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According to WHO, headache is among the most common disorders of the nervous system. (1) It has been estimated that almost half of the adult population have had headache at least once within a year. Headache has been underestimated, under-recognised and under-treated which can affect quality of life.

Migraine

What is it?

It is the most commonly diagnosed headache. It is usually recurrent in nature and occurs mostly in women.

How does it present?

It often presents as a one-sided pounding/throbbing pain that starts off mild but will worsen. The pain is usually located at the front, side of head, around the eye or neck and can last for 4 to 72 hours.

Pain can be worsened by routine activities like walking or climbing stairs.

Episodes may be preceded by nausea (80%), vomiting (50%) or sensitivity to light and sound. (2) This is known as aura.

Tension-type

What is it?

It is the most prevalent headache in general population and the 2nd most prevalent disorder in the world.

It is usually caused by stress or mental tension, poor posture, muscle tension or depression.

If there is presence of both migraine and tension-type headache, migraine can precipitate it.

How does it present?

It is characterised as a mild to moderate pressure or tightness on both sides of the head (band-like pain). Pain is usually located at the front and back of the head. Episodes usually last from 30 minutes to 7 days.

Cervicogenic

What is it?

It is pain that develops in the neck, though a person feels the pain in their head.

It is most commonly due to structural problems in the spinal vertebrae of the neck.

Example of people who are at risk of neck strains are hairstylists, drivers and manual labourers.

How does it present?

The pain usually begins in the neck and the back of the head then radiates to the front of the head.

Certain neck movements can provoke pain.

The pain can be associated with pain in the shoulders and arms, nausea and blurred vision.

Red flags

Although headaches are usually primary and are harmless. Some headaches are due to presence of underlying serious illness such as brain tumours, brain infections or systemic illnesses. This should warrant an urgent visit to the doctor.

It is crucial to differentiate headaches that are due to serious illness

DANGER SIGNS OF HEADACHES
  • Thunderclap headaches that is characterised as an excruciating headache that occurs within minutes.
  • Presence of symptoms like fever, neck-stiffness, weight loss and night sweats.
  • New onset of severe headaches, especially if older than 50 years old.
  • Worsening and persisting headache or any changes in pattern of usual headaches.

WHAT CAN I DO?

The management of headaches can be divided into:

  • Non-pharmacological
  • Pharmacological

Non-pharmacological management of headache does not involve the use of medications. This includes: •Identifying triggers for your headache and avoiding it. Common triggers for headaches are stress, menstruation, bright lights, lack of sleep, poor posture, alcohol and use of certain medications. •Practicing mindfulness such as deep breathing exercises and relaxation therapies. •Physical therapy such as chiropractic treatment to aid in relief of muscle tension and promote better posture and spinal health which is a large contribution to the occurrence of headaches.

Pharmacological management is indicated upon doctor’s consultation and advice according to the type of headache presented.

1. World Health Organization (WHO) (2016) Headache Disorders, Available at: https://www.who.int/news-room/fact-sheets/detail/headache-disorders.

2. F. M. Cutrer et al. (2018) Pathophysiology, clinical manifestations, and diagnosis of migraine in adults, Available at: https://www.uptodate.com/contents/pathophysiology-clinical-manifestations-and-diagnosis-of-migraine-in-adults