Every day, one in 20 of us will develop a headache, making them second only to backache as the most common cause of pain.
Meanwhile, as many as eight million Britons suffer from migraine — severe headache that can coincide with nausea, light sensitivity and other troubling symptoms.
As anyone who suffers from them knows, headaches can be extremely debilitating.
Most of us will suffer from a tension headache — they are the ‘ordinary’ headaches that 95 per cent of us will have at some point
The good news is that the pain is usually simple to manage — unfortunately, we often take the wrong action, inadvertently prolonging the misery.
Here, in this third part of our brilliant How To Beat series, we’ve enlisted the help of the country’s top experts to show you how to banish the pain. Their advice could be life-changing.
The first priority is to identify what might be triggering your headache so you can find the best treatment . . .
DO YOU NEED YOUR EYES TESTING?
Staring at a screen for too long can also cause eyes strain and headaches
Headaches around the front of your head and eyes may be a sign you need glasses for the first time or that your lens prescription is out of date.
As Dr Susan Blakeney, clinical adviser to the College of Optometrists, explains: ‘When you go to the gym and use your muscles a lot they get tired and ache.
'The same sort of thing happens with eyes.
‘If you are straining to focus clearly or if your eyes don’t work efficiently together, the muscles around your eyes will tire quickly and this can lead to headaches.
'It’s nothing to do with the optic nerve, which is responsible for seeing, or the blood vessels.
‘I would expect headaches caused by the eyes to be around the front of your head, as that is where the muscles are.
‘Staring at a screen for too long can also cause eyes strain and headaches.’
She recommends the 20:20:20 rule: every 20 minutes, fix your gaze on an object 20 metres away for 20 seconds.
* Intense, sudden and constant eye pain in conjunction with a headache and possibly seeing halos or rainbow lights can be a sign of acute glaucoma, which is when the drainage channels in the eye becoming blocked.
‘This causes a build-up of pressure and, if left untreated, can lead to sight loss,’ says Dr Blakeney.
Go straight to A&E or your nearest eye hospital.
TENSION HEADACHE
SYMPTOMS: Headache combined with a tight squeezing sensation around the head (like a tight band), which might spread down the neck.
DURATION: A few hours.
Most of us will suffer from a tension headache — they are the ‘ordinary’ headaches that 95 per cent of us will have at some point, says Dr Fayyaz Ahmed, a consultant neurologist at Hull Royal Infirmary and former chair of the British Association for the Study of Headache.
They cause mild to moderate pain that typically lasts a few hours, but can persist for days or even a few weeks in some cases.
Tension headaches are triggered by dehydration, stress, tiredness (which can disrupt the normal balance of chemicals in the brain) or physical factors such as sitting at a computer screen (causing contraction of the neck, face and scalp muscles).
They are twice as common in women and can strike around twice a month.
TREATMENT: Instead of reaching for pills, try simple relaxation techniques, such as head or neck massage or a hot bath, says Dr Andrew Dowson, director of headache services at King’s College Hospital, London.
While painkillers, such as aspirin, paracetamol or ibuprofen, will help, there is the risk of being addicted to them.
PAINKILLER HEADACHE
SYMPTOMS: Persistent nagging headache, despite taking pain-killers regularly (two to three days a week, every week).
DURATION: Constant.
These are caused by the very pills you’re taking for your headaches.
‘If you get headaches often and take painkillers regularly, you can then suffer more headaches,’ says Dr Dowson.
‘Painkiller headaches occur because the body becomes accustomed to a frequently used pain reliever and then develops a withdrawal effect — a headache — when medication is stopped.’
Painkiller headaches are linked to taking pain relief for more than two days a week for three months.
Around one in ten patients who are referred to headache clinics suffer painkiller headaches, says Dr Ahmed.
‘These can develop with any type of painkiller, but are more common with pills that contain codeine or caffeine, such as Solpadeine and Syndol, which are potentially more addictive.’
TREATMENT: It’s simple advice, but stop taking the painkillers.
‘This can be difficult because there will be a great temptation to go back on the drugs,’ says Dr Dowson.
‘The headaches may get worse before they improve, but by the third week many people start to feel much better.’
