The Dreaded Headache

“…there have been discoveries of skulls dating back to Neolithic times (between 10,200 BC and 2000 BC) drilled into and partially removed in what is thought to have been an early attempt at treatment”

I was speaking to a friend recently who claimed that he had never had a headache. On further enquiry, it appeared he simply had no concept of what one might feel like, even the dreaded hangover headache.  Now I don’t have any statistics on this, but I suspect that this situation is very rare. Let’s face it, most of us get headaches and, unfortunately, there are lots of things that can lead to one.

Throughout history people have suffered and there have been discoveries of skulls dating back to Neolithic times (between 10,200 BC and 2000 BC) drilled into and partially removed in what is thought to have been an early attempt at treatment. Drastic though that may seem, some have shown signs of bone growth around these holes, suggesting the patients survived this process. Altogether more civilised were the ancient Greeks and Romans who tried either peppermint tea or rubbing raw potato into their heads.

Overwhelmingly the most common cause is the tension headache and most of us will have experienced one of these. They occur due to muscular tension that can develop from the shoulders and neck or from around the muscles of the forehead if, for instance, one’s posture in front of the computer is not optimised. They can also develop through stress or if the eyes have been straining to read a screen for too long. It’s always worth popping to your optician to get your eyes tested if you feel you are straining a lot, especially if you’re getting headaches.

Although tension headache is most common, it is perhaps over-diagnosed at the expense of another common cause of headache – the migraine. Thought to have a global prevalence of 14.7%, it is estimated that the UK population loses 25 million work or school days from the condition each year. That equates to roughly £2.25 billion loss to the economy and produces a £150 million cost to the NHS through prescriptions and GP appointments.

Migraines are typically one sided (although not always), hence the derivation of their name from the Greek word ‘hemikrania’ meaning ‘half the skull’. Despite their impact and prevalence, the process behind what causes them is still unknown. Rather than relating to blood vessels in the brain constricting and then dilating as once thought, it is now suspected to be more related to particular neurological systems. There is ongoing research into various facets of this, including particular gene associations (there is a definite hereditary element to migraines), specific brain regions activated in the earliest stages and the roles of various neuropeptides. It’s all pretty complex stuff.

One third of migraines will start with an aura (a visual phenomenon a little like the image below although it can differ from person to person) and may progress to a throbbing ache, typically lasting for between 4 to 72 hours. Women are more prone than men, and tend to suffer more often during or just before their periods.

Just one way you might visualize an aura

If you have a migraine, it is best treated as early as possible with paracetamol or ibuprofen. If these don’t work, regular sufferers may benefit from trying one of the triptan medications available on prescription. Once established however, a migraine can be debilitating and so lying down in a dark room and resting is often the best course of action.

It’s worth considering that there can be certain triggers. Coffee, chocolate, sugar-free food sweetened with aspartame or sucralose and any foods containing tyramine such as citrus fruits, bananas, processed meats, onions and nuts are all potential offending items.

What of other causes of headaches? I mentioned hangovers earlier and these must be up there alongside tension and migraine headaches in terms of prevalence. Essentially, when we drink lots of alcohol, our bodies dehydrate and this reduces our circulating volume of blood. This causes a shrinkage of the brain that then pulls upon the membranes holding it in place, thus causing an ‘ache’. Like the migraine however, the full process is not wholly understood and there is a theory that suggests a significant contributing factor may be the build-up in the brain, in place of glucose, of a chemical known as acetaldehyde (which is a breakdown product of alcohol).  Either way, the best way to avoid it is obviously to limit alcohol intake and, if you are going to drink a lot, ensure you drink plenty of water before bed and in between alcoholic drinks.

There are several more severe and mercifully less common headaches worth mentioning.

Trigeminal neuralgia (the trigeminal nerve is a major nerve that supplies various areas of the head and neck; neuralgia is ‘nerve pain’) is characterised by short episodes of sharp, intense, electric shock pain in the eyes, nose, scalp, forehead, jaw or even lips. Even the slightest touch can trigger it, including a light breeze, and it can be life-changing for sufferers of severe forms.

Similarly, cluster headaches can be so severe that they are sometimes referred to as the suicide headache. The pain from these is often described as a penetrating and excruciating pain around the eye and can last anything from 15 to 180 minutes. Some have labelled it the worst pain a human can experience. If you are suffering from these, the chances are you won’t need prompting to come and see a doctor.

If you suddenly experience a sudden severe (often described as thunderclap) headache, one that you might describe as the worst headache you have ever had (assuming you have never had a cluster headache!) or as if you have been hit on the back of the head, it might be a sign of a different cause – a subarachnoid haemorrhage (subarachnoid means below the outer layer of the brain, haemorrhage = bleed). This can be accompanied by sensitivity to light and neck stiffness, much like those suffering from meningitis. This needs a trip to A&E to get tested.

More subtly, but still serious, is a headache that manifests in tenderness over your scalp. If you have pain when you press over your temples (typically, in contrast, rubbing here with a tension headache helps) then it may represent an inflammation of the blood vessels in the scalp known as temporal or giant cell arteritis. This is a rheumatological condition and may require blood tests and maybe even biopsy of the offending areas. It can also cause blurred vision so if you think this is happening (typically you will be a woman around your 70th year) then it is worth coming to see us.

Finally, if you are waking up every morning with a headache over the course of several weeks, this is probably something you should also get checked out. It could well be tension, a stiff neck or blocked sinuses but this pattern can sometimes point towards pressure within the brain itself caused by a tumour. No harm in coming to get it checked by us.

Far from wanting to worry you, the chances are that, if you have a headache, it is caused by tension or a migraine. So my advice is similar to what it would be for many other health conditions. Maintain a healthy and balanced diet, with plenty of exercise, and ensure you drink enough water through the day. Get your eyes checked regularly and make sure you consider your posture both at work and at home on the sofa. Manage stress (as much as that is possible!) and if you are worried that the headache has any worrying features, feel free to come and see your GP. As for hangover headaches though, I’m afraid you’re on your own. “