Headache Types
Allergy
Location & Symptoms
Generalised. Often accompanied by runny nose and sore eyes.
Precipitating factors
Seasonal - allergens, such as pollens, can trigger hay fever and sinusitis.
Treatment / Prevention
May include anti-histamine medication and decongestant nasal sprays.
Altitude Sickness
Location & Symptoms
Headache is the most frequent complaint of climbers who ascend to high altitudes without oxygen support. Commonly affects both sides of the head, but is limited to one side in about one-quarter of cases.
Precipitating factors
Altitude.
Treatment / Prevention
May be prevented in some instances by taking drugs that alter salt and fluid balance.
Aneurysm
Location & Symptoms
Sudden, severe onset (‘thunderclap’) of pain. In early stages, may mimic migraine or cluster headaches. Symptoms may also include loss of consciousness, a stiff neck, and double vision.
Precipitating factors
Family history, uncontrolled hypertension.
Treatment / Prevention
Urgent hospital treatment should be sought. Treatment may include surgery, and medication to keep blood pressure under control.
Arthritis
Location & Symptoms
Pain at the back of head and upper neck. Often made worse by movement.
Precipitating factors
Bony changes in the structure of the neck
Treatment / Prevention
May be relieved by anti-inflammatory drugs
Brain Cancer / Tumour
Location & Symptoms
Severe headaches, progressively becoming worse. It is rare that a headache is the only symptom the patient has -other symptoms may include vomiting, visual disturbances, a weakness in an arm and/or leg, speech problems, personality changes or epileptic fits.
Precipitating factors
Unknown.
Treatment / Prevention
Treatment may include chemotherapy, radiation therapy, surgery, or some combination of these.
Chinese Restaurant Syndrome
Location & Symptoms
Sensations of pressure and tightness in the face, burning over the trunk, neck and shoulders; pressing pain in the chest. Headache is a pressure or throbbing over the temples and a band like sensation around the forehead, coming on 20-25 minutes after eating Chinese food and lasting for an hour.
Precipitating factors
About 3 grams of MSG (monosodium L-glutamate) will affect sensitive individuals, contained in about 200 millilitres of wonton soup.
Treatment / Prevention
Avoid food containing MSG- ask before ordering which items on the menu contain MSG.
Chronic Daily Headache
Location & Symptoms
Pain is all over head, diffuse and dull, every day. There may be additional migraine attacks. Usually occurs in 30s and 40s. General feeling of being unwell. Types of CDH are Transformed Migraine, New Persistent Daily Headache and Hemicrania Continua.
Precipitating factors
Daily recurrence can be the result of associated anxiety and depression, or may be associated with overuse of medication.
Treatment / Prevention
Relaxation therapy, psychological counselling, amitriptyline, non-steroidal anti-inflammatory drugs.
Chronic Paroxysmal Hemicrania (CPH)
Location & Symptoms
A variant of cluster headache, however shorter in duration but more frequent, from 6 up to 20 attacks per day. While for cluster headaches men are more affected, it is women who are more affected by CPH.
Precipitating factors
See cluster headache.
Treatment / Prevention
Frequent daily episodes of CPH almost always respond to the use of 25-50mg of indomethacin taken three times daily.
Cluster Headache
Location & Symptoms
Severe pain centred around one eye. May include drooping eyelid, watering eye and nasal congestion. Most frequently affects males. May be episodic or chronic.
Precipitating factors
None known.
Treatment / Prevention
During acute attacks, treatment may include oxygen inhalation, sumatriptan subcutaneous injection, ergotamine and intranasal lignocaine. Preventative medications may include calcium channel blockers, lithium, ergotamine, methysergide and corticosteroids
Cough Headache
Location & Symptoms
A variation on exertional vascular headache, felt only when coughing, sneezing, bending or straining (including during a bowel movement)
Precipitating factors
In small number of people an obstruction blocking the flow through the normal fluid channels of the brain (the ventricles). In older patients, narrowing of the carotid arteries should be excluded
Treatment / Prevention
Warrants a consultation with a general practitioner and/or neurologist to rule out structural abnormality. Benign form can be presented by use of indomethacin or a beta-blocking agent such as propranolol. May improve without treatment
Exertional Vascular Headache
Location & Symptoms
Generalised head pain of short duration (minutes to an hour) during or following physical exertion.
Precipitating factors
Sport, exercise, sexual intercourse.
Treatment / Prevention
Can usually be prevented by taking suitable medication, such as ergotamine tartrate or indomethacin, before the exercise starts.
Eyestrain
Location & Symptoms
Pain and feeling of heaviness around the eyes.
Precipitating factors
Uncorrected visual problems.
Treatment / Prevention
An eye test: wearing appropriate glasses or contact lenses will often resolve the problem.
Fasting
Location & Symptoms
Dull generalised headache.
Precipitating factors
Lowered blood sugar level.
