Causes and Remedies of Headache

Headaches are a leading cause of reduced productivity and loss of working hours. Among neurological disorders, headaches are the most common. Recurrent headaches negatively affect family, social, financial, and professional life. Globally, approximately 46% of adults (aged 18–60) experience headaches at least once a year.

Among these headache sufferers:

• About 11% experience migraine or one-sided headaches.

• Around 70% suffer from tension-type headaches caused by muscle contraction.

• Approximately 3% have chronic daily headaches.

Headaches are more common among older women, and about 20% of children and adolescents experience headaches annually.

Types of Headaches

1. Primary Headaches:

• Migraine, Tension-Type Headache, Cluster Headache, etc.

2. Secondary Headaches:

• Caused by other medical conditions such as sinusitis, mastoiditis, glaucoma, stroke, head injury, brain tumor, etc.

Migraine

• Affects roughly 11% of adults, more common in women than men.

• Symptoms usually start between ages 15–16 and often persist until 40–50.

Symptoms of Migraine:

1. Pain on one side of the head (may switch sides in subsequent attacks).

2. Lasts 4–72 hours.

3. Throbbing pain due to blood vessel constriction/dilation.

4. Severe intensity that prevents normal activity.

5. Sensitivity to light and sound.

6. Nausea or vomiting may occur.

7. Visual disturbances (aura) like flashing lights or zigzag lines before onset.

8. Pain may ease in a dark room.

Tension-Type Headache

• Affects about 70% of adults, also more common in women.

• Caused by muscle contraction in the head.

Symptoms:

1. Pain all over the head.

2. Feels like a tight band or pressure.

3. Less intense than migraine; sufferers can continue normal activities.

4. Usually no nausea or vomiting.

5. Lasts from a few hours to several days.

6. Often associated with stress, family, or work pressures.

Cluster Headache

• Rare, affecting about 0.1% of adults, more common in men (male:female = 6:1).

• Usually starts after age 20.

Symptoms:

1. Short, repeated episodes.

2. Extremely severe pain around or behind the eye.

3. Red eyes, tearing, drooping eyelids.

4. Occurs daily at the same time or several times a day for weeks, then may disappear for months.

Secondary Headache

Caused by other medical or head conditions such as typhoid, viral infections, meningitis, sinusitis, mastoiditis, brain tumor, hemorrhage, stroke (SAH), etc.

Diagnosis and Treatment

Most headache sufferers do not seek medical advice and self-medicate with over-the-counter painkillers. For example, in the UK and USA, only 50% of migraine sufferers consult a doctor annually. People usually seek medical help for secondary headaches only when serious symptoms appear (excessive vomiting, vision loss, limb weakness, seizures).

Modern medical imaging like CT scan, MRI, or PET scan allows precise identification of headache causes.

Treatment of Primary Headaches:

1. Abortive Treatment: Immediate relief using painkillers (with gastric-protective medication). Overuse of painkillers can itself cause headaches (medication-overuse headache).

2. Prophylactic Treatment: Long-term medication to prevent recurrence and reduce severity. Lifestyle adjustments are also important: avoid smoking, alcohol, drugs, excessive caffeine, irregular sleep, extreme heat, physical or mental stress, and prolonged fasting. Positive lifestyle practices and mental relaxation help reduce headache frequency.

Treatment of Secondary Headaches:

• Treating the underlying cause is essential. Diagnosis and treatment should be guided by a neurologist for effective recovery.

Author:
Professor, Department of Clinical Neurology, National Institute of Neurosciences and Hospital, Dhaka.