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A pain in the head - coping with headaches and migraines

You're in the midst of a work crisis ad it starts. The pain is in the middle of your forehead. You hope it will go away but it doesn't. It gets worse. Eventually you raid a colleagues desk for medication. You swallow the pills with water, and wait for them to provide you with relief. It cant come soon enough.

If you've never had a headache, you're in the minority, Headaches affect almost all of us, with different levels of severity.

The most common types of headaches are tension headaches and migraine, according to Professor James Lance, on of the worlds leading neurologists and president of the Migraine Foundation of Australia.

The causes

Different types of headache are caused by a variety of conditions, which is why it is important to see a doctor so he or she can make a correct diagnosis and suggest the treatment that will work best for you.

The most common headaches are:

Tension headaches, which produce a band-like, crushing pain around the forehead and often the back of the head and neck. They can be attributed to anxiety, depression, fatigue and stress. It is thought that thin muscles in the scalp go into spasm, which then squeezes sensitive nerve endings, resulting in pain that can last for anything from 30 minutes to seven days.

Hormonal headaches usually affect premenstrual women when oestrogen and progesterone levels are at their lowest although experts cant pinpoint why oestrogen levels are related to headaches. Some women also get headaches when they're taking the contraceptive pill.

Sinusitis, or inflammation of the sinuses, can cause throbbing pain.

Infections frequently produce dull, persistent headaches.

Cluster headaches tend to affect one side of the head, are often severe, occurring several times a day for a few weeks, the disappearing, returning some months later. They are thought to be caused by vascular disturbances, as are migraines.

Temporal arteritis, the inflammation of the temporal artery which runs along the side of the face, is most common in elderly males and produces severe pain on one side of the face. The skin over the artery is inflamed, the artery itself is thickened and painful to touch, and it should be treated urgently as it can cause blindness.

Diseases of the eyes, ears, nose, throat and gums can all cause pain which is referred to the head.

Toxins that poison the system because of the body's inability to eliminate the broken-down by-products can cause headaches, eg alcohol and cigarettes.

Toxic fumes, such as dry-cleaning agents, tar and diesel fumes can cause headaches.

Prescription drugs, such as the anti-angina treatment glyceryl trinitrate, can cause headaches.

Rare causes of headache include:

Meningitis, an infection of the membranes that enclose the brain and spinal cord, causes severe headaches along with a stiff neck, vomiting, fear of light, and fever.

Subarachnoid haemorrhage, which is a leakage of blood from a vessel into the liquid that bathes the spinal cord and brain, can cause the sudden onset of a severe headache after a period of exertion and is often accompanied by vomiting, a stiff neck and convulsions.

Brain tumours produce gradually increasing, dull headaches, accompanied by other symptoms. A brain abscess, an infection that enters the brain through broken skull-bone with overlying skin damage, or from ear, throat, sinus and lung infections, can cause headaches. They can be accompanied by fever and convulsions.

The physiological changes

While the brain itself doesn't feel pain, the meninges (the membranes around the brain), the arteries in the skull and the walls of the sinuses are pain sensitive. Pain (in any part of the body) occurs when damaged or stressed cells release prostaglandins, which in turn trigger pain receptors. The receptors send signals through nerves to the brain, which interprets the signals as the sensation of pain.

Treatment

Paracetamol and aspirin can relieve tension headaches, although ideally you treat the source of the tension first with relaxation techniques. Anti-inflammatory drugs such as ibuprofen can also help reduce inflammation if that is causing the headache. Acupuncture can help tension headaches and some migraines.

If you are already taking anti-inflammatory medication for arthritis, you should avoid treating headaches with aspirin, as it increases the risk of stomach upsets and bleeding, and ibuprofen can interfere with blood-pressure drugs as it encourages salt retention.

The severity factor

If you experience severe, long-lasting or recurrent headaches, headaches accompanied by visual disturbance or nausea, headaches in a specific area of your head or headaches that don't respond to ordinary over-the-counter medication, see your doctor.

Food aggravators

Dietary considerations are more relevant to migraine sufferers than people with tension headaches, but people who have cluster headaches should steer clear of alcohol.

Headache v Migraine

Migraines are sometimes called "sick headaches", because as well as experiencing intense, throbbing headaches, usually on one side of the head, sufferers develop an acute sensitivity to light and noise, and have upset stomachs (diarrhoea, vomiting or constipation).

About 20 per cent of migraine sufferers experience migraine with aura; they see flashing lights, a shimmering haze, or have double vision, and some people have numbness in their arms and tingling in the fingers.

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