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It’s a long list that involves descriptions like tension, rebound, cluster and chronic.
Pain can vary from pulsating to throbbing to squeezing to pressing. Headaches can affect one side of the head or the back of the head or perhaps be centred around one eye.
They can happen infrequently or make your life a misery with their prevalence. When, then, should you seek medical help for what could be, not just a headache, but a headache disorder?
Headache disorders include chronic daily headache (an umbrella term for three types), cluster headache and, of course, the many types of migraine.
Symptoms and triggers can vary with the individual and overlap between the disorders making diagnosis difficult on occasion.
‘Gold dust’ diary helps with diagnosis
“Keeping a diary of your headache experience is recommended as it is gold dust when it comes to aiding diagnosis as it shows the patterns of your headaches,” says Hazel Breen communications and information officer with the Migraine Association of Ireland (MAI) about the many types.
“You keep a record of when the headache started, how long it lasted, what the pain was like, your diet and other factors like sleep patterns at the time. Bringing this to your GP will help you make the most out of your appointment. If referred on to a consultant this will help him/her figure out what type of migraine or headache disorder you have and tailor specific treatment for you. Headache is very individual as is treatment. You can get a free headache diary from the MAI*.”
The less serious
So what are the different types of headache? She starts with the less serious list:
1 Sinus headache
This is caused by a clogged sinus cavity and is sometimes confused with migraine. It usually involves a dull ache in the face and other symptoms. An x-ray will confirm a sinus blockage and this headache is treated with antihistamines and antibiotics if necessary.
2 Benign exertional headache
This is brought on by intense physical exercise including sexual activity and the moderate to severe pain generally lasts from a few minutes to an hour.
3 Caffeine withdrawal headache
A throbbing headache caused by dilation of the blood vessels once the constrictive effects of caffeine are no longer present. It can occur about 12 hours after the last cup of coffee.
4 Tension headache
This is the most common type of headache and can be caused by stress, poor posture or inadequate lighting and can last from one to six hours. Symptoms involve a ‘band-like’ or ‘pressing’ headache and tension in the shoulders and back of the neck. It can be treated with over the counter medication and stress management techniques like taking regular breaks from screens, exercise and eating sensibly. If you are taking painkillers frequently for this it is time to seek medical help, however.
The more serious (headaches disorders)
Chronic daily headaches
Chronic daily headache (CDH) is an umbrella term for types of headache that occur on 15 days of the month or more and last at least 4 hours. These types of headache affect 4-5% of population. Like migraine they can affect a person’s ability to function within the family, society and the workplace.
The three types of CDH are:
a Chronic tension headache – People with this usually have a history of tension headaches and have headaches at least 15 days per month. The headaches are often triggered by ongoing stress or other emotional factors such as job conflict, family relationships, grief or depression. They usually last for four to 72 hours.
b Medication overuse headache (Analgesic Rebound) – This is caused by the overuse of analgesic medication like paracetamol, aspirin ibuprofen or codeine.If you are experiencing regular headaches and are getting into a cycle of taking medication you should consult your GP to get a diagnosis, Hazel says. “Taking more and more medication and feeling that you can’t stop taking them and having withdrawal symptoms (worse headache, nausea and anxiety) are indicators that you need treatment, usually gradual withdrawal. 40% of medication overuse headache sufferers will relapse so it is important to seek help and proper treatment.”
c Chronic (transformed) – migraine.
Migraines– different types
1 Without aura
This involves intense throbbing on one side of the head that is worsened by movement. It can last 4-72 hours. Nausea, vomiting, sensitivity to light, smells and noise can also be experienced along with blurred vision.
2 With aura
Aura is experienced 20-60 minutes before the headache starts. Symptoms can include blind spots, flashing lights and seeing, zigzag patterns. Also pins and needles in fingers and arms, sometimes spreading up into the face. “People can be worried that they are having a stroke as slurring of speech, loss of coordination and confusion can be involved.” 20% of people with migraine experience aura.
3 Aura with no headache
One per cent of migraineurs experience that and the most common symtpoms again are blindspots, flashing lights and seeing zigzag patterns.
