Guide to Treating Headaches and Managing Migraines

 

Headaches

In most cases, headaches can be treated at home with over-the-counter painkillers and by taking care of yourself  - getting more rest and drinking plenty of water.

However, if your headaches persist we recommend seeing a doctor particularly if over-the-counter treatments are not providing any sustained relief and it is impacting everyday activities.

 

The main types of headaches and common causes are:

 

Tension headaches

Tension headaches is the most common form of headache and are what we think of as "everyday" headaches. They feel like a constant ache that affects both sides of the head or temple area.  They can last from anywhere between a few hours to a few days.

The exact cause is unclear, but tension headaches have been linked to things such as stress, poor posture, skipping meals and dehydration. Tension headaches can usually be treated with ordinary painkillers such as ibuprofen and paracetamol and with ensuring your getting regular sleep, managing stress and staying well hydrated.

 

Migraines

Migraines are usually felt as a severe, throbbing pain at the front or side of the head or temple. Some times migraines are accompanied such things as nausea, vomiting and increased sensitivity to light or sound.

Migraines tend to be more severe than tension headaches and can get in the way from carrying out your normal daily activities. They usually last at least a couple of hours and most people treat migraines by staying in bed and or with over-the-counter medication.

 

Cluster headaches

Cluster headaches are rare but they occur in clusters for a month or two at a time around the same time of year. They're excruciatingly painful, causing intense pain around one eye, and often occur with other symptoms, such as a watering or red eye and a blocked or runny nose. Pharmacy medications do not ease the symptoms of a cluster headache, but a doctor can prescribe specific treatments to ease the pain.

Medication and painkiller headaches

Some headaches occur as a result of taking medication or too many painkillers. These types of headaches usually get better when you stop taking medication or painkillers. Though sometimes the pain is worse before you get better for the first few days.

 

Hormone headaches

Headaches in some women are often caused by hormones, and many women notice a link with either their periods, their use of the contraceptive pill, menopause or pregnancy.

Reducing stress, having a regular sleeping pattern, and ensuring you don't miss meals may help reduce headaches associated with your menstrual cycle

 

Other causes of headaches

Headaches can also be a result of:

  • drinking too much alcohol
  • a head injury or concussion
  • a cold or flu
  • problems affecting the "chewing" muscles and the joints between the lower jaw and the base of the skull
  • inflammation of the lining of the sinuses
  • carbon monoxide poisoning
  • sleep apnoea

 

Could it be something serious?

In the vast majority of cases, a headache isn't a sign of a serious problem.  Sometimes it can be a symptom of something more serious such as a stroke, brain tumour or meningitis. It may be more serious if the following occurs and is worth seeing your doctor or presenting at our local hospital’s emergency room:

  • it occurs suddenly and is very severe – often described as a blinding pain unlike anything experienced before
  • it doesn't go away and gets worse over time
  • it occurs after a severe head injury or head knock
  • it's triggered suddenly by coughing, laughing, sneezing, changes in posture, or physical exertion
  • you have symptoms suggesting a problem with your brain or nervous system, including weakness, slurred speech, confusion, memory loss and drowsiness
  • you have additional symptoms, such as a high temperature (fever), a stiff neck, a rash, jaw pain while chewing, vision problems, a sore scalp, or severe pain and redness in one of your eyes

 

The term ‘headache’ covers any pain around the head, temple, face or neck area.

There are two main types of headache:

  • primary – which often “just happen” and are not caused by another injury or illness
  • secondary – which are caused by some underlying health condition.

 

Primary headaches

Primary headaches are the most common form of headache and include tension headaches, migraines and cluster headaches. Primary headaches can be caused by:

  • stress
  • eye strain
  • poor posture
  • dehydration.

 

Secondary headaches

Secondary headaches can be caused by an illness, too much alcohol, a head injury or concussion.

Headaches in some women are often caused by hormones, and many women notice a link with either their periods, their use of the contraceptive pill, menopause or pregnancy.

Some headaches can even occur as a side effect of medication, or painkillers, or even an allergic reaction, others still occur as a result of being unwell with a cold or flu or infection.

 

Dehydration

Lack of fluid can cause dehydration and is a common cause of headaches. Fluids are needed for the body to function correctly and may be lost through:

  • illness, vomiting or diarrhea
  • exercise
  • sweating
  • alcohol,
  • having large amounts of caffeine
  • working in high-temperatures.

 

Migraines

A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head or temple. Many people have accompanying symptoms such as nausea, vomiting and increased sensitivity to light or sound. Migraine is a common condition, affecting around one in every five women and around one in every 15 men.

 

Several types of migraine, including:

  • migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights.
  • migraine without aura – the most common type, where the migraine occurs without the specific warning signs.
  • migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache doesn't develop.

