What’s causing your headache?

Everyone gets headaches at some time – from the trifling to the terrifying. But before you reach for the painkillers, find out how to treat your particular type with the help of our expert guide

Headaches cost the UK around £3billion per year in NHS expenditure and sick days off work. It's tempting to simply take a tablet as soon as the first twinge strikes - but if you don't know exactly what's causing the pain, it's not always the best tactic.

 

'Headaches are linked with various factors, from hormones and dehydration to stress - and even painkiller usage,' says Dr Anne MacGregor, director of clinical research at The City of London Migraine Clinic and treasurer of the International Headache Society. 'They're entirely normal and natural - it's just our body's reaction (sometimes an overreaction) to something that's potentially harmful. For example, the most common trigger for migraines is going too long without food. However, chronic headaches have a massive impact on sufferers' lives and are not taken as seriously as they should be. Those who suffer from migraines, tension headaches and cluster headaches often put their lives on hold for days at a time.' Indeed, the World Health Organisation (WHO) rated migraines as 12th in a list of conditions that most affect women's lives.

 

'There is still ambiguity surrounding the causes of headaches,' says Dr Annabel Bentley, BUPA's assistant medical director. 'We know that some types of headache - migraines for example - are associated with chemical changes in the brain, but we don't know if these are a cause, or a result. The key to identifying which type you have is to look at the time of the day or month when you suffer from them and what immediately precedes them.'

Our expert guide will help you to find out what's causing your headache - and the most effective way of treating it.

 

When to see your GP

 

● A headache is usually nothing to worry about, but in some circumstances it may need investigation. See your GP if:
● You develop migraine-like headaches for the first time.
● Your migraines become more frequent.
● You have other symptoms accompanying a headache, such as a fever, neck stiffness, numbness or mental confusion.
● You're taking headache medication daily.
● The headache develops after a head injury.

 

Is it a tension headache?
The symptoms: Some 75 per cent of us suffer from tension headaches. The exact cause is not known, but anxiety is usually a precursor. The tension starts in your neck and shoulders and works its way up to the muscles in your head, where the muscular contractions produce a headache.
'This headache is characterised by the feeling of a tight band around your head, with the pain radiating into your neck and shoulders,' says Angela Chalmers, consultant pharmacist at Boots. 'It can be caused by stress, the way you sit at your desk, or even grinding your teeth.'
The treatment: Take a specific medication designed to alleviate tension headaches, such as Syndol Tension Headache tablets (from chemists, £4.59 for 30).
The natural solution: Try rubbing 4Head, which contains the natural painkiller levomenthol, into your temples to relax the muscles (from chemists, around £5.95). Or hold a hot-water bottle on the back of your neck to relax the muscles that caused the headache.

 

Is it a cluster headache?
The symptoms: Cluster headaches are a neurological disease whose cause remains unknown. The agonising pain usually starts around one eye, then spreads throughout one side of your head. Sufferers say it feels as though someone is drilling into their skull. Cluster headaches occur once or twice a day for a couple of weeks at a time (hence the name ‘cluster').
The treatment: 'Cluster headaches can be treated with prescription-only medication from your GP,' says Angela Chalmers. 'GPs often prescribe the migraine drug sumatriptan, to help dilate blood vessels in the brain. It's the constriction of these blood vessels that is thought to cause the pain. The drug also prevents the release of chemicals that transmit pain signals. Medication for cluster headaches is usually given as an injection, providing a fast-acting, higher dose. In addition, patients are often put on oxygen at the onset of an attack, as this also alters the blood flow to the brain, which can help reduce the inflammation and constriction of the blood vessels.'
The natural solution: 'Acupuncture or acupressure can help relieve cluster headaches,' says Angela. 'Ask your GP if you can be referred to a trained therapist.'

 

Is it the result of medication overuse?
The symptoms: Headaches can be caused by painkillers. Some two per cent of us suffer from ‘medication overuse' headaches, which occur when you suddenly stop using painkillers you've been taking regularly. 'These headaches are usually the result of taking paracetamol with codeine or ibuprofen for long periods,' says Dr Annabel Bentley. 'By ‘regular use', we mean daily, for weeks on end. These headaches tend to occur in the morning, as the effects of the previous day's tablets have worn off. The pain is usually dull and non-specific and can worsen during the day. This prompts sufferers to reach for painkillers - so the cycle continues.'
The treatment: 'Switching medication will help,' says Angela Chalmers, 'but you must reduce the amount you take. Get advice from your GP, because if you're trying to withdraw from a codeine-based painkiller, you can become restless, shaky and suffer from insomnia. Dealing with this sort of withdrawal usually needs expert help.'
The natural solution: 'An Indian massage may help relieve this type of headache,' Angela suggests, 'as it will help relax the muscles in your head.'

