Who has not had a headache? Like the common cold, headaches can be just a part of life. And like the common cold, we mostly do not know where they come from or how to ‘cure’ them.
For many people, a headache is an occasional annoyance or discomfort, but for others, they are a recurrent, sometimes disabling, problem. We can describe types of headaches and related symptoms, but to pinpoint their cause is much less likely.
Headache pain occurs when sensitive nerve endings in the skull, scalp, neck and neighbouring tissues send pain messages to the brain — the brain itself has no pain sensors. Headaches are divided into two main types: Primary, and secondary. Secondary headaches are relatively straightforward because they can be explained, and treated. That is, they are secondary to another, underlying, disorder such as infection or trauma. Not so much with primary headaches which have no identifiable cause and are most common.
The headache we most hear about is migraine, partly because it can be so debilitating and is fairly common, affecting about a third of the population. Migraines tend to affect men more often, about three to one versus women. The onset of migraines usually comes in the teens or twenties and peaks during a person’s thirties. They tend to ease or even stop as a person gets older.
About a third of people describe (neurological) symptoms at the start of a migraine: distorted vision, shooting lights, blind spots or temporary loss of vision. The pain can be incapacitating and last from a few hours to several days and may be accompanied by nausea, severe sensitivity to light or noise.
While the cause of migraines is unknown, it is believed to begin in the brain as a neurological dysfunction. It may involve imbalances in brain chemicals, notably serotonin which helps regulate the perception of pain. And genetics are likely at play as migraines show up within families.
What we might call the ‘common headache’ is the tension headache, so called because it seems related to stress and tension that generate muscle contraction and tightness. These headaches show up as dull pain or pressure around the forehead or the back of the head and neck; the pain may feel like a clamp squeezing the skull. These are the most common type for adults. While the cause is unknown, the pain is associated with fatigue, anxiety, eyestrain, stress and depression.
The pain of a cluster headache can be excruciating. These occur in cyclical patterns (clusters) and will often awaken a person in the middle of the night with intense pain in or around one eye on one side of the head. Cluster periods can last from weeks to months, but then go into remission for long periods. The cause of cluster headaches is unknown, but the patterns suggest that abnormalities in the body’s biological clock (hypothalamus) play a role. Unlike migraine and tension headache, cluster headache generally isn't associated with triggers, such as foods, hormonal changes or stress.
Exertion headaches arise after strenuous physical activity. This suggests they may be caused by abrupt dilation or constriction of blood vessels. Because an exertion-related headache could also be a sign of brain hemorrhage, seek treatment right away with your doctor.
Treating headaches is often left to the sufferer. There are over-the-counter pain killers that can help treat symptoms, but so too can a heating or cooling gel pack. Relaxation techniques can help, as will good posture especially at a desk or computer. Try to identify foods or other triggers. Headaches can be inconvenient, or debilitating, but there are ways to help keep them at bay.
Written by Dr. Paul Martiquet, Medical Health Officer for the Sunshine Coast and Powell River.