National Post (National Edition)
OH, MY ACHING HEAD!
THERE ARE WAYS TO EASE THOSE POUNDING SYMPTOMS
From the pounding of a migraine to a low-level nagging discomfort, few of us escape the pain of a headache. According to a 2022 study published in The Journal of Headache and Pain, 52 per cent of the world's population have experienced some type of “primary” headache during the past year.
There are two types of headache, says Peter Goadsby, professor of neurology and director of the National Institute for Health Research, Wellcome Trust King's Clinical Research Facility, King's College London.
“Primary headache disorders are those where the headache is the problem and there's nothing else going on,” he says, “while secondary headache disorders are when the headache is caused by something like a brain tumour or meningitis, or if you've banged your head.”
So what are the causes of headaches and what can we do about them?
TENSION HEADACHES
These are normal, everyday headaches. Tension-type headaches (TTH) typically feel like a tight band or pressure around your head, with pain on both sides, but unlike migraines, you can have one and still carry on with your usual activities.
“Like a migraine, a tension-type headache can be caused by missed meals, lack of sleep, dehydration, anxiety and stress,” says Prof. Anne MacGregor, specialist in headache and sexual and reproductive health care at Barts Health NHS Trust. “But unlike migraine, it can quickly be resolved with food, hydration, sleep or taking time out to decompress.”
What to do about it: address the above lifestyle factors. Muscle tension is another common trigger, whether from sitting hunched over a computer, lifting a heavy object or even wearing a badly fitting bra.
Over-the-counter painkillers, such as ibuprofen, paracetamol and Aspirin, will usually resolve a TTH within 20 minutes.
SIGNS IT'S A MIGRAINE
“Migraines occur in attacks, sometimes several times a month or they may occur just once or twice a year, and they can last anything from a few hours to a few days,” says MacGregor.
“The key features are episodes of headache on one side or both sides of your head, accompanied by nausea (two-thirds of sufferers have this) and sensitivity to light and sound. The pain is so bad that sufferers often find it difficult to continue their usual daily activities and may have to stay in bed.”
A predisposition to migraines can be passed down through families. Triggers include skipped meals, dehydration, sleep deprivation and a lack of exercise.
What to do about it: “A healthy brain needs regular food, water, sleep and exercise, so aim for consistency in these areas,” adds MacGregor.
Studies have shown that a single dose of 900 mg Aspirin is as effective as 50 mg-100 mg of sumatriptan, a prescription medication for migraines. But, for many, a cold compress and a dark, quiet room work just as well.
Migraine sufferers might be prescribed triptan to manage attacks. “In the early part of a migraine attack, blood vessels on the surface of the brain dilate and trigger a cascade of chemical changes,” says MacGregor.
“These are processed by the brain and ultimately perceived as pain and all the other typical migraine symptoms of nausea, light sensitivity and so on. Triptans constrict these blood vessels and prevent the headache developing into a full-blown migraine attack.”
A new type of treatment known as CGRP mAbs is the first preventive medicine to be prescribed for migraine, given by injection.
CLUSTER HEADACHES
Sometimes referred to as “suicide headaches,” cluster headaches affect about two in 1,000 people. Attacks are characterized by severe pain on one side of the head, accompanied by agitation and restlessness.
“Such headaches typically occur at night, in clusters lasting six to eight weeks, often at the same time of year, with periods of remission in between,” says MacGregor. “Attacks tend to come on quickly, last between 30 to 90 minutes, and can occur several times a day, too. They're so painful that sufferers can't keep still, sometimes even banging their heads because of the pain. The intensity is often centred around one eye, which can become red and watery, while the other side of the face is completely unaffected.”
Attacks often wake the sufferer within an hour of falling asleep and can be triggered by alcohol and spicy foods.
“The cause of cluster headaches is unknown, but research has highlighted changes in a part of the brain known as the hypothalamus, the area that controls the body clock, which might explain why clusters often occur at the same time of year and the same time of day or night,” adds MacGregor.
What to do about it: effective treatments include sumatriptan injections and nasal sprays, which constrict blood vessels. These stop pain signals being sent to the brain and block the release of certain natural substances that cause pain, nausea and other symptoms.
New research is also underway looking at the cluster-relieving effects of psilocybin, a psychoactive compound found in magic mushrooms.
IS IT MY HORMONES?
According to the National Migraine Centre, more than half of women who get migraines notice a link with their periods. The best way to tell if your headaches are hormonal is to keep a diary over several months. If they're linked, see your doctor.
What to do about it: “Treatment to prevent attacks can range from standard migraine prevention to hormonal contraceptives,” says MacGregor.
Hormone headaches may also increase in prevalence during perimenopause, due to hormone fluctuations. A prescription of HRT from your doctor, who may advise a patch or gel with continuous progesterone, may help. The good news is that menopause tends to get rid of hormone headaches altogether.