
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