Health – What kind of headache is it?

I quite like headaches. Not personally, of course, nor for the unfortunate patients who suffer from them – but diagnostically. Troublesome and painful as they are, they generally fall into four categories and have clear treatment options.

(For this article I won’t comment on acute headaches due to “flu” and medical emergencies such as meningitis and cerebral haemorrhage, except to say that if a headache is sudden onset and unusual for you, medical advice should be sought without delay).

• Tension headache: Common parlance refers to some person or situation as a “real headache”. Tension headache typically is band-like around the head, gets worse as the day goes on and is clearly related to stressful circumstances. It tends to be dull and persistent and tiring.  • Migraine: Classical migraines start with an “aura”, usually a patch of shimmery vision affecting both eyes but sometimes a sensory disturbance like pins and needles or occasionally speech disturbance. Auras last 20 minutes or so, and then the headache comes, usually one-sided, throbbing and frequently associated with nausea/vomiting and light sensitivity. The affected person often has to lie down in a darkened room until the migraine passes, usually within 24 hours. Less severe manifestations may just have the visual disturbance and a dull headache afterwards. There is an interesting condition called “footballer’s migraine”, with typical symptoms but occurring after a head knock and often mistaken for concussion. Severe and persistent migraine can be a very debilitating condition, but fortunately we have made great strides in treatment and prevention. When I started in general practice one was often called after hours to severe migraine sufferers for whom the only relief was pethidine injections, with their attendant risks of dependence. These days this is hardly ever required. There are also migraines that don’t play by the rules, sometimes having odd neurological symptoms or missing out the aura altogether. It pays to keep an open mind and consider all options.  • Neck-related headaches: Neck dysfunction is a potent cause of headaches in all ages, but often underdiagnosed because patients don’t realise that their neck has become tight and tender because of postural strains. I see this all the time now with device and computer use, in young people in particular. And in older people the neck can become arthritic, with progressive stiffness, nerve irritation and muscle tension. •  Finally, there is a miscellaneous group with interesting names like cluster, icepick and thunderclap headache. I even heard of a new one the other day – “hypnic” headache which wakes the sufferer from sleep.

Sometimes these types of headaches can get mixed up with each other and it is worth a session with your GP to clarify what is going on. Misdiagnosis or overtreatment can lead to a difficult complication called “chronic daily headache” where medication becomes less effective and the headaches more debilitating over time. So it pays to share your headache with your doctor!

Have a headache free Christmas and a Happy New Year!