 

Is it a premenstrual headache?
The symptoms: Many women experience premenstrual headaches in the two or three days just before their period begins. These tend to be dull and persistent and are frequently accompanied by some other premenstrual symptoms, such as cramps and bloating.
The treatment: 'I suffer from these myself,' says Angela Chalmers. 'I take ibuprofen for three days before my period - it builds up in your system to prevent headaches and cramps.'
The natural solution: Try taking a one-a-day supplement of starflower oil throughout the month. This will help balance your hormones and minimise any PMS symptoms before they can occur. Try Boots Feel The Difference Starflower Oil (£8.99 for 60).

 

Is it a migraine?
The symptoms: 'If you've got a migraine, you'll know,' says Dr Bentley. 'They're extremely painful and have other symptoms that occur beforehand, known as an aura, which often warn sufferers of an impending migraine.' An aura can include abnormalities in your vision, such as zigzag lines or blurred sight, or tingling and numbness in your body. 'A migraine will usually strike within 10-30 minutes of these warning signs. The pain is often one-sided and sufferers can also experience an aversion to bright lights as well as nausea and vomiting. One in eight people suffers from migraines and they're twice as common in women as in men,' she adds. Although many contributory factors have been identified, research into why migraines develop is ongoing.
The treatment: Your GP can prescribe specific medication for migraines: eletriptan, almotriptan and sumatriptan are among the most common. They are designed to be taken as soon as an aura occurs, thereby preventing pain before it starts. They work by blocking the release of pain-transmitting chemicals in the brain and also dilating the blood vessels, to help reduce the constriction that can cause much of the pain. Recent changes in legislation mean you can now buy sumatriptan over the counter, under the brand name Imigran Recovery. But you pay £7.99 for two tablets, compared with £7.10 for 20 or 30 on prescription.
The natural solution: 'Try feverfew,' says Angela Chalmers. 'This works like some prescription medicines, by aiding vasodilation. Take one tablet a day (125mg), as a preventative.' (From Holland & Barrett, £5.69 for 100.)

 

Is it due to caffeine?
The symptoms: 'These headaches either occur at the weekend,' says Dr Bentley, 'when a lie-in means you don't get your early morning caffeine dose, or they'll develop soon after drinking coffee, caused by the caffeine itself. The pain is usually dull and all around the head.' Researchers in the US have found that caffeine suppresses the neurotransmitter adenosine, which acts like a tranquilliser in the brain, slowing brain activity and other body functions, so when it's blocked by caffeine you become more alert. When caffeine is withdrawn, your brain is sensitive to the sudden rise in adenosine levels, and a headache results.
The treatment: Try to reduce your caffeine intake slowly by cutting out one cup per day; otherwise you'll get withdrawal headaches. You could also try half-caffeine coffee before switching to decaffeinated. Paracetamol or ibuprofen should curb the headache - but, warns Angela Chalmers, 'check that your painkillers don't contain caffeine, as many medication mixes do'.
The natural solution: 'Try green tea,' says Angela. 'This contains just a small amount of caffeine. It should ease the headache, while helping you to cut back.'

 

Is it a sinus headache?
The symptoms: Sinus headaches feel very general and the pain isn't always felt around your nose and eyes. 'To find out if your sinuses are to blame, bend forward so your head is upside down,' Angela suggests. 'If you feel heaviness under and above your eyes, it may well be your sinuses.'
The treatment: Use Boots Decongestant Tablets (£3.49 for 24), which contain pseudoephedrine hydrochloride, a decongestant. 'Take these three times a day for up to four days. If the headaches persist, see your GP,' says Angela.
The natural solution: Add a couple of drops of Olbas Oil to a bowl of boiling water and inhale the steam for about 10-15 minutes. (From chemists, £4 for 28ml.)

 

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