9 Types of Headaches

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Diagnosing Different Types of Headaches

A person’s medical history and the frequency and severity of the headache is important in distinguishing an uncomfortable but safe headache from a more serious one. A doctor’s consultation is likely to include these questions:

• When did the headaches start?
• Was the onset sudden?
• Is it one headache that is present all the time or does it come in bursts? If so, how long does each burst last?
• When do the headaches occur (for example, in the morning?) and how often do they occur?
• Are they getting worse?
• What sort of pain is it-stabbing or aching?
• Where on the head does it occur-in one particular place or all over?
• Is there anything that seems to bring the headache on, make it worse or relieve it-certain foods, bending or coughing, for example?
• Does anything else occur with the headache?

What causes headaches?

Headaches occur for many reasons. Receptors responsible for the sensation of pain lie in blood vessels at the base of the brain as well as in the meninges, the protective coverings of the brain.

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5 Types of Headaches that are Considered “Harmless Headaches”

The majority of headaches, however painful, are short-lived and are not a cause for concern. Here are five types of headaches that fall into the “harmless” category:

1. Tension headache

A tension headache is the most common type of headache and is experienced by most people at some time. The pain, often described as a band-like pressure around the head, tends to be fairly constant. The sufferer may be able to feel points of tenderness over the scalp. There is no associated vomiting or aversion to bright light (photophobia). The headache is generalized and can last for weeks or months, and for this reason is unlike migraine, which tends not to last for more than 72 hours.

Tension headaches can be brought on by stress, noise, fumes and concentrated viewing of TV or computer screens. Sometimes they arise because the body is dehydrated. The worry of having a headache may cause the pain to continue. It is important to remember that this type of headache is not dangerous.

To manage a tension headache:

• Avoid precipitating factors if at all possible;
• Relaxation and physical exercise may be helpful, as can massage and cooling packs;
• Try drinking a glass of water if dehydration is suspected;
• Painkillers available at the pharmacy may help, but they should only be used as prescribed and for the short term.

2. Migraines

Migraine headaches are characterized by a throbbing pain on one side of the head. This is often accompanied by vomiting, seeing flashes of light and sometimes a tingling sensation or numbness, moving across the body.

Stress and certain foods can trigger migraine attacks. Once trigger factors are identified, they should be avoided where possible. Aspirin or paracetamol are often taken for pain relief, but sufferers should avoid any containing caffeine, such as codeine, as these may cause further headaches once they stop taking them. Specific anti-migraine drugs may be given as prevention, or for use during an attack. While the headache lasts, sufferers usually prefer to be in a dark, quiet place.

3. Sinusitis

Sinusitis is often fairly easily diagnosed since the headache may be associated with an upper respiratory tract infection or a cold with fever, runny nose and tenderness around the sinuses – at the top of the nose and around the eyes.

Simple steam inhalations or decongestants can help, and in a few rare cases surgery is required. Antibiotics are sometimes needed to clear an infection.

4. Cluster headache

Despite being referred to as ‘migrainous neuralgia,’ cluster headaches are not migraines. They are not common, and the ratio of male to female sufferers is 5:3. Usually beginning in the patient’s 30s, they tend to disappear after 35. The condition occurs more frequently among heavy smokers. Alcohol consumption may sometimes trigger an attack, although there appear to be no dietary triggers.

The symptoms are recurring attacks of extreme pain, located around one eye. Other symptoms include excess production of tears and blockage of the nostril on the side of the pain. There may also be vomiting. The patient tends to develop a pattern of pain at certain times in the day, for example, occurring every morning. It may even wake the patient up during the night.

Attacks can last for as little as 15 minutes, but can be up to 3 hours long. (They usually last between 30 and 90 minutes, however.) There are about 250,000 sufferers; they often feel restless and need to walk about.

The attacks may occur several times over a number of weeks and then be followed by months of being free of symptoms before another cluster of attacks occurs. In severe cases, attacks occur several times a day.

Painkillers and treatments for migraine tend to bring little relief. Frequent severe attacks of cluster headache may be prevented by taking prescribed doses of lithium carbonate, but this is quite a toxic drug with unpleasant side effects-including nausea, vomiting and tremor-that need to be set against its potential benefits. The patient will also require regular blood tests to monitor kidney and thyroid function.

Inhalation of concentrated oxygen can sometimes help to stop an attack.

5. Trigeminal neuralgia

Trigeminal neuralgia may be caused by damage to the trigeminal nerve, the main sensory nerve supplying the face. Sufferers tend to be middle-aged or elderly. Common causes of damage include infections such as shingles and diseases such as multiple sclerosis that affect the protective layer that encases the nerve fibres.