Treatment / Prevention
Eat regular nutritious meals.
Just because a headache regularly occurs in the early hours of the morning does not mean that it is caused by low blood sugar. And it is not likely to be prevented by eating before going to bed.
Fever
Location & Symptoms
Generalised pain, ranging from mild to severe, depending on the underlying illness. If accompanied by nausea and vomiting, a stiff neck and/or rash, urgent medical treatment is required.
Precipitating factors
Viral or bacterial infection.
Treatment / Prevention
Depending on the underlying illness, treatment may include antibiotics and pain relief.
If bacterial meningitis/meningococcal disease is suspected, the patient should be taken without delay to the nearest hospital emergency department, or doctor.
Goggle Headache
Location & Symptoms
So-called because the nerves running from the orbit over the forehead are compressed in swimmers wearing tight-fitting goggles.
Precipitating factors
Constant pressure on the nerves of the scalp.
Treatment / Prevention
Such headaches can be prevented by changing the position of the goggles each day or using goggles with a single soft-rubber rim that fits around both ends and does not require a very right head strap in order to be watertight.
Hangover
Location & Symptoms
Migraine-like symptoms of throbbing pain and nausea not localised to one side.
Precipitating factors
Alcohol, the breakdown products of which cause dilation and irritation of the blood vessels of the brain and surrounding tissue.
Treatment / Prevention
Treat with liquids (including broth and an oral rehydration solution - Hydralyte™). Consumption of fructose (honey, tomato juice are good sources) to help burn alcohol. Drink alcohol only in moderation.
Headache & Dehydration
Location & Symptoms
Generalised headache – headaches are one of the symptoms of dehydration.
Precipitating factors
Dehydration is caused by a lack of fluid intake or excess fluid losses. You are most likely to lose fluid through vomiting, diarrhoea, sweat and urine. Many cases of dehydration are caused by: heat, vomiting and diarrhoea (i.e. ‘gastro’), fever, vigorous exercise or strenuous activity, alcohol consumption (alcohol acts as a diuretic), travel (travellers’diarrhoea, long-haul flights – dry cabin conditions, sun exposure, physical activities and alcohol consumption) or lack of food/fluid intake.
Treatment / Prevention
Under normal circumstances a ‘good hydration status’ can be adequately achieved with water and a balanced diet. However, if you are at risk of dehydration, an oral rehydration solution (Hydralyte™) will have some advantages, including:
- Rehydration is likely to be more rapid
- The retention of water is better.
Hormonal
Location & Symptoms
Severe, migraine-like headaches experienced by women.
Precipitating factors
Fluctuations in hormonal levels around the time of menstruation or ovulation and/or in the years leading to the menopause; also experienced by some women starting oral contraceptives.
Treatment / Prevention
See Headache and Adults and Treatment of Headache.
Hot-Dog Headache
Location & Symptoms
Dilatation (expansion) of the blood vessels inside the skull leads to moderately severe headache.
Precipitating factors
Nitrites in cured foods such as hot-dogs, salami, bacon and ham.
Treatment / Prevention
Eliminate offending foods from the diet.
Hunger
Location & Symptoms
Migraine-like headache, more common in young women.
Precipitating factors
May be triggered by fasting, skipping meals, or oversleeping (and thus eating late).
Treatment / Prevention
Eating regular, nutritious meals
Hypertension
Location & Symptoms
An all-over pressure or “hair band” type pain, most severe in the morning and diminishing through the day. May feel depressed and generally unwell. Can affect any age person and usually occurs daily
Precipitating factors
A sudden increase in blood pressure may cause the headache but there are no symptoms of slightly elevated blood pressure.
Treatment / Prevention
Don’t smoke, have an active lifestyle, relax, eat less salt and fat, have your blood pressure checked by your doctor who may prescribe blood pressure medication. Have your blood pressure tested regularly.
Ice-Cream Headache
Location & Symptoms
Sharp pain in front of head - centre of forehead or in one temple - immediately after swallowing ice cream or a very cold drink. Occasionally may produce pain behind the ear.
Precipitating factors
Localised pain in the palate or throat from holding ice or ice cream in the mouth or swallowing it while still very cold may refer pain to the head through the trigeminal nerve endings or the glossopharyngeal nerve. More severe and typical migraine suffers are more likely to be prone to ice-cream headache.
Treatment / Prevention
Don’t eat ice cream or have drinks that are very cold.
Idiopathic Intracranial Hypertension (IIH)
Location & Symptoms
A disorder of elevated spinal fluid pressure in the brain. IIH headaches may be dull, are often at the back of the head, and tend to be worse at night or first thing in the morning.
Precipitating factors
Tends to affect overweight individuals, especially after recent weight gain, even during pregnancy. Certain medications can also predispose individuals to the syndrome, including the antibiotic tetracycline, steroids (as they are weaned off) and vitamin A. Some people may be predisposed to IIH because of being born with a narrowed vein that drains blood from the brain; a condition that was in place since birth.