A GP can prescribe a short course of steroids to help with pain and may suggest initially switching to ibuprofen.
SEX HEADACHE
Around 1 per cent of people experience headaches during or after sex, known as orgasmic cephalgia
SYMPTOMS: Thunderclap headache that occurs during sex or at the point of orgasm.
DURATION: Can last for just a minute or many hours.
Around 1 per cent of people experience headaches during or after sex, known as orgasmic cephalgia.
‘These can feel as if you’ve been hit over the head with a cricket bat,’ says Dr Ahmed.
‘If this happens for the first time, I recommend going to A&E to rule out a bleed on the brain — the symptoms are indistinguishable.
‘But if the headaches are regular, they are unlikely to be a stroke or brain haemorrhage and more likely to be orgasmic cephalgia.’
These headaches are a form of acute migraine, which doctors don’t fully understand.
However, sex headaches are harmless and usually go away after a few attacks.
‘Thunderclap headaches are not restricted to sexual intercourse and may occur at other times,’ says Dr Ahmed.
‘The key is that the first ever thunderclap needs investigation to rule out a haemorrhage.’
TREATMENT: ‘Taking non-steroidal anti-inflammatory painkillers such as ibuprofen half an hour to an hour before you have sex can help prevent attacks,’ says Dr Ahmed.
In severe cases, beta blockers, such as propanol, can be prescribed by your GP.
CLUSTER HEADACHE
SYMPTOMS: Excruciating knife-like pain on one side of the head, often behind the eye, which may wake you at night. The headaches can recur up to several times a day over a few weeks.
DURATION: Attacks usually peak within five to ten minutes of the pain starting and typically last 30 to 45 minutes, though can persist for up to two hours.
Cluster headaches are caused by problems in the way pain is processed by the brain, which means the effect is exaggerated.
‘Other symptoms include a runny nose and a restless feeling, so you can’t keep still,’ says Dr Ahmed.
‘These headaches can also wake you every night — sometimes at the same time — because they affect the hypothalamus, the area of the brain which is responsible for sleep and wakefulness.’
Most sufferers have a few attacks a day for a few days once or twice a year — the condition is more common in middle-aged men.
TREATMENT: Ordinary painkillers are rarely fast-acting enough to help, but some patients find prescription only migraine remedies — such as Imigran injections or a sumatriptan nasal spray — can help.
Your GP may also prescribe 100 per cent pure oxygen therapy to use during an attack. This comes from a cylinder that’s delivered to your home — smaller, portable tanks are available for taking outside the home in a car.
‘The treatment can offer fast relief,’ says Dr Ahmed. ‘But you need to start breathing it in as soon as the attack starts.’
TOOTH-GRINDING HEADACHE
SYMPTOMS: Headache in the morning, combined with pain around the ear and jaw.
DURATION: The first few minutes after you wake up.
‘If you habitually clench or grind your teeth during the night, the muscles that move the jaw can get tired — this leads to muscle spasm and can result in dull pain in the temples, cheeks and jaw, especially first thing in the morning,’ says Dr Ahmed.
TREATMENT: A dentist should be able to recommend a mouth guard (one you can buy off the shelf or have custom made). This will help reduce the teeth clenching at night.
In extreme cases, corrective jaw surgery may be necessary.
SINUSITIS HEADACHE
SYMPTOMS: Pain above the eye, cheek or around the nose.
DURATION: Constant persistent pain that can last for weeks.
Sinusitis is an infection in the sinuses, which are the air-filled cavities in the face. It may follow a cold and can trigger pain in the face that lasts up to four weeks — the pain is due to the membrane that lines the sinuses becoming swollen and inflamed, trapping air and mucus inside.
TREATMENT: Painkillers and steroid nasal sprays help, but your GP may prescribe antibiotics (though the evidence is that these won’t speed recovery) or suggest an antihistamine if symptoms persist.
‘In extreme cases, chronic sinusitis can be eased by an expert washing out the sinuses,’ says Dr Ahmed.
MONTHLY HEADACHE
SYMPTOMS: Headache that occurs in the first few days of your period.
DURATION: Two to three days of constant pain.
