Headaches & Migraines
This text is for educational purposes only. It is not meant to diagnose, or outline treatment for, any particular individual or condition. It is also not meant to contradict any particular diagnosis or treatment. Any diagnosis, treatment, or change in treatment should only be carried out by an appropriate healthcare practitioner.
Tension headaches
These "everyday" headaches most commonly give a constant ache on both sides of the head.
The causes can be many and interlinked. Typically they’re associated with:
Stress.
Neck and shoulder tension or poor posture (Cervicogenic Headaches).
Eye strain.
Tiredness.
Lack of exercise.
Skipping meals.
Dehydration.
Noise.
Certain smells.
Migraines
Migraines are caused by how the brain processes and deals with information, such as light or sound, and other triggers, such as certain foods, caffeine and tiredness. They can often run in families. They are typically associated with:
One sided throbbing pain at the front or side of the head.
Flashing lights.
Nausea and vomiting.
Highly sensitivity to light or sound.
Usually gets better in 4 to 72 hours.
Migraines in children can have different symptoms to adults. They tend to affect both sides of the head, be shorter and less severe, and may include stomach pain and vomiting.
A migraine doesn’t have to involve a headache. A ‘silent migraine’ is when a patient experiences the other symptoms, for example flashing lights, but without experiencing the headache.
Cluster headaches
Cluster headaches are acutely painful coming on quickly and without warning. They’re called cluster headaches because you get a cluster of them every day for weeks or months at a time (usually lasting for four to twelve weeks). The headaches can then disappear for long periods (for months or years) before returning. They tend to occur at the same time of day (most commonly a couple of hours after going to sleep) and same time of year (most commonly spring and autumn). Standard headache and migraine medications don’t help but your GP can prescribe you specific medications.
Pain is often felt around the eye, temple and sometimes face. It tends to effect the same side on each attack.
You may also get:
Watering or red eye.
Drooping and swelling of one eyelid.
A smaller pupil in one eye.
Sweaty face.
Blocked or runny nose.
Causes can include smoking, drinking alcohol, a family history of cluster headaches and strong smells e.g. perfume
Medication overuse headaches or ‘rebound’ headaches
1 in 10 headaches occur from taking pain killers. Therefore you can get a headache for whatever reason, take some pain killers, but in some cases, the pain killers, over a period of time, cause these types of headaches!
All pain killers, of any type, including migraine pain relief medication, can cause medication overuse headaches when used more than two days per week. The most common pain killers that cause headaches are:
Triptans.
Ergots.
Opiate based medication e.g. codeine based medication, tramadol and morphine.
Paracetamol.
NSAID’s e.g. aspirin, ibuprofen or naproxen.
Medication with caffeine in.
After stopping the medication patients commonly feel worse and experience more frequent headaches or migraines for a week or more. This can be accompanied by nausea, poor sleep, restlessness, stomach upset, diarrhoea and anxiety. TO AVOID ANY HEALTH COMPLICATIONS ANY CHANGES TO YOUR MEDICATION SHOULD ONLY BE MADE BY YOUR GP.
Hormone headaches
Many women notice a link between their headaches and periods, menopause, HRT or use of hormone contraception. In these cases it is advisable to consult your GP for advice on the treatment and prevention of headaches.
Warning signs
You should get immediate medical advice if you develop any of the following symptoms with your headaches:
High temperature or fever.
Rash.
Sudden, very severe headache which reaches its peak in just a few seconds.
Paralysis/weakness or abnormal sensations in your face, arms or legs or difficulty speaking.
Confusion.
Seizures.
Slurred or garbled speech.
A red or painful eye or any change to your vision e.g. double vision.
Other causes of headaches
Other causes of headaches can include:
Having a cold or flu or sinusitis.
Caffeine. Especially in children.
Alcohol consumption.
Dehydration
Not eating regular meals.
Jaw or temperomandibular joint disorders (TMD).
Sleep apnoea.
What can be done?
Headaches and migraines can usually be cured, managed or at the very least improved. Like with all conditions this isn’t always the case but it can be surprising how some simple lifestyle changes can have a major impact on your symptoms.
