Don't lose your head over a headache

Headaches drive millions of us to despair, and according to Harvard scientists half of us have at least one a month. Yet the majority are not caused by any disease. So what triggers them? And how are they best treated? Roger Dobson investigates

TENSION HEADACHE

WHAT ARE THEY?

The most common type of headache, they involve pain or discomfort in the head, scalp, or neck, and are usually linked to muscle tightness. Research shows that they usually develop in the afternoon, and rarely last more than a few hours.

WHO GETS THEM?

Up to 80 per cent of the population at some time. More women than men suffer, and around 3 per cent of adults have chronic tension headache, with attacks on more than 15 days a month.

SYMPTOMS

Pain that feels like a tight band or dull pressure around the head is the most universal symptom, but shoulder and neck muscles may also ache, and symptoms can be made worse by bright lights, noise and stress. They are not usually one-sided.

CAUSES

Exact cause unknown; several factors may be involved. Tension headaches are caused at least in part by changes in how the nerves of the head, neck and shoulders sense pain. Muscle contraction caused by stress, depression, anxiety or posture can trigger one; so can teeth-grinding, loud music and eye strain.

TREATMENTS

Good posture and avoiding repetitive movements can help. Don't rest the chin on the chest while reading or hold a phone between shoulder and ear. Tricyclic antidepressants and muscle relaxants help prevention. Treatments include acupuncture, Botox, hypnosis, deep breathing, meditation and yoga. If caused by a poor bite, dentists can treat this with devices such as mouthguards.

MIGRAINE

WHAT ARE THEY?

Headaches that are caused by the brain's blood vessels working abnormally. Dilated blood vessels in the head are a chief trigger for migraine pain.

WHO GETS THEM?

They affect all ages, but most commonly those between 20 and 50. There may be a genetic predisposition. One in four women and one in 12 men will experience them at some time, and there are around six million UK sufferers.

SYMPTOMS

Severe pain on one or sometimes both sides of the head. Can also include weakness in a limb, speech difficulty, confusion, nausea and sensitivity to light. In migraine with aura, which affects 10 to 20 per cent of sufferers, there are visual disturbances, such as zigzag lines or flashing lights.

CAUSES

The pain of a migraine headache is caused by the dilation of blood vessels, but what sets it off is not known for sure. One theory is that blood vessels may overreact to triggers such as stress. It's suggested that this reaction narrows some arteries, and that other arteries open up to get more oxygen to the brain, which causes the release of pain-producing prostaglandins. Research has found that a hole in the heart may contribute to migraines.

TREATMENTS

A wide range of drugs is used to treat symptoms and prevent attacks. Aspirin can ease symptoms; triptans work by constricting blood vessels in the head; beta-blockers are thought to stop blood vessels expanding; calcium-channel-blockers combat inflammation; anticonvulsants affect pain signals in the brain. Botox has also been used, but with mixed results. Some sufferers may be helped by drinking coffee or removing certain foods from their diet.

SINUS HEADACHE

WHAT ARE THEY?

The sinuses can become infected when they are blocked by mucus, which results in a pain in the head and face.

WHO GETS THEM?

Around four out of 10 people suffer at some time, and anyone who has a cold or is prone to allergies is at risk.

SYMPTOMS

Pain or pressure around the eyes, cheeks and forehead, as well as tenderness of the skin and facial bones. One survey found that 93 per cent of sinus sufferers get pain around the eyes and forehead.

CAUSES

Allergies and colds that lead to inflammation of the nose and sinus membranes are the usual culprits. Sinuses get congested and become infected as bacteria or viruses infect the lining.

TREATMENTS

Aspirin and ibuprofen to temporarily relieve pain, or a decongestant when sinuses are blocked. Antibiotics may also be prescribed, and antihistamines when allergies are the cause. Some research shows that a room humidifier can prevent these headaches.

CLUSTER

WHAT ARE THEY?

One of the most painful of all headaches - sometimes described by women as being worse than childbirth - they get their name because attacks usually come in clusters.

WHO GETS THEM?

Relatively unusual, affecting around one in 1,000 people. Usually start between the ages of 20 and 40, and male sufferers outnumber women 10 to one. Studies of cluster patients show that they are more likely to have hazel-coloured eyes.

SYMPTOMS

Usually begin as a minor pain around one eye, but then spread to the remainder of that side of the face. Other symptoms can include a runny nose and droopy eyelid. Each attack usually lasts between 30 and 45 minutes, but can be quickly followed by another, sometimes several times a day, before suddenly stopping for months or years.

CAUSES

Not yet known, although one clue may lie in the discovery that cluster patients tend to have a spot above an eye where there is reduced blood flow.

TREATMENTS

Calcium-channel blockers can prevent attacks, while steroids may prevent further attacks. Harvard researchers say that sumatriptan, when given by injection, can end about 75 per cent of attacks within 15 minutes. Inhaling pure oxygen also eases symptoms.

DRUG-REBOUND HEADACHE

When an occasional headache becomes daily, it may be a drug-rebound headache, the result of overuse of pain relievers.

Around 5 per cent of adults have daily headaches, and it's estimated that a third of these may be due to drug rebound.

Pain, usually on both sides of the head, and sometimes nausea and vomiting as well as muscle weakness and depression.

Occur when the body adapts to pain relievers. One theory is that when used too often, painkillers create a false tolerance for pain so that when the effects wear off, the user feels an exaggerated level of pain. According to researchers at the Mayo Clinic, taking pain relievers for headaches more than two or three times a week increases the risk. Almost any pain reliever, including aspirin and ibuprofen, can cause problems.

Stop taking the medications causing the problem. Other drugs can be used, including muscle relaxants and antidepressants. Mayo Clinic doctors say that within a week to 10 days the headaches usually lessen in frequency and intensity.

Heads up: other causes

* HANGOVER

Drinking too much alcohol results in a four-fold increase in the amount of water excreted by the body, causing, according to one theory, dehydration and head pain. There are hundreds of suggested cures, from aniseed to zinc.

* WEEKEND HEADACHE

Caused by caffeine withdrawal, and usually occurring 12 hours after the last cup of coffee, it leads to opening up of blood vessels which causes the pain. It's easy to self-diagnose - just compare the number of cups of coffee you have at work and at weekends.

* SUGAR HEADACHE

Low blood sugar can cause headache. Those who wake up in the morning with a headache may be reacting to the low blood sugar caused by the lack of food overnight.

* TOXIC HEADACHE

Can be the result of illness or chemicals. Repeated exposure to dietary nitrite compounds, which dilate blood vessels, can lead to a dull, pounding headache. Nitrite is used to preserve meat. Eating foods prepared with monosodium glutamate can result in headache too.

* ORGASMIC HEADACHE

One in 100 people get it at some time, and it is three times more common in men, according to research at the University of Munster. Sudden, severe pain around the point of orgasm, it's thought to be caused by changes in blood flow.

* ICE-CREAM HEADACHE

Affects around one in three people, according to a report in the British Medical Journal. Pain usually begins a few seconds after the rapid ingestion of cold foods or beverages and peaks in 30-60 seconds. The only preventive treatment, short of abstinence, is to hold the ice-cream in the mouth for a few seconds to warm it before swallowing.