Some women suffer severe migraine-like headaches for the first few days of their period — this can be caused by levels of the female hormone oestrogen dropping in the body as part of the monthly menstrual cycle, says Dr Ahmed. It’s effectively an oestrogen-withdrawal headache.
TREATMENT: ‘If these headaches are happening regularly, your GP can prescribe oestrogen tablets or skin patches to take in the week before your period is due,’ he says.
Simple painkillers, especially non-steroidal anti-inflammatory such as ibuprofen, also help reduce the pain.
COATHANGER HEADACHE
SYMPTOMS: Headache when standing up; you may also suffer from dizziness.
DURATION: Usually as long as you remain standing – with headache relieved soon after lying down.
Could bad posture be giving you a headache?
Dr Brendan Davies, a consultant neurologist at the Midlands Regional Headache Unit at North Staffordshire Hospital, says the two can be linked. Sitting hunched over a computer for hours can lead to a headache, but usually there are other environmental factors contributing to it, such as dehydration, skipping meals or stress.
There are also several types of headaches that occur when you change your posture. These include the so-called coathanger headache.
‘We call it this because the pain is felt across the shoulders and up through the neck into the base of the head in a coat hanger shape,’ says Dr Davies, a medical adviser to the Migraine Trust.
‘It is caused by a sustained fall in blood pressure when you stand up from a lying or sitting position. Known as postural hypotension, as well as headaches, it can sometimes cause dizziness and falls.’ It is linked to a lack of salt in the diet and pills to lower blood pressure.
Headaches when standing up can also be caused by postural-orthostatic tachycardia syndrome (POTS). Standing up causes the heart rate to increase, leading to dizziness and fainting as well as headaches.
TREATMENT: This may include drinking more fluids and care with posture; some patients also need to have extra salt and medication.
MIGRAINE
SYMPTOMS: Throbbing pain at the front or side of the head, which gets worse with movement.
DURATION: Four hours to three days.
‘Migraines are thought to be caused by temporary changes in the chemicals and blood vessels in the brain,’ says Dr Ahmed.
‘Though many people associate migraine with other symptoms including nausea, sensitivity to light or aura (flashing lights that precede the headache), many migraines are indistinguishable from an ordinary, albeit severe, headache.
‘Their key characteristic is the throbbing, pulsating sensation that eases when you lie down or sit still and gets worse if you move around.’
TREATMENT: Paracetamol and ibuprofen can help in milder cases.
FIVE WAYS TO SOOTHE A TENSION HEADACHE
1 Take deep breaths. As you exhale slowly, lower your chin towards your chest and move your head in a semi-circle from side to side. Specialist headache nurses are instructed to teach patients this method, says Dr Fayyaz Ahmed, a consultant neurologist from Hull Royal Infirmary. ‘It is helpful to practise this technique for five to ten minutes, twice a day while listening to soft music — it helps ease tension and can distract you from the pain.’
To soothe a tension headache: Lie on your back on the floor (choose a carpeted surface), with your head elevated by a book, your legs apart and your knees pointing towards the ceiling. Relax for 15 minutes
2 Lie on your back on the floor (choose a carpeted surface), with your head elevated by a book, your legs apart and your knees pointing towards the ceiling. Relax for 15 minutes. This position — ‘semi supine’ — lengthens the spine, releasing tension and taking pressure off the neck and head, says Mark Blackburn, an Alexander Technique teacher, who practises in York.
3 Try acupressure: Place both thumbs at the point where your skull joins your neck; apply pressure and move your thumbs in small circles in 30-second bursts, suggests Tamsin Freeman, of the British Acupuncture Society
4 Move your tongue against the roof of your mouth then drop it to the bottom of your mouth, repeat several times. This relieves tension in your head, neck and face.
5 Adjust computer screens: sometimes a headache could mean you’ve been holding your head in one position too long, causing muscle tension or spasm. Move your head and take regular screen breaks.
WATCH FOR DANGER SIGNS
See your GP if headaches are new, severe or frequent, says Dr Ahmed. Also see your GP if you experience the following symptoms:
- You’re over 50 and experience any new persistent headaches. ‘This can be a sign of inflammation of the arteries in the temple — giant cell arteritis — and is potentially curable if treated with steroids within two weeks, but if left untreated, can lead to blindness,’ says Dr Ahmed.