Some people have very frequent migraines up to several times per week while others have migraines occasionally.

 

Seeking medical advice

You should see a doctor if you have frequent or severe migraines. Over the counter painkillers such as paracetamol or ibuprofen can be effective for migraines. However, avoid using too many painkillers to treat migraines and if pain persists see your doctor. For example, if you have frequent migraines - more than five days a month, even if they can be controlled with medication, you still make the effort to see your doctor.

If any of the following are experienced please call for an ambulance or present immediately at our nearest hospital’s emergency room:

  • paraylsis or weakness in one or both arms and/or one side of the face
  • slurred or garbled speech
  • a sudden agonising headache resulting in a blinding pain unlike anything experienced before
  • headache along with a high temperature/fever, stiff neck, mental confusion, seizures, double or blurred vision and a rash

These symptoms may be a sign of a more serious condition, such as a strike, or meningitis and should be assessed by a doctor as soon as possible.

 

Causes of migraines

The exact cause of migraines is unknown, although they're thought to be the result of temporary changes in the chemicals, nerves and blood vessels in the brain. Around half of all people who experience migraines also have a close relative with the condition, suggesting that genetics may play a role.

Some people find migraines are associated with certain triggers, such as:

  • starting their period
  • stress
  • tiredness
  • certain foods or drinks

 

Treating migraines

While there is no cure for migraines, there are a number of treatments available to help reduce the symptoms.

  • painkillers – including over-the-counter medications such  as paracetamol and ibuprofen
  • triptans – medications that can help reverse the changes in the brain that may cause migrainess
  • anti-emetics – medications often used to reduce nausea and vomiting

During a migraine many people find that sleeping or lying in a darkened room can also help.

 

Preventing migraines

If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of having a migraine. Maintaining a healthy lifestyle will also help including plenty of sleep, eating well, maintaining a healthy diet, regular exercise, staying well hydrated and minimizing alcohol and caffeine intake.

Medications used to prevent migraines include anti-seizure medication topiramate and a medication called propranolol that's usually used to treat high blood pressure.

 

Outlook

Migraines can severely affect your quality of life and stop you carrying out your normal daily activities. Some people find they need to stay in bed for days at a time as a result of very severe migraines.

The main symptom of a migraine is usually an intense headache on one side of the head or temple. The pain is usually a moderate or severe throbbing sensation that gets worse when you move and prevents you from carrying out normal activities. In some cases, the pain can occur on both sides of your temple and may affect your face or neck.

Other symptoms commonly associated with a migraine include:

  • nausea
  • vomiting
  • increased sensitivity to light and sound

 

Some people also experience other symptoms:

  • sweating
  • poor concentration,
  • feeling very hot or very cold
  • abdominal pains
  • diarrhea

Not everyone with a migraine experiences these additional symptoms and some people may experience them without having a migraine.  These symptoms of a migraine usually last between four hours and three days, although you may feel very tired for up to a week afterwards.

 

Symptoms of aura

Approximately, one in three people with migraines have temporary warning symptoms, known as aura, before a migraine. These include things like:

  • visual problems – such as seeing flashing lights, zig-zag patterns or blind spots.
  • numbness or a tingling sensation like pins and needles that usually starts in one hand and moves up your arm before affecting your face, lips and tongue
  • feeling dizzy or off balance
  • difficulty speaking
  • loss of consciousness – although this is unusual

Aura symptoms typically develop over the course of about five minutes and last for up to an hour. Some may experience an aura followed by only a mild headache or no headache at all.

 

When to seek medical advice

You should see your doctor if you are suffering from frequent or severe migraine symptoms that can't be managed with occasional use of over-the-counter painkillers.

You should also make an appointment to see your doctor if you have frequent migraines (on more than five days a month), even if they can be controlled with medication, as you may benefit from preventative treatment.

You should call for an ambulance immediately if you or someone experiences any of the following:

  • paralysis or weakness in one or both arms and/or one side of the face
  • slurred or garbled speech
  • a sudden agonising headache resulting in a blinding pain unlike anything experienced before
  • headache along with a high fever, stiff neck, mental confusion, seizures, double visions and a rash

These symptoms may be a sign of a more serious condition, such as a stroke or meningitis and should be assessed by a doctor as soon as possible.

 

Stages of a migraine

Migraines develop over 4 clear and distinct stages, although not everyone goes through each one of these stages:

  1. 'Prodromal' (pre-headache) stage –changes in mood, energy levels, behaviour and appetite can occur several hours or days before an attack.
  2. Aura – usually visual problems, such as flashes of light or blind spots, which can last for five minutes to an hour.
  3. Headache stage – usually a pulsating or throbbing pain on one side of the head, often accompanied by nausea, vomiting, and/or extreme sensitivity to bright light and loud sounds, this can last between four and 72 hours.
  4. Resolution stage – when the headache and other symptoms gradually fade, though you may feel tired for a few days afterwards.

