Headaches - Causes, symptoms, diagnosis and treatmentDecember 6 2021
Causes, Symptoms, Diagnosis and Treatment
When we ask patients, who have often come to see us for a different reason, if they suffer with headaches, their answer will often be ‘yes’, when we ask them how often they have a headache, they will often say ‘Oh just the normal amount, the same as everyone else.’ There is no normal amount of headaches, and they always need investigating if they are more often than once or twice a month.
Almost everyone around you will have suffered a headache at some point in their life. It is estimated people in the UK lose a total of 25 million days from their work and education each year because of migraine. Headaches are very common and can be quite debilitating. There are many different types of headaches, however, finding the cause is crucial if you want to get rid of them.
Headaches can be primary or secondary, which means they are a side effect of a separate illness or injury.
Tension headaches are usually felt as a band around the head like a tight hat, or across the forehead. They can last for several days. They can be uncomfortable and tiring, but they do not usually disturb sleep. Most people can carry on working with a tension headache. They tend to worsen as the day progresses and are not usually made worse by physical activity, although it's not unusual to be a little sensitive to bright light or noise.
Migraines are also very common. A typical migraine is one-sided and throbbing. Indeed, headaches that are one-sided, headaches that throb and headaches that make you feel sick are more likely to be migraines than anything else. Migraines are often severe enough to be disabling. Some patients need to go to bed to sleep off their headache.
Cluster headaches are very severe headaches. They occur in clusters, often every day for a number of days or even weeks. Then they disappear for months on end. They are uncommon and tend to occur particularly in adult male smokers. They are severe, one-sided headaches, which are really very disabling (they prevent regular activity). People often describe them as the worst pain they have ever felt.
Chronic tension headaches
Chronic tension headache is usually caused by muscle tension in the back of the neck and affects women more often than men. Chronic means that the condition is persistent and ongoing. These headaches can be started by neck injuries or tiredness and may be made worse by medication overuse. A headache that occurs almost every day for three months or more is called a chronic daily headache.
Other causes of headaches:
- Overuse of medication
- Over exertion
- Alcohol or drug related
- Lack of sleep
- Blocked sinuses
Most headaches are not serious however, dangerous headaches tend to occur suddenly, and become progressively worse over time. These can include:
Bleeding around the brain (subarachnoid haemorrhage)
Subarachnoid haemorrhage is a very serious condition which occurs when a small blood vessel bursts on the surface of the brain. Patients develop a severe headache and stiff neck and may become unconscious. This is a rare cause of severe headache.
Meningitis and brain infections
Meningitis is infection of the tissues around and on the surface of the brain and encephalitis is infection of the brain itself. Brain infections can be caused by germs called bacteria, viruses or fungi and they are thankfully rare. They cause a severe, disabling headache. Usually patients are sick (vomit) and cannot bear bright light (this is called photophobia). Often they have a stiff neck, too stiff for the doctor to be able to bend the head down so that the chin touches the chest (even if you try to relax). Patients are usually also unwell - hot, sweaty and ill.
Giant cell arteritis (temporal arteritis)
Giant cell arteritis (temporal arteritis) is, generally, only seen in people over the age of 50. It is caused by swelling (inflammation) of the arteries in the temples and behind the eye. It causes a headache behind the forehead (a frontal headache). Typically the arteries in the forehead are tender and patients notice pain in the scalp when they comb their hair. Often the pain gets worse with chewing. Temporal arteritis is serious because if it is not treated it can cause sudden loss of eyesight. Treatment is with a course of steroids. The need to continue these steroids is usually monitored by your GP through blood tests, and they are typically needed for many months.
Brain tumour is a very uncommon cause of headache - although most patients with long-lasting, severe or persistent headaches start to worry that this may be the cause. Usually the headache caused by a brain tumours is present on waking in the morning, is worse on sitting up (the patient may vomit on sitting up too), and gets steadily worse from day to day, never easing and never disappearing. It can sometimes be worse on coughing and sneezing (as can sinus headaches and migraines).
Headaches are, very rarely, a sign of a serious or sinister underlying condition, and most headaches go away by themselves.
If you have a headache which is unusual for you then you should discuss it with your doctor. You should also talk to your doctor about headaches which are particularly severe or that stop your regular activities, those which are associated with other symptoms like weakness or tingling.
Remember that headaches are less likely to occur in those who:
- Manage their stress levels well.
- Eat a balanced, regular diet.
- Take balanced regular exercise.
- Pay attention to posture and core muscles.
- Sleep on a supportive pillow.
- Drink plenty of water.
- Have plenty of sleep.
What are some treatments for headaches?
Most people treat occasional tension-type headaches with over-the-counter medications like paracetamol or ibuprofen.
You can also try to rest in a quiet and dark room, especially if you are having a migraine.
Hot or cold compresses to your head or neck
Alternative therapies aimed at stress reduction might help. They include:
Cognitive behavioral therapy
How can Chiropractors help with headaches?
If your headaches are getting more frequent or severe, it is important to seek professional help to try and determine the cause of the headache and to receive some treatment. Chiropractors can assess, diagnose, and manage headaches. Current evidence suggests that chiropractic care, including manual therapy, can be effective in treating cervicogenic and tension headaches. Studies have also shown that chiropractic care can help decrease the intensity and frequency of migraines.
The treatment options may include:
Soft tissue therapy
Modalities including electrical stimulation, acupuncture, and ultrasound
Lifestyle changes and education
Referral and co-management
When is a headache an emergency?
Most headaches can resolve quickly and do not require urgent attention. However, seek emergency care if you have:
- A very severe, sudden headache
- Headache after a head injury or fall
- Fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
- Pain that worsens despite treatment
These symptoms suggest a more serious condition, so it's important to get a prompt diagnosis and treatment.
How can you prevent headaches?
Taking care of yourself might help ease chronic daily headaches.
Avoid headache triggers- Keeping a headache diary can help you determine what triggers your headaches so that you can avoid the triggers. Include details about every headache, such as when it started, what you were doing at the time and how long it lasted.
Avoid medication overuse- Taking headache medications, including over-the-counter medications, more than twice a week can increase the severity and frequency of your headaches. Consult your doctor about how to wean yourself off the medication because there can be serious side effects if done improperly.
Get enough sleep- The average adult needs seven to eight hours of sleep a night. It's best to go to bed and wake up at the same time every day. Talk to your doctor if you have sleep disturbances, such as snoring.
Don't skip meals- Eat healthy meals at about the same times daily. Avoid food or drinks, such as those containing caffeine, that seem to trigger headaches. Lose weight if you're obese.
Exercise regularly- Regular aerobic physical activity can improve your physical and mental well-being and reduce stress. With your doctor's OK, choose activities you enjoy — such as walking, swimming or cycling. To avoid injury, start slowly.
Reduce stress- Stress is a common trigger of chronic headaches. Get organized. Simplify your schedule. Plan ahead. Stay positive. Try stress-reduction techniques, such as yoga, tai chi or meditation.
Reduce caffeine. While some headache medications include caffeine because it can be beneficial in reducing headache pain, it can also aggravate headaches. Try to minimize or eliminate caffeine from your diet.
In summary, if you suffer with more than a very occasional headache, talk to your local chiropractor. It is not normal to suffer with regular headaches and help is available.