4 Basilar migraine
This is rare and can affect children. It involves loss of balance, double vision, difficult speaking and fainting. The loss of consciousness can be very frightening as people again may believe that they are suffering from a stroke.
5 Hemiplegic migraine
With this type of migraine symptoms build up slowly as the migraine progresses. The weakness and the numbness usually goes away within 24 hours but may last a few days. Visual disturbance can occur and one side of the face can fall which looks like a stroke and aura (circles and shimmers) may be experienced along with fever, brain fog, dizziness and vertigo.
6 Ophthalmoplegic migraine
This is very rare and occurs mainly in young people. It involves weakness of one or more of the muscles that move the eye. Dilation of pupil occurs along with an inability to move the eye up, downward or across as well as drooping of the upper eyelid.
7 Vestibular migraine
Often occurs later in life and involves problems with co-ordination, the sensory information that is sent to the brain from the eyes, muscles and bones and the vestibular organs in the ears. Nearly 40% of migraine sufferers experience some kind of vestibular symptoms during their lifetime – sensitivity to light, stiffness in neck, nausea, motions sickness, vertigo, diminished eye focus, sensitivity to light and sound, tinnitus, nausuea, vomiting, ataxia (loss of control over body movements in upper spine area), confusion, disorientation and anxiety or panic.
Treatment
Treatment for migraine can include triptan medication, analgesics, preventives and trigger avoidance.
This type of headache is rare but is very severe and affects about 1% of the population. It is six times more prevalent in men than women and usually begins in the late 20s or early 30s.
Unlike migraine, sufferers don’t get ease from lying down in a darkened room. Cluster headaches typically begin in the middle of the night and present as a severe stabbing pain (hot poker in one eye) lasting 15-180 minutes and affecting one side of the head. Agitation occurs also with no relief from sitting or lying down. Attacks come in clusters that last weeks or months and then may disappear for months or even years.
While the cause is unknown trigger factors include alcohol, tobacco, irregular sleeping patterns and stress.
Treatment for this can include the fast inhalation of 100% oxygen for 15-20 minutes. Tryptan medication may also be used to treat or abort the attack.
Treatments can be short term preventative and long-term preventatives including corticosteroids and ergotamine as short-term treatments and verapamil and lithium as long term treatment. In severe cases two types of surgery may be considered – occipital nerve stimulation or deep brain stimulation.
With many people now going back to work in offices the Migraine Association of Ireland is asking employers to be aware of migraine and employees who have it.
“Without putting pressure on employers we are asking that they have an open-door policy where those with migraine can just say they need to go take their medication immediately, for example.
“Doing things like missing breaks or lunch can bring on an attack as can fluorescent lighting as it produces glare. Fitting LED bulbs can help greatly. Regular screen breaks are important too. It’s about stopping the triggers in the work environment. It could be providing noise reducing headphones if noise is a trigger for an employee with migraine.”
For employees showing your employer a letter stating your diagnosis is important.
“You are telling them you have a health condition which otherwise would be invisible. Knowing that you are able to leave a meeting to take medication when you need to without people questioning what you are doing reduces stress.”
See https://migraine.ie/2021/07/migraine-in-the-workplace-for-employers/
The headaches listed in this article are primary headaches. Headaches caused by other medical problems are known as secondary headaches which can have benign or serious causes. Although rare, the MAI recommends that you consult your doctor, in the interests of safety and for proper evaluation when you are experiencing headaches, for example, after head injury or if your headaches are triggered by sneezing or coughing. See more information about Headaches Causes By Medical Disorders at https://migraine.ie/other-headache-disorders/
The stress of the COVID-19 pandemic led to people having more headaches, according to Hazel.
“We saw (calls to) our information line spike,” she says.
“2020 was a really busy year for us as people were ringing our info line worried and scared and stressed. With our healthcare system under so much pressure, people needed more telephone and online support related to headaches and migraine.”
The pandemic has actually shown the Migraine Association of Ireland the value of video conferencing, she says.
“Face-to-face events don’t always work for migraine sufferers because if you are suffering with a migraine you are not going to be able to travel to one. Zoom calls meant that we can have greater input of global specialists at events too.
“We now also online GP appointments with our specialist GP Dr Mary Carney which are proving very helpful for those experiencing severe headache.”
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