- You’re taking the contraceptive pill and experience a new throbbing headache — this could be a sign of thrombosis (a blood clot blocking a blood vessel).
- A new daily headache that gets progressively worse over time or gets worse on coughing, sneezing or bending forward, may indicate ‘intercranial’ pressure — pressure in the skull — caused by a growth.
Go to A&E if you experience the following:
- A ‘thunderclap’ headache, where it feels as if you’ve been hit on the head with a cricket bat and it peaks within one minute. ‘This could be a bleed on the brain and needs urgent investigation,’ says Dr Ahmed.
- A headache that gets worse over a few days, accompanied by a fever, rash, sensitivity to light and/or stiff neck. These are possible signs of meningitis.
Act fast to tackle your migraine
The good news for migraine sufferers is that new treatments are being developed all the time
For the millions of Britons who suffer from migraine the symptoms are all too horribly familiar — a very painful throbbing ache at the front or side of the head, along with sensitivity to light and noise, and nausea.
A third of migraine sufferers also experience ‘aura’ — neurological disturbances such as changes to the vision (seeing zig-zag lines, flashing lights and blind spots), numbness and tingling in limbs and dizziness. These often occur before the headache phase.
However, migraine sufferers often don’t experience the aura.
And about 1 per cent have a ‘silent migraine’ — they experience the aura, but without the headache; the first time it happens this is often mistaken for a stroke.
The good news for the millions of migraine sufferers is that new treatments are being developed all the time.
Experts used to think migraines were caused by the blood vessels in the brain expanding and contracting, but now it’s thought the symptoms are due to abnormal brain activity affecting nerve signals and chemicals in the brain (such as serotonin, which carries messages across the brain).
This in turn leads to changes in the blood vessels in the brain, causing the pain and aura.
Two nerves — the trigeminal nerve, which connects the brain with the face, and the occipital nerve which runs from the top of the scalp to the spine — carry migraine pain to the face and scalp.
HOW TO TREAT IT: ‘Time is of the essence — if you can tackle the migraine in the first half hour any treatment will be far more effective,’ says Dr Andrew Dowson, director of the headache service at King’s College Hospital, London.
He says you may be able to halt an attack with ordinary non-prescription painkillers such as ibuprofen, but he recommends migraine sufferers take a large initial dose.
‘Migraines can slow down the progression of the gastrointestinal tract resulting in sluggish absorption, so you might want to take three ibuprofen or paracetamol for the first dose to achieve the same blood level of the painkiller, then return to the normal dose thereafter.’
Or you could try pain relief in a fast-acting form — for instance, Nurofen migraine pain caplets (£5.28 for 12) contain ibuprofen lysine which speeds absorption. Dr Dowson also suggests having an anti-sickness drug (domperidone) handy.
Not only will this aid the absorption of painkillers during an attack, but it will reduce symptoms of nausea that often occur. Domperidone (brand name, Motilium) is available on prescription only.
Regular sufferers who find ordinary painkillers ineffective can try a drug called sumatriptan. It’s one of the triptan family of drugs, which work by replacing some of the depleted serotonin, and allowing the enlarged blood vessels in the brain to return to their normal size; these drugs also calm the trigeminal nerve.
Sumatriptan is available without prescription, as Migraleve Ultra £7.89 for two tablets or Imigran Recovery, £7.99 for two tablets.
Migraleve is expensive, and you may have to fill out a questionnaire to get it from your pharmacist (to screen for possible contraindications and to ensure you don’t take too many), but you may find it useful to take at the first sign of a migraine.
As well as domperidone, there are a number of other drugs your GP can prescribe. These include betablockers such as propanolol which work by narrowing the blood vessels in the brain and reducing activity of brain cells.
Antidepressants such as amitriptyline, which acts on the brain’s receptors for serotonin, may also be offered; the anti-convulsive drug, topiramate (usually prescribed for epilepsy) can help control electrical activity in the brain.
However, all these come with strong potential side-effects including dizziness and drowsiness.
