Do Not Take Headache Lightly

Dr. WONG Wing Ning, Rosanne

Resident Medical Officer

Headaches are very common and causes are varied. Sometime they may have to do with problems in the brain, and cannot be relieved by mere over-the-counter painkillers. Immediate medical attention may be required.

Types of Headaches

Headaches fall into two main categories: primary and secondary headaches. While primary headaches have no clear medical causes, secondary headaches are usually caused by certain medical conditions.

Most people should be familiar with primary headaches: they are chronic and recurrent headaches. A secondary headache can be a pain that one has not experienced before with distinct features. This article focuses on primary headaches.

There are three main types of primary headaches, i.e. migraines, tension headaches and cluster headaches

1. Migraine

Do migraines occur only on one side of the head? Definitely not. It is more than about when the pain occurs, as 1 out of every 3 patients feels pain on both sides at the same time. Typical symptoms include a severe throbbing sensation or sensory symptoms such as aura, distorted vision or unusual smells.  

The causes of migraines remain uncertain. Triggering factors vary from person from person, such as stress, lack of sleep, jet lag, excessive exercise, etc. Estrogen changes during the menstrual cycle may cause migraines in women, which may improve after menopause. Diet-related factors include inadequate water intake, irregular mealtime or consumption of chocolates, cheese, pickled food and alcohols.

Lifestyle changes are crucial to migraine prevention: try to have adequate sleep, keep warm and eat less migraine-triggering foods. Research suggests that migraines are more common in women than men, and young adults are mostly affected. The condition will improve with age, i.e. middle-age. Migraines can also be genetic: one is more likely to have migraines if both parents suffer from the same condition.

2. Tension Headaches

Most adults have experienced tension headaches. They are characterised by tightness and pressure on both sides of the head, e.g. the forehead, the top and the back of the head. One may feel like vomiting and as if the head were being squeezed. The pain can be mild or moderate, and will not exacerbate during activities and while shaking head.

To treat and prevent tension headaches, one must look into the causes and triggers. Try to listen to soft, relaxing music, practise belly breathing, limit caffeine and alcohol consumption, and quit smoking. They can help reduce headache onset.    

3. Cluster Headaches

Cluster headaches mostly happen during sleep, and are more common in male youths and adults. They usually occur on one side of the head, around the eye sockets or on the forehead, and last from about 10 minutes to even 2 hours. Possible symptoms are red eyes, tearing, runny nose as well as forehead and face swelling.

Cluster headaches can be caused by problems in the trigeminal nerve and hypothalamus. Clinical diagnosis, sometimes complemented with brain MRI, is necessary to rule out pituitary tumour or other brain conditions.

Do I Need to Have Brain Scan whenever a Headache Occurs?

Your doctor will first try to rule out other severe conditions during clinical diagnosis, such as intracerebral haemorrhage, stroke, brain tumours, etc. Assessments or imaging examinations will be arranged if necessary. With all possible medical conditions ruled out, a detailed assessment of your age, medical history, frequency and site of headache, lifestyles, family history, etc. will be made for diagnosis.  

However painful it can be, excessive reliance on painkillers is no solution to the headache. Instead, seek early medical attention and intervention whenever a headache occurs.