A Brief Overview of Headaches and Migraines

Headaches are an extremely varied and common symptom of many conditions. In fact, about 15 per cent of Australians are estimated to be taking medication for a headache at any given time (ABS, cited in Better Health Channel 2015).

The term headache refers to any pain in the head, face or neck area (Healthdirect 2017).

Headaches vary in severity, frequency and length. The pain may be sharp, throbbing or dull, with gradual or sudden onset, and may last from less than an hour to several days (Mayo Clinic 2018).

Headaches are so prevalent because there are numerous causes (Better Health Channel 2015). Headache & Migraine Australia (2019) lists 37 different types of headache.

Headaches are divided into two categories:

• Primary headaches, which are not caused by an underlying illness or injury; and
• Secondary headaches, which are ‘secondary’ side effects of an underlying illness or injury.

(Mayo Clinic 2018; QLD Health 2019)

A headache can be caused by anything that stimulates the pain receptors in the head or neck (Better Health Channel 2015).

Primary Headaches

Primary headaches can be related to chemical activity in the brain, nerves or blood vessels surrounding the skull, the muscles in the head and neck, or a combination of these. Some people may have a genetic predisposition to develop primary headaches (Mayo Clinic 2018). Some common types of primary headaches include:

• Cluster headache;
• Migraine; and
• Tension headache.

(Mayo Clinic 2018)

Primary headaches may be caused by:

• Alcohol;
• Certain foods (e.g. processed meats containing nitrates);
• Changes in sleep or lack of sleep;
• Poor posture;
• Skipping meals; and
• Stress.

(Mayo Clinic 2018)

Secondary Headaches

When an underlying condition or external cause activates the pain-sensitive nerves of the head, the individual may experience a secondary headache (Mayo Clinic 2018). Secondary headaches can include:

• Sinus headache;
• Spinal headache (caused by low pressure or volume of cerebrospinal fluid);
• Thunderclap headache (a sudden, severe headache caused by migraine, orgasm or rapid increase of blood pressure);
• Medication headache (from overuse of pain medication);
• External compression headache (from compression-causing headwear); and
• Ice cream headache (‘brain freeze’).

(Mayo Clinic 2018; Headache Australia n.d.)

There are many possible causes of secondary headaches, varying in severity. These can include:

• Acute sinusitis;
• Blood clot;
• Brain aneurysm;
• Brain tumour;
• Carbon monoxide poisoning;
• Concussion;
• Dehydration;
• Ear infection;
• Hangover;
• Influenza;
• Meningitis; and
• Stroke.

(Mayo Clinic 2018)

Please note this is not a complete list of possible causes.

Migraines

Migraines are a common type of primary headache characterised by severe, throbbing pain on one side of the head (Better Health Channel 2014).

They can be debilitating, accounting for 5 million ER visits every year in the United States (Minen et al., cited in Jesani & Simerson 2019).

They may be recurring depending on the individual, with some people experiencing two or three per week (Better Health Channel 2014).

Migraines can last between four hours and three days. Women are more affected than men, which is thought to be related to reduced oestrogen during menstruation (Better Health Channel 2014).

Migraine Symptoms

According to the diagnostic criteria of migraines, symptoms include:

• Moderate to severe pulsating headache on one side of the head;
• Headache that is worsened by physical activity; and
• Nausea and vomiting and/or sensitivity to light and noise;

(Moriarty & Mallick-Searle 2016)

Migraine with Aura

Also known as ‘classic migraine’, this type of migraine is characterised by recurrent migraine symptoms accompanied or preceded by visual and sensory disturbances known as aura (Mayo Clinic 2019; Jesani & Simerson 2019).

Aura symptoms most commonly begin within an hour before migraine symptoms, though sometimes they will occur without a migraine (Mayo Clinic 2019). Aura symptoms may include:

• Blind spots;
• Zigzag lines across the field of vision;
• Shimmering spots or stars;
• Changes in vision or vision loss;
• Flashes of light;
• Numbness, generally on one side of the face or one hand that slowly spreads;
• Speech or language difficulty; and
• Muscle weakness.

(Mayo Clinic 2019)

Diagnosing Headaches

Headaches can be caused by a combination of factors and in some cases, a serious underlying issue. If a headache is recurring you may need to seek help from a health professional in order to determine what the cause is. Tests such as scans, eye tests and sinus x-rays may be used (Better Health Channel 2015). A health professional may consider the following factors when diagnosing a headache:

• Location of the pain;
• The severity of the pain;
• Duration of the pain;
• Other symptoms;
• How often the pain recurs; and
• Factors that worsen and improve the pain.