The cause of migraines is unknown, but they're thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain. It's not clear what causes this change in brain activity, but it's possible that your genes make you more likely to experience migraines as a result of particular triggers.

 

Migraine Catalysts

Many possible migraine triggers have been suggested, including hormonal, emotional, physical, dietary and environmental.

 

Hormonal changes

Some women experience migraines around the time of their period, possibly because of changes in the levels of hormones such as oestrogen. These type of migraines usually occur between two days before the start of your period to three days after. Some women only experience migraines around this time, which is known as pure menstrual migraine. However, most women experience them at other times too and this is called menstrual related migraine.

Many women find their migraines improve after menopause although the menopause can trigger migraines or make them worse in some women.

 

Emotional triggers:

  • stress
  • anxiety
  • tension
  • shock
  • depression
  • excitement

 

Physical triggers:

  • tiredness
  • poor or insufficient sleep
  • shift work
  • poor posture
  • neck or shoulder tension
  • jet lag
  • low blood sugar
  • strenuous or too much exercise or physical exertion

 

Dietary triggers:

  • missed, delayed or irregular meals
  • dehydration
  • alcohol
  • food additives such as tyramine
  • caffeine base products
  • specific foods such as chocolate, citrus fruit and cheese

 

Environmental triggers:

  • bright lights
  • flickering screens, such as a television or computer screen
  • smokings
  • loud noises
  • changes in temperatures
  • strong smells

 

Medication Triggers:

  • some types of sleeping tablets
  • the contraceptive pill
  • hormome replacement therapy

Migraines can be unpredictable, sometimes occurring without the other symptoms. Unfortunately, there's currently no cure for migraines, although a number of treatments are available to help ease symptoms as mentioned earlier in this guide.

 

Painkillers

Many find that over-the-counter painkillers, such as paracetamol, aspirin and ibuprofen can help reduce pain and symptoms. They tend to be most effective if taken at the first signs of a migraine attack, as this gives them time to absorb into your bloodstream and ease symptoms.

It's not advisable to wait until the headache worsens before taking painkillers as it's often too late for the medication to work. In this situation soluble painkillers dissolved in a glass of water are the next best alternative as they're absorbed quickly by the body.

 

Cautions

When taking over-the-counter painkillers, always make sure you read the instructions on the packaging and follow the recommended dosage guidelines. While children under 16, shouldn't take aspirin unless it's under the guidance of a healthcare professional. Aspirin and ibuprofen are also not recommended for adults who have a history of stomach problems, such as stomach ulcers, liver and kidney problems.

Taking any form of painkiller on a frequent basis can make migraines worse and can lead to painkiller headaches. Please see you doctor if you are using painkillers on a regular basis but your headaches and migraines persist.

 

Triptans

If ordinary painkillers aren't helping to relieve your migraine symptoms, you should make an appointment to see a doctor. They may recommend taking painkillers in addition to a type of medication called a triptan and possibly anti-sickness medication.

Triptan medicines are a specific painkiller for migraine headaches. They're thought to work by reversing the changes in the brain that may cause migraine headaches.

They cause the blood vessels around the brain to contract (narrow). This reverses the dilating (widening) of blood vessels that's believed to be part of the migraine process.

Triptans are available as tablets, injections and nasal sprays.

Common side effects of triptans include:

  • warm-sensations
  • tightness
  • tingling
  • flushing
  • feelings of heaviness in the face, limbs or chest

Some people also experience nausea, dry mouth and drowsiness. These side effects are usually mild and improve on their own.

As with other painkillers, taking too many triptans can lead to medication overuse headache.

 

Anti-sickness medicines

Anti-sickness medicines, known as anti-emetics, can successfully treat migraine in some people even if you don't experience nausea or vomiting. These are prescribed by your GP and can be taken alongside painkillers and triptans.

As with painkillers, anti-sickness medicines work better if taken as soon as your migraine symptoms begin. Side effects of anti-emetics include drowsiness and diarrhoea.

 

Seeing a specialist

Specialist migraine clinics can assist with treatments and in investigating the advice of your doctor and the symptoms currently being experienced.

In addition to recommending medications, a specialist may recommend other treatments such as transcranial magnetic stimulation.

 

Transcranial magnetic stimulation for the treatment and prevention of migraines (TMS)

TMS involves holding a small electrical device to your head that delivers magnetic pulses through your skin. It's not clear exactly how TMS works in treating migraines, but studies have shown that using it at the start of a migraine can reduce its severity. It can also be used in combination with various medications  previously mentioned above.

