Headaches and Migraine: Frequently Asked Questions

Headaches are not uncommon. We have all experienced a headache at a certain point in our lives. It is a common neurological problem affecting people of all-region, race, ages, etc. According to WHO, at least 50% of the adults aged 18–65 years, globally have experienced a headache in their lives. These headaches are mostly caused by disorders of the nervous system. 

A headache causes discomfort or pain in the head region that can radiate to your face too. They can vary from mild, moderate to severe and can occur frequently. Headaches can impair your work, social life, and quality of life. 

There are many types of headaches:

  • Primary headaches are generally not caused due to an underlying disease. They include tension-type headache (TTH), migraine, cluster headaches, etc.

  • Secondary headaches are caused due to over-usage of medications or are a symptom of an underlying disease, injury, tumour growth, or infection. They may not be common but are potentially life-threatening compared to primary headaches and may require immediate medical attention. 

Tension-type headache (TTH)

  • A tension-type headache is one of the most prevalent and most common types of primary headache and is usually causes mild to moderate pain that affects both sides of your head.

  • Although it is not clear what triggers this type of headaches, it is speculated to be caused due to stress, sleeplessness, clenching of the teeth, improper blood flow, neck ache, eye strain, etc. 

  • Unlike, migraines, tension-type headaches are tolerable and do not interrupt our routine life

  • A tension-type headache can be episodic or chronic

  • Episodic headaches are usually mild to moderate and can occur for less than 15 days a month. The pain may last anywhere between 30 minutes to several days. They typically start after waking up and may become severe later in the day.  

  • Chronic headaches are severe and can last for more than 15 days in a month. 

Migraine

  • Migraines are the second-most prevalent type of primary headaches. 

  • Although migraine can happen to anyone and at any age, it mostly affects adults aged 35 - 45 years. 

  • Women are more likely to suffer from migraine than men because of the oestrogen imbalance. 

  • Migraines are easily triggered in people with a sensitive nervous system. 

  • The brain’s nerve cells produce electrical activity disturbing various functions including sensation, vision, gait, coordination, speaking ability, etc. 

  • These nerve cells send pain-producing inflammatory substances to the brain causing severe headache which can last for a few hours or few days. Other symptoms include nausea, vomiting, sensitivity to sound and light, etc.

  • Migraines can also be triggered by head injuries, insomnia (sleeplessness), skipping meals, alcohol (red wine) and some foods such as soya, aged cheese, dried fishes, foods with monosodium glutamate (MSG), caffeine, etc. 

  • These triggers vary from person to persons. 

Cluster Headaches

  • Unlike migraines, cluster headaches are rare, mostly affects adults aged 20 - 40 years. 

  • Men are commonly affected compared to women.

  • A person with cluster headache experiences a sudden, throbbing, one-sided headache with water flowing out of their eyes and nostrils on that side.

  • The pain spreads to the eyes causing the eyelids to droop and pupils constrict on the affected side (same side of the headache).

  • Headaches usually occur in a cluster period, that is, it can occur regularly for a couple of months (1 - 3 months) than leaving a gap of several months to years before the attack begins. 

  • Headaches can also be a chronic cluster headache type, i.e., there is no headache-free interval. 

When should you see a doctor?

You should see a doctor immediately if you have a headache along with the following symptoms:

  • Fever

  • Confusion 

  • Imbalance

  • Changes in your vision

  • Pain in your temples

  • Pain in your jaw while chewing

  • Stiffness and pain in your neck

  • Weak immunity

Diagnosis

  • There are no specific methods to diagnose a headache. 

  • Diagnosis is generally based on your description of the headache symptoms. 

  • To rule out any associated disorders, sometimes blood tests, CT (computed tomography) scans or MRI (magnetic resonance imaging) of the head is also suggested. 

Treatment 

  • Over-the-counter (OTC) pain-relief medications are generally prescribed for mild to moderate headaches. 

  • If the headache is severe for example migraine, specific medicines such as abortive medicines, rescue medicines and preventive medications are given

  • Along with drugs, behavioural and psychological interventions such as relaxation, walking, meditation, listening to music as a way of stress management is also helpful.

  • You may have to avoid foods that trigger headaches

Frequently Asked Questions

1. Are there any warning signs before a migraine attack?

Just before you get a migraine headache, you may experience the following symptoms which are also referred to as ‘aura’:

  • Trouble in speaking

  • Imbalance

  • Weakness in arms and legs

  • Seeing light flashes or blind spots 

2. What is a ‘Medication-overuse headache’?

Medication-overuse headache is a type of secondary headache disorder that is caused by excessive or over-use of medication to treat a headache for a longer period.

3. What are the common causes of secondary headaches?

Some common causes of secondary headaches include but not limited to:

  • Infections such as sinusitis

  • Conditions of the brain such as aneurysm, tumour, blood clot formation, etc

  • COVID-19

  • Dehydration

  • Glaucoma

  • High blood pressure

4. Can headaches be an emergency?

You may require seeing a doctor right away if you experience the following symptoms:

  • Unbearable or intolerable headache

  • Difficulty in speaking 

  • Unable to speak fluently

  • Numbness of the face on one side

  • Double vision

  • Drooping of eyelids on one side

  • Constriction of pupils on one side

5. How is a migraine headache different from a tension-type headache? 

Migraines cause pain only one side of the head and get aggravated with physical activities thus disrupting your routine. Migraines cause nausea, vomiting, and make sense to light and sound.

Unlike migraine, tension-type headache is generally not so severe and affects both sides of the head. These types of headaches also do not disrupt your routine.

 

Dr. Anurag Saxena

HOD & Consultant - Department of Neurosurgery

Manipal Hospitals, Dwarka, Delhi

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