Treatment / Prevention
Medications to reduce the spinal fluid pressure or repeated lumbar punctures to keep the pressure down to a safe and tolerable level. Weight loss can cure the condition; nutritionists, medications, and weight-loss programs are often helpful. The sheath surrounding the optic nerves is sometimes surgically opened with small holes to relieve pressure and prevent deterioration of vision. In severe cases, an implantable tube (shunt) that drains the spinal fluid out of the brain needs to be surgically placed.
Marijuana
Location & Symptoms
Mild frontal headache.
Precipitating factors
Use.
Treatment / Prevention
Analgesics. Stopping use.
Medication-Overuse Headache
Treatment / Prevention
The best way of treating MOH is to prevent it from developing in the first place. If you are using any acute medications more than 1-2 times per week, you are at risk of developing MOH and may need preventative medication for your headaches.
Migraine
Location & Symptoms
Severe, one-sided throbbing pain, often accompanied by nausea, vomiting, cold hands, sensitivity to sound, light and smells. Migraine with aura may include visual disturbances, numbness in arm or leg. May last from part of a day to three or four days. Onset in childhood, teens and 20s, usually through to 40s/50s, but may last into 60s and beyond
Precipitating factors
Many triggers, including dehydration, certain foods, insufficient food, hormones, environmental such as sudden changes in weather, oversleeping or too little sleep, physical factors such eye, dental problems, over-exertion or strenuous exercise, certain medications.
Treatment / Prevention
See Treatment of Headache and Migraine
Post-traumatic Headache
Location & Symptoms
Can be localised or generalised pain, can mimic migraine or tension-type headache symptoms. Headaches may occur on daily basis and are frequently resistant to treatment.
Precipitating factors
Pain can occur after relatively minor traumas.
Treatment / Prevention
Possible treatment by use of anti-inflammatory drugs, or biofeedback.
Rebound or Withdrawal Headache
Location & Symptoms
Throbbing headache caused by rebound dilation of the blood vessels.
Precipitating factors
Overusing and then coming off medication such as ergotamine (which constricts the blood vessels) can actually lead to headache. Caffeine and nicotine have the same effect.
Treatment / Prevention
Avoid excess consumption.
Temporal Arteritis
Location & Symptoms
A burning or boring pain caused by inflammation of the blood vessels in the scalp, particularly the arteries in the temple. Pain is often around jaw muscles when chewing. May be accompanied by redness, swelling, and tenderness of the arteries in the scalp. Generally affects people over 55.
Precipitating factors
Unknown
Treatment / Prevention
Early diagnosis and treatment with steroids essential, as may lead to blindness
Temporomandibular Joint Dysfunction (TMJ)
Location & Symptoms
A muscle-contraction type of pain, sometimes accompanied by painful “clicking” sound on opening the jaw. An infrequent cause of headache
Precipitating factors
Malocclusion (poor bite), stress, and jaw clenching
Treatment / Prevention
Relaxation, biofeedback, use of bite plate and in some cases, dental treatment – correction of malocclusion
Tension-type Headache
Location & Symptoms
A dull, non-throbbing pain, frequently bilateral, associated with tightness of scalp or neck. Degree of severity remains constant
Precipitating factors
Emotional stress, hidden depression
Treatment / Prevention
Avoidance of stress. Use of biofeedback, relaxation techniques, psychotherapy, and treatment with tricyclic antidepressant medication. Treat with rest, aspirin, ibuprofen, naproxen sodium, ice packs, and muscle relaxants.
Click here for detailed information on Tension-type headaches
Transformed Migraine
Location & Symptoms
Typical episodic migraine may increase in frequency to the point where it recurs daily
Precipitating factors
May be caused by emotional disturbance or the daily dosage of ergotamine or analgesics.
Treatment / Prevention
A combination of approaches, including the attainment of a calm, relaxed state, the establishment of a satisfactory pattern of living, with regular daily exercise and the right balance of work and leisure time, and the use of tricyclic medication
Trigeminal Neuralgia
Location & Symptoms
Any ache that arises from a nerve is called neuralgia. The trigeminal nerve supplied the face and the front part of the brain. Spontaneous discharge of the trigeminal nerve causes sudden, severe stabbing pains in the cheek and upper gum, or in the jaw and lower gum, known as trigeminal neuralgia. Usually affects older people and women more than men. Recurs irregularly.
Precipitating factors
Since branches of the trigeminal nerve are responsible for conveying pain sensation from the eye and sinuses, disease of these structures may cause a headache in the centre of the forehead. The trigeminal nerve can become infected by the virus of shingles (herpes zoster virus). Compression or irritation of the nerve fibres, commonly caused by the progressive lengthening of a branch of an artery as it hardens with age, multiple sclerosis, and malocclusion
Treatment / Prevention
Medication such as anti-epileptic drugs, surgery, dental treatment
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