More than 10 million of us regularly suffer from headaches. Knowing which type is the key to getting effective treatment

Suffering from headaches

It’s probably a tension headache (the most common type of headache)…

If you have A tight band of pain around the front or back of your head, which isn’t severe enough to prevent you doing everyday activities and usually lasts for 30 minutes to several hours.

Causes The exact cause is unclear, but tension headaches have been linked to stress, poor posture, skipping meals and dehydration. They’re twice as common in women as men.

Treat it They can usually be treated with ordinary painkillers, such as paracetamol and ibuprofen. Lifestyle changes, such as getting regular sleep, reducing stress, eating regularly and staying hydrated, will also help.

Self-help tip Take painkillers with coffee. Caffeine helps analgesics work better by aiding absorption and penetration of the central nervous system.

It’s probably a cluster headache…

If you have A throbbing pain on one side of your face around the eye that can last as long as four hours, along with watery eyes and a runny nose.

Headaches come in clusters – up to as many as eight in a single day.

Causes Research suggests the part of the brain called the hypothalamus becomes overactive.

This area releases chemicals – including serotonin – which trigger nerve cells to cause pain. Cluster headaches are five times more common in men.

Treat it These can be the most difficult headaches to diagnose and treat, and over-the-counter medication rarely helps.

A self-administered injection of sumatriptan can stop the pain within five minutes for many sufferers but is prescription only.

Breathing pure oxygen through a mask is one of the best treatments but is only available in a few UK clinics.

If your GP can’t treat you, ask to be referred to a neurologist specialising in cluster headaches.

Self-help tip Support is available from the Organisation for the Understanding of Cluster Headaches (call 01646 651 979 or visit ouchuk.org).

It’s probably a rebound headache…

If you have A dull headache combined with a foggy, heavy feeling. It’s usually worst first thing in the morning and only goes when a painkiller is taken.

Causes All painkillers can cause a withdrawal headache if taken regularly over a long time.

Professor MacGregor (see Migraine) explains, ‘If you take painkillers more than 15 days a month, or triptans or codeine-related drugs more than 10 days a month, ask your GP to refer you to a specialist migraine clinic.’

Treat it The only way of treating this condition is to stop the medication.

The withdrawal process is individualised, based on the types of drugs you’re taking.

The headache often gets worse initially, but then it will improve and should clear after a few weeks.

Self-help tip Use non-drug remedies (see panel, far right) while withdrawing.

It’s probably a migraine…

If you have Throbbing pains, usually on one side of the head, are bothered by light, feel sick and your usual daily activities are affected.

Causes It can run in families, but researchers think that sufferers have a particularly sensitive or ‘hyper-excitable’ brain, making them much more sensitive to certain stimuli (foods, lights, alcohol, anxiety).

Migraine symptoms are thought to be due to abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.

Professor Anne MacGregor, a specialist in headaches and women’s health (annemacgregor.com), says, ‘Although there are many different triggers, the two most common are simply dehydration and low blood sugar – usually caused by going for too long without eating.’

Treat it There’s a ‘window of opportunity’ during a migraine attack before the stomach stops working properly (‘gastric stasis’) when any drugs you take won’t be absorbed properly, so act quickly.

Professor MacGregor says, ‘Take aspirin or ibuprofen with a sweet, fizzy drink, like regular cola, to help absorption and boost blood-sugar levels which can aid recovery.’

Stronger drug sumatriptan is available, in tablet form, without prescription from pharmacies (you’ll need to complete a health questionnaire first).

If these don’t help, prescribed treatments range from beta blockers (to prevent blood vessels in the head dilating), to antidepressants (which keep the brain chemistry under control), to triptans, designed to increase the levels of serotonin (a neurotransmitter found naturally in the brain).

‘If nausea and sickness make it impossible to take tablets, talk to your GP about alternative routes,’ advises Professor MacGregor. ‘These include nasal sprays, suppositories and sumatriptan (as described above) through an injectable device.’

Self-help tip Keeping a headache diary can help identify triggers.

The Migraine Trust has a useful online diary, or check out curelator.com – which can be accessed through an app.

It’s probably a menstrual migraine…

If you have Migraine symptoms that occur solely two to three days before your period, or on the day it starts.

Causes ‘These can be related to the release of prostaglandin, the same hormone that causes heavy periods or, if the headache comes on in the two weeks before your period, it may be related to dropping oestrogen levels,’ says Professor MacGregor.

Treat it For chronic sufferers, GPs can prescribe oestrogen patches to supplement dropping levels. Or they may suggest a contraceptive that switches off your natural cycle, such as Depo-Provera, the progestogen-only contraceptive injection, or Mirena, a coil that releases hormones.

Self-help tip ‘Reduce intake of fat or alcohol and take milk thistle (try Boots Milk Thistle, £8.99 for 30 capsules) for the week before your period,’ says Marilyn Glenville, author of Overcoming PMS The Natural Way (£8.99, Piatkus Books).

And supplementing your diet with 100mg a day of co-enzyme Q-10 can significantly reduce the frequency of migraines.

Something more serious?

‘Brain tumours are rare,’ explains Dr Manuela Fontebasso, medical advisor for Migraine Action (migraine.org.uk).

‘But a sudden-onset severe headache associated with fever, neck stiffness and light sensitivity might suggest meningitis or encephalitis.

‘And headaches brought on by straining, coughing or sneezing, might indicate raised intracranial pressure (raised pressure inside the skull), while head pain associated with speech disorders, or numbness or paralysis could be a sign of a stroke.’

If you’re concerned that your headache might be serious, contact your GP or NHS 111 as soon as possible, or go to your nearest accident and emergency department.