According to the WHO ,migraine is among the 3 most widespread health conditions.
There are two main types of headache: primary headache, which is a headache that isn’t due to any underlying health problem; and secondary headache, which is a headache caused by a separate illness or injury.
Experts aren’t clear about what exactly causes headaches, though several things seems to trigger headaches, including stress, drinking too much alcohol, not drinking enough water (dehydration), not eating regularly and being tired after not getting a good night’s sleep.
The most common type of headache is a primary headache called a tension headache. These can be either episodic or chronic. In other words, if you have headaches on up to 15 days out of the month, it’s classed as an episodic tension headache. But if you have headaches on more than 15 days of the month for an average of three months out of a year, the type of headache you have is a chronic tension headache.
Also a type of primary headache, migraine has no clear cause, but several things may trigger one, including hormone changes (called menstrual migraine), emotional factors, low blood sugar, certain foods and even bright lights or strong smells.
A migraine may also come with additional symptoms, including nausea and vomiting, and about one in three migraine sufferers also experience a set of symptoms called aura before their migraine strikes. This can include things such as flashing lights, pins and needles and dizziness.
The good news is headache and migraines are often easily treated and usually not serious. Some experts also recommend a healthy lifestyle as one way to try to reduce the frequency of headaches, including eating a healthy balanced diet, not smoking, drinking a moderate amount of alcohol, getting plenty of sleep and being physically active.
Is it a migraine or a headache?
If you have a pounding head, how can you tell whether it’s a headache or a migraine? Confusingly, perhaps, migraine is actually a type of headache, as it belongs to the class of headache called primary headache (that is, a headache that isn’t caused by an underlying health problem).
Here’s a guide to help you tell the difference between the main types of primary headache: tension headache, cluster headache and migraine:
This is the everyday type of headache most people suffer from. The symptoms include a dull ache on both sides of the head, with a feeling of pressure around the head or behind the eyes. They can last anything from half an hour to several hours – although some tension headaches can last for days.
According to the NHS, about half the adult population in the UK has tension headaches once or twice a month, with one in three people suffering from a tension headache up to 15 times a month (episodic tension headache). Two to three percent of adults also have tension headaches more than 15 times in a month (chronic tension headache).
What causes a tension headache? There are many causes, including stress, lack of sleep, skipping meals and not drinking enough (dehydration). Other triggers include bright sunlight, eye strain, loud noise, lack of exercise, poor posture and even certain types of smells.
Cluster headaches can also be incredibly painful, so it’s good to know that they are fairly rare. Around one in 1,000 people are thought to be affected, eight out of 10 of whom are men, and mostly smokers. The symptoms typically include intense pain on one side of the head (usually around or behind one eye) that is more severe than the pain of a tension headache or even a migraine.
The reason they’re called cluster headaches is that you can get up to three attacks a day for weeks or even months. Then the headaches typically disappear for a while – perhaps for a few months or years – before starting again.
As with tension headache, a cluster headache can be episodic or chronic (episodic cluster headache is when you have a pain-free period of a month or more between clusters, while chronic cluster headache sufferers have pain-free periods of less than a month).
What causes a cluster headache?:It’s generally thought that cluster headache is linked to a part of the brain called the hypothalamus. Experts have studied what happens in the brain during an attack, and some believe the hypothalamus releases chemicals called neurotransmitters. These may cause pain by stimulating nerve cells in the brain. Another theory is that cluster headache may also be caused by the widening of blood vessels in the brain, which causes pain by adding pressure to tissues in the brain.
Unfortunately, most cluster headaches don’t have any triggers, though some people who have them find things like alcohol, strong smells and being too hot can bring on an attack.
According to the NHS around one in five women and one in 15 men suffer from migraine. The symptoms include a pounding or throbbing pain, with about a third of sufferers also experiencing visual disturbances such as flashing lights, zigzag patterns, blind spots, numbness, tingling and pins and needles in the limbs, as well as dizziness and feeling off-balance, all of which are collectively known as aura.
There are three main types of migraine: migraine with aura, migraine without aura and migraine aura without headache. The latter is sometimes called a’ silent’ migraine as it causes aura symptoms but not the pounding headache.
What causes migraine? Nobody really knows what causes migraine, though some experts believe that it’s the result of certain chemicals being released in the brain.
However, there are several things that trigger migraine, including fluctuating hormone levels, stress, anxiety, depression and excitement. Not getting enough sleep or having low blood sugar can also cause migraine, as can bad posture, not eating or drinking regularly, or drinking alcohol. Certain foods are also linked with migraine, including chocolate, cheese and citrus fruits.
Other migraine triggers include bright lights, loud noises, strong smells, computer or television screens and very cold temperatures, as well as certain types of medicines including hormone replacement therapy (HRT), the oral contraceptive pill and some sleeping tablets.
Pain relief for headache and migraine
Most tension headaches and migraines can be treated with simple pain relief medicines (for cluster headache treatments, however, see your GP). But which one should you choose? Here’s a quick guide that may help:
- Paracetamol: Good for tension headache and migraine.Paracetamol is thought to act on the production of prostaglandins, substances produced by the body in response to injury that sensitize nerve endings involved in the process of inflammation.
- Ibuprofen:Good for migraine.Ibuprofen blocks a chemical called COX, which is used in the production of prostaglandins. It may be a good option for migraine sufferers who find paracetamol isn’t effective. However, it isn’t recommended for long-term use, as it can cause stomach-related side effects.