However, TMS isn't a cure for migraines and it doesn’t work for everyone. The evidence for its effectiveness isn't strong and is limited to people who have migraine with aura.

There's also little evidence about the potential long-term effects of the treatment, although studies into the treatment have so far only reported minor and temporary side effects, such as:

  • slight dizziness
  • drowsiness and tiredness
  • muscle tremors that make standing difficult
  • increased irritability

 

Treatment for pregnant and breastfeeding women

In general, migraine treatment with medicines should be limited as much as possible when you're pregnant or breastfeeding. Instead, trying to identify and avoid potential triggers if a migraine is recommended and preferred. If medication is essential, then a doctor may prescribe a low-dose painkiller, such as paracetamol and in some cases, anti-inflammatory drugs or triptans.

 

Complications of migraine 

Migraines are associated with a small increased risk of ischaemic strokes, and a very small increased risk of mental health problems.

 

Stroke

An ischaemic stroke occurs when the blood supply to the brain is blocked by a blood clot or fatty material in the arteries. Studies have shown that people who experience migraines, particularly migraines with aura, have about twice the risk of having an ischaemic stroke at some point compared to people without migraines, though this risk is very small.

 

Contraceptive pill

The risk of having an ischaemic stroke is increased by the use of the combined use of the contraceptive pill. Medical professionals generally advise women who experience migraine with aura not to use the combined contraceptive pill.

Women who have migraine without aura can usually take the combined contraceptive pill safely, unless they have other stroke risk factors such as high blood pressure or a family history of cardiovascular disease.

 

Mental health problems

Migraine is associated with a very small increased risk of mental health problems, including:

  • depression
  • bipolar disorder
  • anxiety disorder
  • panic disorder

There are a number of ways you can reduce your chances of experiencing migraines.

  1. Identifying and avoiding triggers or migraine catalysts – by recognising the things that can trigger an attack in you can then consciously avoid them.
  2. Keep a migraine diary to try and track and identify triggers.

In your migraine diary, try to record:

  • the date of the attack
  • the time of day the attack began
  • any warning signs
  • your symptoms - including the presence or absence of aura
  • what medication you took
  • when the attack ended

 

Medication and supplements

Medication is also available to help prevent migraines. These medicines are usually used if you've tried avoiding possible triggers but you're still experiencing migraines. You may also be prescribed these medicines if you experience very severe migraine attacks, or if your attacks happen frequently.

Some of the main medications used to prevent migraines are:

Topiramate

Topiramate is a type of medication originally developed to prevent seizures in people with epilepsy, but is now much more commonly used in migraine. It's been shown to help prevent migraines and is usually taken every day in tablet form.

Topiramate should be used with caution in people with kidney or liver problems. It can also harm an unborn baby if taken during pregnancy and can reduce the effectiveness of hormonal contraceptives.  Discuss alternative methods of contraception with your doctor.

Side effects of topiramate can include:

  • decreased appetite
  • nausea
  • vomiting,
  • constipation or diarrhea
  • dizziness
  • drowsiness
  • problems sleeping

 

Propranolol

Propranolol is a medication traditionally used to treat angina and high blood pressure, but it’s also been shown to effectively prevent migraines. It's usually taken every day in tablet form. Propranolol is unsuitable for people with asthma, chronic obstructive pulmonary disease and some heart problems. It should be used with caution in people with diabetes.

Side effects of propranolol can include:

  • cold hands and feet
  • pins and needs;s
  • sleep problems
  • tiredness

 

Preventing menstrual-related migraines

Menstrual-related migraines usually occur between two days before the start of your period to three days after. As these migraines are relatively predictable, it may be possible to prevent them using either non-hormonal or hormonal treatments.

Non-hormonal treatments

The non-hormonal treatments that are recommended are:

  • non-steroidal and inflammatory drugs– a common painkiller
  • triptans – medicines that reverse the widening (dilation) of blood vessels, which is thought to be a contributory factor in migraines.

These medications are taken as tablets two to four times a day from either the start of your period or two days before, until the last day of bleeding.

 

Hormonal treatments

Hormonal treatments that may be recommended include:

  • combined hormonal contraceptives, such as the combined contraceptive pill, patch or vaginal ring.
  • progesterone-only contraceptives, such as progesterone-only pills, implants or injections.
  • oestrogen patches or gels, which can be used from three days before the start of your period and continued for seven days.

Hormonal contraceptives aren't usually used to prevent menstrual-related migraines in women who experience aura symptoms because this can increase your risk of stroke

 

Acupuncture

If medication is unsuitable, or it doesn't help to prevent migraines, you may want to consider acupuncture. A course of up to 10 sessions over a five to eight week period may be considered beneficial.