Headache disorders are among the most common neurological complaints worldwide, impacting a significant proportion of the population at some point in their lives.
These disorders can range from mild, occasional headaches to severe, chronic conditions that significantly impair quality of life.
Below is a non-exhaustive list of common headache presentations. Other types of headaches requires comprehensive assessment by a neurologist and are not included in this list.
Overview
Tension-type headaches are the most common type of primary headache, characterised by a dull, aching pain across the forehead, temples, or back of the head and neck. These headaches can be episodic, occurring sporadically, or chronic, with headaches occurring on 15 or more days per month.
Causes
Tension-type headaches are often associated with muscle tension in the scalp, neck, and shoulders, which can be triggered by stress, anxiety, poor posture, and fatigue. Other contributing factors include eye strain from prolonged screen use, dehydration, and lack of sleep.
Symptoms
Treatment Options
Treatment for tension-type headaches usually involves over-the-counter pain relief, such as paracetamol, aspirin, or ibuprofen. For chronic tension-type headaches, preventive treatments may include low-dose antidepressants (eg: amitriptyline), muscle relaxants, and stress management techniques such as cognitive behavioural therapy (CBT) and biofeedback. Regular physical activity, maintaining good posture, and ensuring adequate hydration and sleep are also important preventive measures.
Overview
Migraine is a complex neurological disorder characterised by recurrent episodes of moderate to severe headaches, often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound.
Migraines can last anywhere from a few hours to several days and are often debilitating, affecting daily activities and quality of life.
Causes
The exact cause of migraines is not fully understood, but they are believed to involve a combination of genetic, environmental, and neurological factors. Changes in brain chemicals, particularly serotonin, are thought to play a key role. Common triggers include hormonal changes (such as those associated with the menstrual cycle), stress, certain foods and drinks (eg: chocolate, caffeine, alcohol), lack of sleep, and sensory stimuli (eg: bright lights, loud noises).
Symptoms
Treatment Options
Treatment for migraines typically involves both acute and preventive strategies. Acute treatments include over-the-counter pain relievers (eg: paracetamol, ibuprofen), triptans (a class of prescription drugs specifically for migraines), and anti-nausea medications. Botox injections may also be considered if indicated.
Preventive treatments may include beta-blockers, anticonvulsants, antidepressants, and CGRP inhibitors, which are a newer class of migraine-specific drugs. Lifestyle modifications, such as managing stress, regular exercise, maintaining a consistent sleep schedule, and avoiding known triggers, are also crucial in managing migraines.
Overview
Cluster headaches are a rare but extremely painful type of primary headache, characterised by severe, unilateral (one-side of head only) stabbing pain around one eye or in the temple. They occur in cycles or “clusters”, with multiple headaches occurring daily for weeks or months, followed by periods of remission.
Causes
The exact cause of cluster headaches is not known, but they are thought to involve abnormalities in the hypothalamus, the part of the brain that regulates biological rhythms. Triggers may include alcohol, smoking, strong smells, and changes in sleep patterns.
Symptoms
Treatment Options
First line treatment for cluster headaches typically include prescription drugs specifically for migraines, known as triptans (either injectable or nasal forms, or oral if tolerable) to alleviate immediate pain. This may be followed by high-flow oxygen therapy if needed.
Preventive treatments may involve the use of medications such as verapamil (a calcium channel blocker), corticosteroids, or lithium. In some cases, nerve blocks such as an occipital nerve block, or neuromodulation therapies may be considered. Avoiding known triggers, particularly alcohol and smoking during this cluster period is also important.
Overview
Sinus headaches are associated with sinusitis, an inflammation or infection of the sinuses, leading to pain and pressure in the forehead, cheeks, and around the eyes. These headaches are often confused with migraines due to their similar symptoms.
Causes
Sinus headaches are caused by a blockage or inflammation of the sinuses, often due to an infection (viral, bacterial, or fungal), allergic reaction, or nasal polyps.
Symptoms
Treatment Options
Treatment for sinus headaches involves addressing the underlying sinusitis. This may include decongestants, nasal corticosteroids, antihistamines, and, if a bacterial infection is suspected, antibiotics. Warm compresses, steam inhalation, and saline nasal irrigation can also help relieve symptoms. In chronic cases, surgery may be necessary to remove blockages or polyps and improve sinus drainage.
Overview
Medication-overuse headache (MOH), also known as rebound headache, occurs as a result of the frequent use of headache medications. This type of headache is most common among individuals with pre-existing headache disorders, such as migraines or tension-type headaches, who regularly use pain relief medications.
Causes
MOH develops when headache medications are used too frequently, leading to a cycle of worsening headaches and increased reliance on medication. Common culprits include over-the-counter pain relievers like paracetamol, aspirin, and ibuprofen, as well as prescription medications like triptans and opioids.
Symptoms
Treatment Options
The primary treatment for MOH involves gradually tapering off the overused medication, under the supervision of a healthcare professional. This may initially worsen headache symptoms, but improvement typically follows after a period of withdrawal.
Preventive strategies may include using alternative therapies, such as CBT, biofeedback, and relaxation techniques, and considering preventive medications for underlying headache disorders.
Overview
Hemicrania continua is a rare chronic headache disorder characterised by continuous, unilateral pain that varies in intensity but is always present. The pain is typically moderate but can have severe exacerbations, often resembling cluster headaches or migraines.
Causes
The exact cause of hemicrania continua is unknown, but it is classified as a primary headache disorder, meaning it is not caused by another underlying condition.
Symptoms
Treatment Options
The hallmark of hemicrania continua is its responsiveness to indomethacin, a nonsteroidal anti-inflammatory drug (NSAID). Most patients experience complete relief of symptoms with indomethacin, making it both a treatment and a diagnostic tool for this condition. Other medications, such as gabapentin or topiramate, may be considered for those who cannot tolerate indomethacin.
Overview
Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from the face to the brain. It is characterised by sudden, severe, shock-like or stabbing pain on one side of the face.
Causes
Trigeminal neuralgia is often caused by compression of the trigeminal nerve, usually by a blood vessel. This compression wears away the nerve’s protective coating (myelin), leading to erratic and hyperactive nerve signals. It can also be associated with multiple sclerosis or be idiopathic (with no identifiable cause).
Symptoms
Treatment Options
First-line treatment for trigeminal neuralgia typically includes anticonvulsant medications such as carbamazepine or oxcarbazepine. If medication is ineffective or causes intolerable side effects, surgical options may be considered. These include microvascular decompression (to relieve pressure on the nerve), radiofrequency lesioning, or gamma knife radiosurgery.
Overview
Post-traumatic headache is a secondary headache disorder that occurs after a head injury, ranging from mild concussions to more severe brain trauma. These headaches can develop immediately after the injury or may appear days or weeks later.
Causes
Post-traumatic headaches result from trauma to the head, which can cause physical injury to the brain, changes in brain chemistry, or damage to the structures of the head and neck.
Symptoms
Treatment Options
Treatment depends on the type of headache and its severity. It may include pain relievers, antidepressants, or anticonvulsants. Non-pharmacological therapies, such as physical therapy, cognitive behavioural therapy, and relaxation techniques, are also commonly used.
It is essential to monitor symptoms closely, as persistent headaches after a head injury may indicate more serious underlying issues requiring further evaluation.