- Aspirin: Because aspirin can cause side effects in the stomach, it isn’t usually recommended for either headache or migraine. However, some experts believe it is an effective treatment for migraine. Aspirin is also found in pain relief medicines combined with other ingredients such as caffeine or paracetamol. Do not give aspirin to children under the age of 16. It’s also not suitable for pregnant women or people who have asthma.
Pain on the rebound: One of the problems with painkillers is that if you take them for headaches too often, it can lead to rebound headaches (or what the medical profession refers to as medication-overuse headaches). Experts believe around one in 50 people suffer from this type of headache, with women five times more likely to be affected than men.
If you use painkillers such as paracetamol or ibuprofen on 15 or more days each month for more than three months, or prescription painkillers that contain opioids or other ingredients called triptans for 10 days a month, you may be diagnosed with medication-overuse headaches.
Symptoms include having a chronic or continuous headache, a headache that may be worse during the mornings or a headache that gets worse when you’re active or exercising.
If you’re suffering from medication-overuse headaches, you must see your GP for advice on stopping taking painkillers (depending on the type of painkiller, you may have to stop immediately or gradually).
When is a headache serious?
While the vast majority of headaches aren’t serious, a very small number may indicate an underlying health problem. These serious headaches are more common in older people, and can appear very quickly and become worse over time. Here are some of the main examples:
Meningitis:A severe headache can be a symptom of meningitis, which causes an infection and inflammation of the tissues around the brain. Other symptoms include a high temperature, vomiting, muscle and joint aches and pains, sensitivity to bright lights and a stiff neck. More than 2,000 people are thought to be affected by bacterial meningitis every year in the UK, but figures for viral meningitis are not available, since the symptoms are often similar to those of flu.
Hemorrhage: A sudden severe headache may also be a symptom of a subarachnoid haemorrhage, which is typically caused by an aneurysm. Thankfully, subarachnoid haemorrhages are very rare and are thought to affect just six to 12 people in every 100,000 each year (i). Other symptoms may include vomiting and seizures.
Temporal arteritis: Usually confined to people over the age of 50, temporal arteritis causes a frontal headache (behind the forehead) and is caused by inflammation in the arteries behind the eye and in the temples. People who are affected may also feel generally unwell and experience pain in their jaw muscles while chewing. If left untreated, temporal arteritis can lead to loss of vision in one or both eyes.
Tumour: Many people who have persistent, severe headaches fear the cause may be a brain tumour, but in reality this is very rare (both benign and malignant primary brain tumours are found in just 12 out of every 100,000 people a year). But if it is a tumour, you may also feel sick, and if you cough, sneeze or bend over, your headache may feel worse.
Thankfully most serious headaches aren’t at all common, but if any of the following applies to you, see your GP as soon as possible:
- Your headache comes on suddenly and severely (especially if you’ve recently suffered a knock to the head)
- Your headache is accompanied by a fever, convulsions, feelings of drowsiness, blurred vision or vomiting
- There’s a dramatic change in your normal headache or migraine pattern
- You have a migraine with aura symptoms that happen on the same side of the body with every attack
- Your experience your first migraine at the age of 50 or older
Natural headache and migraine relief
Nutritional or herbal supplements and natural treatments that may help to alleviate headache and migraine include the following:
- Magnesium: The mineral magnesium has been shown to be an effective treatment for migraine. For instance, in one study, volunteers who took a daily magnesium supplement had 40 percent fewer migraine attacks than those who took a placebo (ii). Other studies have produced similar findings, while some suggest magnesium may be useful as a treatment for hormonal migraine (menstrual migraine) in women (iii).Good food sources of magnesium include brewer’s yeast, blackstrap molasses, wheat bran and dry roasted nuts.
- Ginger: There is also some evidence to suggest ginger may help to reduce the pain of a migraine. In a study published in 2014, migraine sufferers were given either ginger powder or a prescription migraine drug called sumatriptan (a type of triptan). Both groups claimed their migraine improved by 90 percent within two hours, which suggests ginger may be as effective as sumatriptan (iv).
- Vitamin B complex: If you tend to get headaches when you’re under too much stress, you may find that vitamin B complex – a supplement that contains a combination of B vitamins – helps. That’s because certain B vitamins are thought to help the body to cope better with the negative effects of stress. There is some evidence to support this: for example, a study found that taking a B complex supplement for 90 days may lead to a significant reduction in the experience of stress at work (v).
- Sticks and strips: Designed to be applied directly to the forehead, these sticks and strips contain an ingredient called levomenthol (a type of peppermint). The idea behind them is that they may block pain signals caused by tension headaches and relax the muscles in the head.
Meanwhile natural treatments that may be worth trying for tension headache and migraine include acupuncture, chiropractic, hypnosis, osteopathy and relaxation therapies.
(i) Becske T et al; Subarachnoid hemorrhage, eMedicine, Dec 2010
(ii) Peikert A, Wilimzig C, Kohne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia. 1996;16:257-263
(iii) Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium.Headache. 1991;31:298-301. Facchinetti F, Borella P, Sances G, et al. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol.1991;78:177-181.
(iv) Maghbooli M, Golipour F, et al. Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine. Phytother Res. 2014;28(3):412-415.
(v) Stough C, Scholey A, Lloyd J, et al. The effect of 90 day administration of a high dose vitamin B-complex on work stress. Hum Psychopharmacol. 2011 Oct;26(7):470-6.