What’s really causing your headache – and how to treat it

If you woke up with a headache this morning, you are far from alone. A new study in the Journal of Headache and Pain has illustrated the sheer prevalence of headaches, finding that around one in six people worldwide will experience some form of pounding head pain today. In particular, the authors found that seven per cent of people suffer from migraine with nine per cent experiencing a tension headache.

Migraine is known to have a crippling economic effect in the UK, costing the country approximately £2.3 billion every year in lost work days. “Migraines are the commonest cause of disabling headache in the world,” says Peter Goadsby, professor of neurology at Kings College London. “The WHO describe it as the most disabling problem for under 50s.”

Overall there are more than 100 different clinical categories of headaches, ranging from temporary twinges which pass within a few hours to severe and even life-threatening ones. Below is a guide to some of them and their causes, as well as ways of preventing and treating them.

Migraines

This is characterised as a severe throbbing headache on one side of the head, which can be accompanied by blurred vision, nausea and acute sensitivity to light and sound. Women are far more vulnerable to migraines – the latest figures suggest that 17 per cent are affected by migraine in a given year, compared to 8.6 per cent of men – for reasons which scientists believe are linked to fluctuating ovarian steroid hormones, such as the drop in oestrogen during the menstrual cycle.

Common migraine triggers include stress, skipping meals and inadequate sleep, which is why consistency in your daily routine can help reduce the likelihood of attacks. They can also occur as a reaction to certain elements of your diet such as artificial sweeteners, processed meats, aged cheeses and alcohol.

“If you have migraines, you can help yourself somewhat by adding some stability to the physiological variations of your day,” says Goadsby. “Regular sleep, regular meals and regular exercise will help. The advice we give to people experiencing persistent migraines is to have a solid ‘vanilla’ life, to get things under control.”

While triptans have long been the drug of choice for treating migraine attacks, they do not work for all patients and come with side effects. However, in the last few years a number of breakthroughs have been made in developing newer, more effective therapies.

Two classes of drugs known as gepants and ditans have been approved for use in the US and will soon be considered for use in the UK. They are thought to be safer in patients with heart problems than triptans as they bind to blood vessels involved in migraine attacks, without constricting or tightening the vessels.

Tension headaches

These are by far the most common type. Unlike migraine, they cause a steady, mild to moderate ache rather than a throbbing one and do not tend to come with nausea or sensitivity to light and sound.

While they can be treated with common painkillers such as aspirin or paracetamol, tension headaches are often a sign that something else is awry within the body. They can be an indication of dehydration, lack of sleep, emotional stress, dental problems such as jaw clenching or teeth grinding, or too much caffeine.

As indicated by the name, tension headaches can also be a sign of poor posture and stiffness in the neck muscles, and there is some evidence that physiotherapy or acupuncture can prevent their onset.

“Tension type headache can come with abnormalities of muscle contractions in the head, as well as the neck and shoulders,” says Todd Schwedt, professor of neurology at the Mayo Clinic. “Using heat on the muscles, as well as massage and gentle stretching, can be useful.”

Covid headaches

The data from the Covid Symptoms Study states that headaches are now one of the earliest signs of Covid-19, typically coming on at the start of the illness and lasting for three to five days. Covid headaches tend to be a pulsing, pressing or stabbing pain, occurring across both sides of the head rather than just one area.

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