Are you making things worse?
Migraine experts agree that knowing and reducing the triggers for your migraines is the single most important step you can take to reduce their frequency and duration.
Dr Fayyaz Ahmed, consultant neurologist at Hull Royal Infirmary, says this may seem very obvious, but the single biggest mistake migraine sufferers commonly make is to ignore their triggers.
‘People are so busy that they don’t have the time to think about the most obvious things that could be causing their migraine,’ he says. Dr Ahmed asks his patients to keep a detailed headache diary to monitor triggers — which are highly individual, and very often work in bizarre combinations.
He also encourages them to eat a balanced diet, drink plenty of water and to make time each day to relax.
* Download a free ‘migraine diary’ template from migraine.org.uk. Or download the app Migraine Diary (developed by patient.co.uk) for your smartphone from the iTunes app store.
Jimmy Osmond: My 'migraine' was a stroke
Heart scare: Jimmy Osmond started having vision-blurring headaches 11 years ago
When I was 40, 11 years ago, I started having vision-blurring headaches after months of working hard.
My wife Michelle (pictured right) took me to hospital and it was discovered I’d had a stroke — I didn’t have high cholesterol, high blood pressure or any other warning sign.
An ultrasound scan showed I had a hole in my heart the size of a pound coin, which had contributed to the stroke because when my body was under stress, it was sending little blood clots up to my brain.
This birth defect, Patent Foramen Ovale, often closes up by itself, but I needed emergency surgery because of the risk of another stroke. It took me several years to overcome it — I felt I didn’t have mental clarity and my vision was blurry.
Though the problem isn’t thought to be genetic, my whole family was tested for it. It turned out three of my brothers, two nephews and my daughter Bella also had it.
It was a fluke the doctors found the hole in my heart. The experience has helped me realise life is a gift and we just have to embrace it, regardless of the trials we go through.
Still in agony? Try a brain zapper or Botox
About 10 per cent of schoolchildren suffer from migraine — tension and stress are potential triggers
IMIGRAN INJECTIONS
Imigran contains sumatriptan and is a drug which helps replace depleted serotonin.
Imigran jabs — which you will be taught to administer yourself — can be used during an attack to reduce symptoms.
They are useful if sickness makes taking tablets impossible. Patients can be offered the jabs on the NHS.
BOTOX
Chronic migraine sufferers can also be offered Botox on the NHS. The injections of muscle-paralysing botulinum toxin, usually used to treat wrinkles, are given in the head and neck. They’re thought to affect the chemicals that transmit signals across the brain which trigger migraines.
Two large studies led by the University of Essen in Germany and the Swedish Neuroscience Institute in the U.S. found those who received the Botox injections every three months for a year had 50 per cent fewer headaches, compared to those receiving placebo injections.
However, NHS waiting lists are likely to be very long. A private consultation with a neurologist trained to use Botox could cost around £600.
ACUPUNCTURE
This involves inserting fine needles into the scalp, neck and other points on the body and is thought to help by disrupting pain signals.
When the authoritative Cochrane researchers reviewed the evidence for acupuncture and migraine, they found that it’s at least as effective as preventative drug treatment, and has fewer adverse effects.
If you suffer from chronic migraine you may be able to get acupuncture on the NHS — under current guidelines, patients can have up to ten acupuncture sessions over a two-month period. However, there is limited availability and funding.
For private sessions expect to pay £30 to £50 a time. The effect of the treatment is cumulative, explains Dr Martin Jones, medical acupuncturist at Sevenoaks Medical Centre — ‘so a “trial” of treatment usually involves a weekly session for six weeks and top-up treatments at increasing intervals if this proves effective’.
To find a practitioner, go to the British Acupuncture Council at acupuncture.org.uk.
NERVE BLOCKING
In extreme cases — where regular migraines defy all other forms of treatment — a headache specialist can offer greater occipital nerve block injections.
Here, local anaesthetic — and sometimes a steroid — are injected next to the greater occipital nerve, which runs over the back of the head to the eyes. It is thought impulses from nerves in the head and neck contribute to migraine.
This remains a specialised treatment and has only a 60 per cent success rate.