Stay hydrated & don’t let your blood sugar drop. Simply drinking water with breakfast, lunch and dinner, and a little throughout the day, can be enough to keep you hydrated. You may need to drink more than this if you eat foods high in salt (including processed foods and meats) or drink caffeine or alcohol. In all you should aim for two litres of non-caffeinated fluid a day. To keep your blood sugar levels stable eat small frequent amounts over the day avoiding high sugar foods.
Posture. A faulty posture will put strain on the muscles that can trigger headaches and migraines. Follow these simple measures to help your sitting posture:
Make sure your workstation is properly measured up correctly. If you use a laptop get a docking station.
Whenever you’re sitting down, especially on a soft chair like a sofa, push your hips back so they’re resting against the back rest of the chair. This will put your neck and shoulders in a far more comfortable position.
Be aware if your head is drifting forward. This is a common postural fault that we all do when reading or looking at something. Without straining, just gently pull your chin in a bit, like you’re trying to give yourself a double chin! This will place your head in a more neutral position reducing the strain on the neck muscles.
Phones. Use a loudspeaker and headset when possible. Never cradle a phone between your shoulder and ear.
Avoid certain foods. Classic triggers for headaches and migraines can be alcohol, caffeine, the food additive tyramine, chocolate, citrus fruits and cheese. However this is not always the case and individual people can have individual food triggers. To complicate matters more sometimes food triggers can develop over time, so just because coffee never triggered a migraine in the past it doesn’t mean it won’t now.
Supplements. Supplements are always being advertised for headaches and migraines. They have different degrees of credibility and shouldn’t be taken by certain patients with certain conditions or if you’re on certain medications. If you’re not sure what is safe and effective for you to take check with your local pharmacist and take a full list of your medication.
Side effects of medication. We’ve already listed what pain killers are most likely to cause headaches (see ‘medication overuse headaches or rebound headaches’). Other medications can also cause headaches. These should be listed under ‘side effects’ on the documentation that comes with your medication.
Reduce eyestrain. Book an appointment with your optician to get your eyes tested. Looking at digital device screens for long periods not only strains the eyes more so than looking at, for example, a book, but it also makes you blink less which means you are not moistening your eyes as much. You should also stop your eyes from drying out by using your eye drops when you have an underlying eye problem, and ensure your eyes aren’t being dried out by a nearby fan or air conditioning. Make sure you’re using the correct glasses. Reduce activities that mean you need to maintain a prolonged focus and stop reading periodically and close your eyes for a few seconds to rest your eyes. Reduce bright light and glare. Don’t read in dim light. Try and adjust text that has a poor contrast between the colour of the text and the background.
Keep a diary. keeping a diary enables you to note any headache or migraine triggers as well as helping you monitor the effects of any treatment.
Relaxation. For most of us a siesta would be nice but not always possible! Slowly rotating your shoulders and being aware of the tightness held in your shoulders, neck and jaw will be enough to relax some of the tension that can cause headaches and migraines.
Relaxation can also be achieved by paying attention to the present moment (Mindfulness).
Paying more attention, and being more aware, of a particular moment in time can include:
An open-minded curiosity to explore and challenge how engrained thoughts, feelings and beliefs influence why you think, feel and act in a particular way.
Being aware of how your body is feeling e.g. doing a ‘body scan’ to see if you are holding tension anywhere. For instance, are you, at this moment, holding tension in your shoulders or jaw? Is your breathing free flowing and easy?
Being aware of the world around you. For instance, you might draw all your attention to the present moment by fully concentrating on the sound of the wind, or the birds, or the feel of the wind against your face.
By drawing all your attention to a particular thing in a moment in time it enables you to stand back from your thoughts and feelings. This helps you realise their patterns and the perspectives that led to them. It enables you to be open-minded and curios entertaining conflicting ideas and arguments that inspire you to explore new potentials and new possibilities.
This allows you to realise that thoughts do not have control over you; they are a ‘mental event’ that can be challenged by challenging your perceptions and redefining yourself.
Here is a NHS link for Mindfulness
References
file:///Users/karenwhiteside/Downloads/Headache%20advice.pdf
https://www.torbayandsouthdevon.nhs.uk/uploads/25409.pdf
https://www.uhb.nhs.uk/Downloads/pdf/PiHeadachesMedicationOveruse.pdf
https://www.nhs.uk/conditions/cluster-headaches/