Factors that trigger trigeminal neuralgia include cold, touch or the actions of eating or drinking. The pain is often sudden and severe and may cause the patient to flinch.

Attacks may last only seconds or minutes but can occur several times a day. Bursts of pain may be followed by a dull, aching sensation.

People who suffer from trigeminal neuralgia should attempt to avoid trigger factors. Drug treatment with tricyclic antidepressants or anticonvulsants such as carbamazepine often proves highly effective. Destroying part of the nerve by either local injection of phenol or by surgery may also be effective but can lead to permanent numbness.

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4 Types of Headaches that are Considered “Dangerous Headaches” 

A headache may also indicate raised intracranial pressure, subarachnoid haemorrhage, meningitis or temporal arteritis-all of which require urgent medical attention.

1. Raised intracranial pressure

An increase in the pressure exerted on the brain can cause a severe headache. This can be due to an increase in the production of fluid within the brain, a decrease in its drainage (hydrocephalus) or a growth (for example, a tumour) within the skull. Other more obvious causes include headache following traumatic head injury or a heart attack, where there has been a reduction in oxygen supply to the body.

Apart from a headache, the symptoms of raised intracranial pressure include problems with speaking or writing, or difficulty with moving limbs. Typically, the headache is felt all over the skull, is most severe on waking and eases upon standing up. The pain tends to be made worse when coughing, straining, sneezing or bending forwards. Vomiting often occurs.

The headache usually becomes progressively worse over a matter of days or weeks, but the speed at which the pain develops depends on the cause. Headaches caused by hydrocephalus tend to develop in hours or days, whereas pain due to a mass or tumour within the brain will progress over weeks or months.

Treatment of raised intracranial pressure depends on the cause-for example, a suspected tumour requires further investigation and, if necessary, surgery or radiation therapy will be carried out to reduce the mass. Hydrocephalus requires the excess fluid around the brain to be drained off (often via a ‘shunt’ inserted from the brain into a major neck vein). Drugs that reduce swelling and excess fluid, such as dexamethasone, may be used to relieve the pressure within the skull.

2. Subarachnoid haemorrhage

A subarachnoid haemorrhage is signalled by a sudden, extremely severe headache that may be like being struck on the head with a hammer. The neck feels stiff and the patient may lose consciousness. It is caused by blood leaking from vessels and pooling under the protective coverings of the brain.

This is an emergency condition requiring immediate hospitalization and probable surgery to secure the bleeding vessel.

3. Meningitis

A severe headache may be a symptom of meningitis. Such headaches often develop over a matter of hours or days. Suspicion should be raised if the individual concerned also has fever, neck stiffness, irritability or varying levels of consciousness and possibly a rash.

Meningitis may be bacterial or viral in origin. Bacterial meningitis needs early treatment with antibiotics. Hospitalization is essential and a doctor should be consulted as soon as possible.

4. Temporal arteritis

Temporal arteritis is caused by inflammation of some of the blood vessels in the brain and can lead to blindness if vessels in the eye are affected. The headache develops over a matter of weeks, and pain may occur on one side of the head or all over. Women are twice as likely to be affected as men.

A typical symptom is that of pain in the jaw muscles when chewing. A quarter of those affected also have generalized joint and muscle aching. Diagnosis is made by blood tests and often requires a biopsy in which a small amount of tissue is taken from a scalp artery for study by a specialist.

Temporal arteritis needs prompt diagnosis and urgent treatment with high doses of steroids.

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Complementary therapies for headache relief

It is important to ensure that your headache is not due to a serious illness before considering the use of any complementary therapy.

Therapies that induce a state of relaxation (such as aromatherapy, holistic massage and reflexology) may help to relieve tension headaches. Similarly, relaxing exercises, such as those of yoga and t’ai chi, may also be useful. Camomile tea and valerian, which have a calming effect, can also help.

Osteopathy and chiropractic often bring rapid relief when headaches are the result of poor posture or of muscle spasm.

If you suffer from migraines, a complementary therapist may recommend that you omit certain trigger foods (such as cheese, chocolate and red wine) from your diet. Eating fish rich in Omega-3 fatty acids (such as mackerel, salmon and tuna), may help to prevent migraines.

Certain supplements can also be beneficial to those affected by headaches. These include:

• Feverfew, which may prevent or alleviate some types of headaches, including migraines, when taken over several weeks or months;
• Riboflavin (a B vitamin) and a combined magnesium and calcium preparation, taken daily, may be effective for persistent migraines.

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