MIGRAINE JABS
The big breakthrough treatment on the horizon is a drug called ALD403, which is given by injection.
It targets a chemical called calcitonin gene-related peptide, which is released from nerve endings in the brain, and widens blood vessels as well as passing on pain signals.
Migraine sufferers appear to have higher levels of this chemical.
There are several different types of drugs, including ALD403, that target this compound. One of the drugs works like an antibody, attacking it; another blocks the site where the chemical docks in the brain.
They are administered as an intravenous infusion or by injection twice a week — which the patient can self-inject — as a preventative. Scientists are also working on a tablet form that could be used during an attack.
ALD403 was recently trialled in a joint study by King’s College London and the University of California, and the results looked good — 33 per cent of those who took the drug had half the usual number of migraines; 16 per cent became migraine-free.
Brendan Davies, consultant neurologist at University Hospital of North Staffordshire NHS Trust, says this treatment could be available in three to five years’ time.
‘These drugs are the most exciting development in migraine for a long time,’ he adds.
‘This is the first drug specifically developed for migraine, and although some people won’t like the idea of injections, it would be a small price to pay given the disabling nature of migraine.’
BRAIN ZAPPERS
Sending magnetic impulses might sound woowoo, but it’s been approved by the National Institute for Health and Care Excellence (NICE) for people with acute or chronic migraine.
The treatment, known as transcranial magnetic stimulation (TMS), involves holding a small device the size of a paperback against the back of the head to deliver a pulse of magnetic energy.
This is said to stimulate the nerves in the occipital cortex, the area of the brain responsible for visual processing.
Studies have shown 30 per cent of people who had the treatment had no migraine for 24 hours after using the device, called Spring TMS. And, when used frequently, it can reduce the number of attacks.
‘This is a breakthrough for those who cannot tolerate or do not respond to current treatment, and opens the door for a new era in treating migraine headaches,’ says Dr Fayyaz Ahmed, consultant neurologist from Hull Royal Infirmary.
It is not clear how widely available the treatment will be, though migraine sufferers can obtain the device from the manufacturers who will provide it free of charge for three months, and then charge £150 per month thereafter.
Dr Ahmed says some patients find another device, called Cefaly, helps. This battery-powered device is worn on a plastic head band and emits a low electrical current that stimulates — and effectively desensitises — the nerves that carry migraine pain.
‘There are good studies into the use of Cefaly,’ he says.
‘I find about two-thirds of patients report they feel better from using this and other non-drug treatments, such as TMS.’
SpringTMS, eneura.com
Cefaly, £250, cefaly.com.
LOW-TECH WAYS TO EASE PAIN
Tiger Balm White: Rub on your temples in circular motion to ease a mild headache
■ Try Tiger Balm White (£4.90 for a 19g jar, Boots). This contains camphor, thought to help by increasing blood flow to affected areas, and menthol, a natural pain reliever. Rub on your temples in circular motion to ease a mild headache.
■ ‘Ice reduces inflammation,’ says Dr Andrew Dowson, a specialist at the Headache Service at King’s College Hospital, London. ‘It seems to be very individual though, as some patients find it doesn’t work, but heat does.’ Another option is 4Head (£4.69 for 3g stick, Boots), which contains levomenthol: ‘Lots of people who suffer from headaches are sensitive to smell — these types of products probably help relieve symptoms via their aromatic properties rather than by penetrating the skull,’ says Dr Dowson. Cold and menthol may also stimulate proteins involved in electrical signals in the brain. As Dr Brendan Davies, adviser to the Migraine Trust explains, this may switch off increased pain signalling, ‘although this is only speculation’.
■ Warm a wheat pack (£9.95 from wheatybags.co.uk) in the microwave, place on neck or over the eyes and forehead and lie down for a few minutes.
■ A scalp massage may help. The Genie Head Massager (£4.95, tesco.com) stimulates nerve endings and blood flow to the scalp, and may soothe mild headaches.
Read more: http://www.dailymail.co.uk/health/article-2756797/Sex-headache-standing-suddenly-taking-pain-killers-How-conquer-head-splitting-pain.html#ixzz3DQLzWuTm
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