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What kind of headache do you have?

Less than 2% of the population have never had a headache. Most of us get them from time to time and they are usually resolved with a couple of painkillers, a rest or something to eat. However, headaches that are more frequent and/or severe can cause concern and disrupt family, social and working life.

They usually fall into one of the following categories:

  • Chronic tension-type headache (CTTH) often occur as a result of stress and/or depression. The pain starts gradually, is mild to moderate and does not usually affect the ability to carry out normal daily activities. Sufferers describe it as a feeling of pressure or a tight band around the head. This type of headache can last for several days and it is better to treat the cause rather than the symptoms.

  • Migraine without aura (previously known as common migraine). The pain can be intense, is described as pulsating, often occurs on one side of the head only and is made worse by movement. People can experience increased sensitivity to light, sound and strong smells and may suffer gastro-intestinal disturbances such as nausea, vomiting or diarrhoea. An attack can last from 4 hours to 72 hours and you may feel drained for a couple of days after that. The average number of attacks is one or two a month.

  • Migraine with aura (formally known as classic migraine or focal migraine) is usually the same as migraine without aura, with the addition of neurological disturbances lasting 15 minutes to an hour before the commencement of the headache. These are typically visual disturbances such as blind spots, flashing lights or zig zag patterns in the vision, but can include tingling, pins and needles or numbness in the limbs or problems with co-ordination and articulation (e.g. getting words mixed up). Some people experience the aura only, without the development of other symptoms or with only a mild headache.

  • Abdominal migraine describes recurrent and episodic attacks of abdominal pain lasting for several hours with complete freedom from symptoms between attacks. It usually occurs in children in whom all investigations for other causes of abdominal pain are normal. Studies have suggested that many of these children outgrow the abdominal symptoms and go on to develop typical migraine. It is unusual for adults to develop “abdominal” migraine without the more usual accompanying symptoms of headache and nausea etc.

  • Menstrual migraine. Over half of the women who suffer from migraine feel that their attacks are linked to their menstrual cycle. However, true menstrual migraine, associated with known hormonal triggers, is defined as attacks which occur within two days either side of a monthly period and at no other time. Hormonal factors are one of many triggers for migraine and women can be more susceptible to other factors around the time of their period.

Rare varieties of migraine include:

  • Hemiplegic migraine is a rare condition which has been linked to a genetic abnormality and it is being more readily diagnosed by the medical profession in the UK. Symptoms include temporary paralysis down one side of the body, which can last for several days. Other symptoms include vertigo or difficulty walking, double vision or blindness, hearing impairment, numbness around the mouth leading to trouble speaking or swallowing. These symptoms are often associated with a severe one-sided headache. This form of migraine may be confused with a stroke, but the effects are usually fully reversible and there are specific treatments available.

  • Basilar artery migraine. In some cases during a migraine attack, the basilar artery, a blood vessel at the base of the brain, goes into spasm causing a reduced blood supply to parts of the brain. This type of migraine affects 1 in every 400 migraineurs and can cause giddiness, double vision, unsteadiness, fainting or even loss of consciousness.

  • Chronic migraine can evolve from episodic headaches to a chronic pain syndrome. Chronic migraine is a sub-type of Chronic Daily Headache. The International Headache Society defines chronic migraine as more than fifteen headache days per month over a three month period of which more than eight are migrainous, in the absence of medication over use.

  • Cluster migraine is a misnomer which is sometimes incorrectly applied when sufferers experience frequent migraine attacks (as many as 2 or 3 a week for a short period of time). It should not, however, be confused with cluster headache (see overleaf). Individuals can experience a period of migraines preceding periods of remission lasting months or even years in some cases.

  • Medication overuse headache. Although medication can be very effective in relieving headache, it is possible to develop a tolerance to it, causing rebound headaches. Sufferers find that they are experiencing more and more headaches, often daily, and that they require increasing amounts of medication to relieve them. The condition can develop with excessive use of ordinary, over the counter painkillers, especially those containing opiates, such as codeine and also with prescribed drugs, such as ergotamine and triptan drugs (e.g. Imigran, Zomig, Naramig, Maxalt).

  • Chronic daily headache is estimated to affect as much as 3% of the population and is defined as headaches which occur on more than 15 days each month. It is described as a syndrome and can consist of several different types of headache occurring throughout the month, such as tension headache, muscle contraction headache and medication misuse headache, sometimes with superimposed attacks of migraine.

  • Cluster headache is often known as “the demon of headaches” because the pain is so intense. The pain is centred around one eye and is described as searing, excruciating, knife-like or as boring into the eye. Those who experience this type of headache find they are unable to sit still and may pace the room, press on the head or assume unusual positions in an effort to find some relief. The eyelid will droop and the eye becomes red and watery. The nostril on the affected side may become blocked or watery. Attacks often wake the sufferer from sleep. Individual attacks last only a short time, usually between 15 minutes and 1 hour, but attacks occur in “clusters” ranging from once every other day to up to 8 times a day. Clusters usually last for 6 - 8 weeks, with periods of remission lasting months or even years in between.

  • Secondary headache.The aforementioned are the most common forms of headache, known as primary headaches. Secondary headaches are a symptom of another condition, for example, if you have influenza, one of the symptoms will often be a headache; if your sinuses are blocked, this can result in a headache etc.

For more information see our self-help pages for headaches and migraines

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