8.APR.2021 5 MIN READ | 5 MIN READ

Are frequent headaches bothering you? Find out what’s causing your headache and how to determine when it's time to see a doctor.

The throbbing pain in your head may be an annoyance, but it doesn't necessarily indicate a bigger problem.

In this article, we outline the different types of headaches and highlight the symptoms that may warrant a visit to the doctor.

Understanding headaches

Understanding the pattern of your headaches is important as it allows your doctor to determine the cause and suggest an appropriate treatment. Headaches can develop with varying intensity – some develop quickly while others evolve gradually. While some headaches may fade off in an hour or so, some may bother you for days.

Fortunately, most headaches aren't the result of a serious illness. However, some headaches may be a side effect of a life-threatening condition that requires immediate medical attention. If you haven't found the help you need to manage your headaches, it may be time to see a specialist.

Types of Headaches

As there are more than 200 different varieties of headaches, your doctor’s diagnosis will be based on a physical examination and review of your medical history. Headaches are classified into 2 main types: primary and secondary. Primary headaches are not caused by underlying conditions, whereas secondary headaches are a result of one.

Primary headaches

The most common forms of primary headaches include migraine, cluster headaches, sinus headaches and tension headaches.

Migraine headaches

Migraine

Migraines are a common cause of disability worldwide. Migraine symptoms include pounding, throbbing pain, and in many cases, nausea, vomiting and light sensitivity.

Migraine headaches can last from 2 – 72 hours and can occur multiple times a month. In some cases, migraines may be preceded by a warning symptom, also known as an aura.

Tension headaches

Tension headaches, the most common type of headache, occur when the muscles in your neck and head contract or become tense. With tension headaches, you may feel as though a tight band is wrapped around your head. The pain is usually mild to moderate in intensity. You may also feel tenderness in your scalp, neck and shoulders.

Some activities that may trigger tension headaches include poor posture, stress, anxiety and fatigue.

Cluster headaches

Cluster headaches are one of the most severe types of pain that you can experience. With cluster headaches, you will feel intense burning or piercing pain behind or around your eyes, temples and even your back. Besides pain, you may also get red or swollen eyes and a runny nose.

Such headaches are termed "cluster" headaches because they tend to occur in groups – you might get them several times a day for a period of days to weeks, which may then disappear for months or years, only to come back later.

Sinus headaches

Sinus headaches are headaches that are caused by swelling and build-up of pressure in your sinuses. Sinuses are hollow spaces behind the face that lead to the nasal cavity. Sinuses get inflamed, usually because of an infection or an allergic reaction.

With sinus headaches, you may feel pressure around your eyes, cheeks and forehead. You may also have a runny nose, ear fullness, fever, and a swollen face.

Sinus headaches are often confused with migraines due to the presence of overlapping signs and symptoms.

Secondary headaches

A secondary headache is usually a symptom of an injury or an underlying illness. Secondary headaches are rarer, but serious.

Secondary headaches may be caused by an injury, brain aneurysms, tumours, spinal fluid dysfunctions or inflammatory diseases.

Post-traumatic headache

Post-traumatic headachePost-traumatic headaches are headaches that develop within seven days of trauma or injury.

Post-traumatic headaches occur due to a traumatic brain injury caused by accidents, assault, sports, or a fall.

Such headaches usually feel like a dull ache that gets worse from time to time. You may also experience symptoms such as vertigo, light-headedness and trouble remembering things.

Rebound headache

Rebound headaches, commonly known as medication overuse headaches, are caused when you overuse pain-relieving or anti-migraine medicines to treat headaches that are already in progress.

Rebound headaches may occur every day, often waking you in the early morning. The headaches may improve with medicines but then return once your medication wears off. Headache can be accompanied by nausea, restlessness, irritability, difficulty concentrating, insomnia and memory problems.

Rebound headaches usually stop when you stop taking pain-relief medicines.

Thunderclap headache

As the name suggests, thunderclap headaches are extremely painful headaches that suddenly come on, like a thunderclap. The pain of these severe headaches peaks within a minute and may last for 5 minutes.

Pain may be accompanied by seizures, weakness, numbness, speech disability, nausea, vomiting, vision changes and confusion.

Thunderclap headaches are rare, but they can indicate a potentially life-threatening condition. Possible causes of this type of headache include a tear, rupture or blockage in a blood vessel, head injury, stroke, narrowed or inflamed blood vessels, and changes in blood pressure.

What can you do if your headache doesn't go away?

Most headaches ease on their own with simple lifestyle changes and over-the-counter medication. You can also practise relaxation techniques, biofeedback, yoga, and acupuncture.

But, how do you deal with a headache that won't go away?

For some of you, headaches can be a big problem. Headaches that do not resolve on their own may need medical attention.

Your doctor can develop a program to prevent and treat migraines and other severe headaches. It's also important to recognise warning signs that call for prompt medical care.

Consult your doctor if you have headaches that occur more often than usual, interferes with your everyday activities, are more severe than usual and don't improve with over-the-counter treatments.

When to visit the A&E for your headache

When to visit the A&E

A headache can sometimes be a symptom of a serious condition, such as a stroke, meningitis or encephalitis. Go to the A&E immediately if you experience a sudden, severe headache accompanied by any of the following symptoms:

  • Confusion
  • Fainting
  • Nausea or vomiting
  • High fever
  • Weakness
  • Numbness or paralysis on one side of your body
  • Stiff neck and trouble seeing, speaking and walking.

 

Article reviewed by Dr John Ng, neurologist, at Mount Elizabeth Novena Hospital

References

May A. (2018). Hints on Diagnosing and Treating Headache. Deutsches Arzteblatt international, 115(17), 299–308. https://doi.org/10.3238/arztebl.2018.0299

Headache Classification Committee of the International Headache Society (IHS) (2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia : an international journal of headache, 33(9), 629–808. https://doi.org/10.1177/0333102413485658

Migraine Headache. Stanford Health Care. Retrieved on 05 March 2021 from https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/headache/types/migraine-headache.html

Tension headache. Medlineplus. Retrieved on 05 March 2021 from https://medlineplus.gov/ency/article/000797.htm

What Type of Headache Do You Have? American Migraine Association. Retrieved on 05 March 2021 from https://americanmigrainefoundation.org/resource-library/what-type-of-headache-do-you-have/

Sinus headaches. Mayoclinic. Retrieved on 05 March 2021 from https://www.mayoclinic.org/diseases-conditions/sinus-headaches/symptoms-causes/syc-20377580

Thunderclap Headaches. Cleveland Clinic. Retrieved on 05 March 2021 from https://my.clevelandclinic.org/health/diseases/17876-thunderclap-headaches

8.APR.2021
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John Ng
Neurologist
Mount Elizabeth Hospital

Dr John Ng is a neurologist practising at Mount Elizabeth Novena Hospital, Singapore.