Dr Noureen Ahmad

General Practitioner, Belgium

Headaches are one of the most common medical complaints today. Most people will have experienced a headache at some point in their lives. 

There are different kinds of headaches that all vary as a result of different factors. 

Primary headaches are headaches when there are no underlying medical conditions. Most of the headaches that fall under this category are tension-type headaches (TTHs), migraines and cluster headaches. TTHs are the most common type of headaches and migraines are the second common. Cluster headaches are not so common and are quite rare. Primary headaches usually don’t require extra technical investigations and the diagnosis is based on the clinical symptoms. 

TTHs are caused by depression, stress or anxiety. Sometimes neck and head problems can also result in TTHs. This headache is located on both sides of the head, feeling like a tightening or pressing sensation. The pain is moderate, so the patient can remain active and is not refrained from daily activities. The pain can last from 30 minutes to 7 days. 

Treatment of TTHs focuses on relieving stress, for example through exercise, yoga and massage. If neck muscle problems are also being experienced, this should be treated with physiotherapy. Sometimes simple analgesics (paracetamol, ibuprofen etc.) can help, however codeine-containing painkillers should be avoided. 

The second type of headache which falls under primary headaches are migraines which are found to be suffered more by women. The exact cause of a migraine is uncertain, but studies suggest that it is related to the blood flow alternations in the brain. 

This headache is mostly located at one side of the head with a throbbing or pulsating sensation. The pain is moderate to severe and can affect normal activities. Alongside the headache, migraine sufferers can also experience other symptoms such as nausea, vomiting and a higher sensitivity to light and sound. The pain can last from a few hours to about 72 hours. 

Migraine patients can also develop aura symptoms in the form of visual symptoms (flickering lights and spots), sensory symptoms (numbness) or speech disturbances. A migraine attack can be triggered by many factors such as stress and extreme emotions, environmental factors (loud noises, weather, perfume), food (lack of food, alcohol, caffeine), overtiredness and sleep problems. 

Treatment lies in the control of an acute attack of migraine with medication. NSAIDs (non-steroidal anti-inflammatory drugs) are commonly used to relieve this headache pain, and it is usually accompanied with anti-sickness medicines for the nausea and vomiting. 

If NSAIDs fail to help against the headache, then special medication for migraines can be used, called triptans. These have an influence on the blood flow in the brain and are very effective in stopping migraine attacks. During an acute attack of a migraine, most patients prefer to rest and sleep in a dark, quiet room. When there are more than 3-4 attacks of a migraine each month, specific medication is required to prevent these attacks.

Finally, the last type of primary headaches are cluster headaches. These are extremely painful headaches, usually located on one side of the head. The pain usually radiates from around the eye and the temple area. This is a deep, worsening and explosive sensation and can last from 15 minutes to 3 hours. Besides the headache, there is also irritation and restlessness and these can affect normal activities quite drastically. It is found to be more common in men and smokers. In an acute attack, treatment exists of inhalation of pure oxygen and triptans. 

Secondary headaches are headaches which are due to an underlying medical condition and require further technical investigations. The most common causes for secondary headaches are sinusitis (infection of the sinuses in the front part of the head), medication overuse (painkillers, codeine), illnesses (infection of the brain and the meninges), post-traumatic stress or trauma (head injury) and malignancy (brain tumours). 

Mostly, these secondary headaches are associated with symptoms such as fever, weight loss, abnormal neurologic functions such as difficulties in speech, vision and senses. 

In these situations, imaging of the brain with an MRI or a CT-scan can be performed as well as a lumbar puncture (spinal tap) sometimes. The latter is for when the cause of the headache is suspected from an infectious, inflammatory or malignancy process. 

(Please always consult a doctor or specialist to diagnose health conditions and follow the advised plan of a qualified doctor.)

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