What causes headaches?

Most people who suffer from regular headaches have either migraine or tension headaches.

Occasionally, headaches can be caused by diseases involving the teeth, sinuses or eyes. In rare cases, headaches can be caused by diseases affecting the brain - including infections, tumours and bleeding.

There is some evidence that taking more than the recommended amount of some painkillers may cause headaches. Food additives can sometimes cause headaches.

What is migraine?

A typical migraine causes quite a severe, throbbing headache often affecting only one side of the head. You may feel sick and find that bright light or moving around makes your headache worse. Before your headache starts you may see flashes of light or experience some other sensation for a few minutes, which acts as a warning that a migraine is coming on. A migraine may last from a few hours to two or three days. You should feel perfectly well between migraine attacks. Not all migraines happen in this way and they vary from person to person.

Migraines may run in your family. They may start in childhood or later in life and you may have migraine attacks for many years.

Common triggers for a migraine attack include:

  • Hormonal changes in women, eg, menstruation and the menopause
  • Caffeine and some foods, such as chocolate and some cheeses
  • Psychological factors, such as anxiety and extreme tiredness
  • Environmental changes, eg, bright light or changes in the weather

What are tension headaches?

This is the most common type of headache, but the link with stress is not clear. A tension headache is usually less severe than a migraine, and affects both sides of the head. It feels like a tight band or a weight pressing down on your head. Tension headaches may come and go over days or weeks.

When should I see my doctor?

If you are having headaches more than twice a week, it is worth seeing your doctor. Your doctor may recommend that you keep a record of your headaches to help with diagnosis and to find out if there are any triggers that may bring on your headaches or migraine.

You should see your doctor urgently if you have a headache together with slurred speech, numbness or dizziness, blackouts or persistent vomiting.

You should also see your doctor if start having frequent headaches when you are over the age of 50, or if your headaches are getting worse and will not go away.

Will I need any tests?

Often the cause of your headache will be clear to your doctor from your description and a simple examination in the surgery. You may need tests to rule out other illnesses that can cause headaches. These may include blood tests, x-rays and special scans. Your doctor may refer you to a hospital specialist if the diagnosis is not clear.

What treatments are available?

For tension headaches, treatment with simple painkillers such as aspirin, ibuprofen and paracetamol, may be all that is needed. These painkillers can all be bought from a pharmacy.

For migraine you may need something to take at the start of an attack, before you begin to feel sick. For mild migraine your doctor may recommend a simple painkiller and some medicine to stop you being sick (eg, cyclizine, domperidone, metoclopramide). Prochlorperazine is another anti-sickness agent that is available over the counter as buccal tablets (Buccastem M®). These tablets are placed high under the upper lip to dissolve.

Combination preparations for migraine are also available. Migraleve® Pink tablets contain two painkillers (paracetamol and codeine) plus an anti-sickness drug (buclizine) and are available over the counter in pharmacies. Other combination preparations include Paramax® (paracetamol plus metoclopramide) and Migramax (lysine acetylsalicylate [aspirin] plus metoclopramide).

The newest agents for the acute treatment of migraine are the triptans, which can help even when an attack has already started. They are all available as tablets but some are also available as a nasal spray, an injection or as a tablet that dissolves on the tongue. Members of this class of drugs include almotriptan (eg, Almogran®), eletriptan (Relpax®), frovatriptan (Migard®), naratriptan (Naramig®), rizatriptan (eg, Maxalt®), sumatriptan (eg, Imigran®) and zolmitriptan (eg, Zomig®). Most triptans are available only on prescription but sumatriptan tablets can be bought from pharmacies without a prescription.

There are a number of other preparations for migraine, which your doctor may prescribe if other therapies are ineffective. Examples include tolfenamic acid, cyproheptadine (Periactin®), products containing ergot derivatives (eg, Migril®) and Midrid® (paracetamol plus isometheptene).

If you suffer from more than two migraine attacks a month and are suffering significant disruption to your life as a result your doctor may prescribe a preventative drug to be taken regularly. This is usually a beta-blocker such as metoprolol, propranolol (eg, Bedranol® SR, Beta-Prograne®, Syprol®) or timolol, but sometimes a serotonin blocker such as pizotifen is used. Clonidine (eg, Dixarit®) and topiramate (eg, Topamax®) may also be prescribed for the prevention of migraine.

Some people say their headaches are helped by complementary therapies, eg, acupuncture or yoga.

Help yourself

  • Keep a diary, recording each headache, what may have caused it and what helped to relieve it
  • Avoid things that you know will trigger a headache
  • Take regular exercise, eg, a brisk walk or swim, for 20 minutes three times a week - this may help to prevent headaches
  • Try to manage stress better
  • Do not take more than the recommended amount of medication

Further information available from:

Migraine Action Association (formerly British Migraine Association)
27 East Street
Leicester LE1 6NB
Tel: 0116 275 8317
Helpline: 0870 050 5898
Email: info@migraine.org.uk
Internet: www.migraine.org.uk

The Migraine Trust
55-56 Russell Square
London WC1B 4HP
Tel: 020 7436 1336
Helpline: 020 7462 6601 (Monday to Friday, 10am-5pm)
Email: info@migrainetrust.org
Internet: www.migrainetrust.org

Fact sheet provided by MIMS

Date last reviewed: October 2008

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