(Better Health Channel 2015)

Treating Headaches

Treatment may depend on the cause of the headache. If the headache is recurring, it may be triggered by a lifestyle factor or particular behaviour (QLD Health 2019). The following strategies may help to alleviate the pain:

• Relax in a quiet space with good ventilation;
• Drink plenty of water;
• Put an ice pack or cool cloth on your head;
• Splash your face with cold water;
• Massage your head, neck, shoulders and jaw (if you have a tension headache); and
• Consult a healthcare professional about appropriate pain medication if necessary.

(QLD Health 2019)

Preventing Headaches

The following strategies may help to prevent headaches:

• Maintaining a healthy diet;
• Staying hydrated;
• Regular exercise;
• Being in well-ventilated rooms;
• Avoiding sitting or standing in one position for a long time (this can cause muscle tension);
• Avoiding caffeine, chocolate, alcohol and tobacco;
• Stress-reduction strategies such as yoga, massage and meditation;
• Maintaining a good posture;
• Consulting an optometrist (if the headache is eye-related); and
• Avoiding overuse of headache medicines, which can cause ‘rebound’ headaches.

(QLD Health 2019; Healthy WA n.d.)

When to Seek a Healthcare Professional

Most headaches are not serious but in rare cases can indicate a serious medical condition such as a stroke, meningitis or encephalitis (QLD Health 2019). Seek medical attention if you are experiencing:

• An especially severe headache;
• Difficulty seeing, speaking, walking, swallowing or understanding speech;
• Confusion;
• Fainting;
• High fever (more than 39 degrees Celsius);
• Numbness, weakness or paralysis;
• Stiff neck;
• Persistent vomiting;
• Fit or seizure;
• Injury from a fall, blow or bump; and
• Possible poisoning from a substance, animal or plant.

(Mayo Clinic 2018; QLD Health 2019; Healthy WA n.d.)

Additional Resources

• Headache & Migraine Australia, Headache Types, https://headacheaustralia.org.au/types-of-headaches/
• Headache & Migraine Australia, Migraine Information, https://headacheaustralia.org.au/migraine/migraine-a-common-and-distressing-disorder/
• Harvard Health Publishing, Headache: When to Worry, What to do, https://www.health.harvard.edu/pain/headache-when-to-worry-what-to-do

References

• Better Health Channel 2015, Headache, Better Health Channel, viewed 16 March 2020, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache
• Better Health Channel 2014, Headache - Migraine, Better Health Channel, viewed 16 March 2020, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache-migraine
• Headache & Migraine Australia 2019, Headache Types, Headache & Migraine Australia, viewed 16 March 2020, https://headacheaustralia.org.au/types-of-headaches/
• Healthdirect 2017, Headaches, Healthdirect, viewed 16 March 2020, https://www.healthdirect.gov.au/headaches
• Healthy WA n.d., Headache, Healthy WA, viewed 17 March 2020, https://healthywa.wa.gov.au/Articles/F_I/Headache
• Jesani & Simerson 2019, ‘Pharmacologic Management of Acute Migraines in the Emergency Department’, Advanced Emergency Nursing Journal, vol. 41, no. 2, pp. 150-162, viewed 20 March 2020, https://www.nursingcenter.com/journalarticle?Article_ID=4982360&Journal_ID=646631&Issue_ID=4982045#P27
• Mayo Clinic 2019, Migraine with Aura, Mayo Clinic, viewed 20 March 2020, https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/symptoms-causes/syc-20352072
• Mayo Clinic 2019, Symptoms - Headache, Mayo Clinic, viewed 16 March 2020, https://www.mayoclinic.org/symptoms/headache/basics/causes/sym-20050800
• Moriarty, M & Mallick-Searle, T 2016, ‘Diagnosis and Treatment for Chronic Migraine’, The Nurse Practitioner, vol. 41, no. 6, pp. 18-32, viewed 20 March 2020, https://journals.lww.com/tnpj/fulltext/2016/06000/diagnosis_and_treatment_for_chronic_migraine.2.aspx
• Queensland Health 2019,When should you worry about a headache?, Queensland Health, viewed 16 March 2020, https://www.health.qld.gov.au/news-events/news/when-worry-bad-headache-symptoms