IN THE CLEAR
The 10 most common types of headache – and the best way to treat each one
Including several where paracetamol won't help
WHEN was the last time you had a headache?
Last weekend after too many pints? Yesterday at work in a stressful meeting? Or this morning before you had a cup of coffee?
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Almost everyone gets headaches now and then.
But have you ever stopped to think about what kind of headache you've been suffering from?
From stress and nerve pain to muscle tension and hormonal changes, it turns out there are more than 150 different types.
And because each has a different cause, each requires a different treatment.
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Dr Unnati Desai, national GP lead at , said: "There are multiple causes for headaches.
"Examples include stress, fatigue, muscle tension, hormonal changes, nerve pain, and the location of the pain and its intensity can vary.
"Each type of headache has certain characteristics, symptoms, signs and sometimes triggers.
"Some are straightforward, but you may require further investigation with your doctor to work out what the pain relates to."
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Before we delve into the most common types, it's important to understand what a headache actually is.
It sounds obvious, but a headache is a pain or discomfort that occurs in any part of the face or head.
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"It's felt as a result of various structures in the head and neck, and not directly from the brain's tissue, which does not have nerve receptors that specifically register pain," Dr Desai said.
"Pain receptors are found in the nerves of the head and neck (cranial nerves) as well as muscles of the scalp, face, neck, shoulders, blood vessels in the head and neck and through a network of nerves on the scalp."
Here are 10 of the most common ones to be aware of.
1. Tension headache
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- How common: 75 per cent of adults
- Cause: stress, sleep problems, caffeine
- Treatment: rest, relaxation, painkillers
Tension headaches are the most common type of headache, with 75 per cent of adults suffering from them.
Thankfully, they are generally mild - but they can last for a few days, Dr Desai said.
"Tension headaches occur when the muscles of the scalp become tense, so the head can feel tender to touch," she added.
"Your head can feel like it's throbbing, with a tight vice around it.
"The pain tends to be bilateral, meaning it's felt on both sides of the head."
While there doesn't have to be a specific cause, the most common triggers include stress, sleep problems, caffeine, fatigue and muscle tension.
They are also associated with upper back and neck tension, Dr Desai added.
The best form of treatment, the GP said, is rest and relaxation techniques such as yoga and Pilates, which also help to improve posture.
Massage and deep heat to the muscles of neck and head can also be beneficial, as are painkillers like paracetamol, aspirin and ibuprofen.
2. Vision-induced headache
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- How common: fairly common
- Cause: glasses, contact lenses, screens
- Treatment: eye test, cutting down screen time
Have you ever found yourself with a thumping headache after staring at a screen for too long?
Or does the area behind your eyes feel sore or tired when you get a new pair of glasses?
Dr Desai said vision-induced headaches are also common when the eyes are overworked.
This could be from working at a computer, or wearing glasses or contact lenses with a new or wrong prescription.
"These headaches often present with frontal discomfort around the eyes, which equates to eye strain,"; Dr Desai said.
If you think your eyesight might be the problem, get your visual acuity checked at your local opticians.
You could also try cutting down screen time.
3. Migraine
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- How common: 10million people in the UK
- Cause: genetics, menstrual cycle, caffeine, alcohol, stress, fatigue, smoking, anxiety, depression
- Treatment: paracetamol, contraception, decrease caffeine intake, prescription medication
While less common than tension headaches, migraines still affect huge numbers of people.
Around 10million live with them in the UK, and three million workdays are lost every day due to migraine-related absenteeism, according to NHS England.
A migraine usually feels like a very bad headache, with a throbbing pain on one side.
"These can happen with aura symptoms - temporary visual or other disturbances that happen before the head pain - or without them," Dr Desai said.
Warning signs include sight problems (such as seeing wavy lines or flashing lights), numbness or a tingling that feels like pins and needles, feeling dizzy and difficulty speaking.
These symptoms should not last for more than an hour, but people may also experience tiredness, food cravings, a stiff neck, mood changes and vomiting.
Dr Desai said: "Note, migraines with aura are associated with a higher stroke and heart attack risk, so seek medical help if necessary."
Migraines in general are two to three times more common in women than men, and they can run in families.
Migraines without aura may be associated with oestrogen withdrawal during the menstrual cycle, Dr Desai said.
"Menstrual migraines are when the migraine occurs at the start of the menstrual bleed," she said.
Migraines are thought to be associated with changes to the flow of blood in the brain or cell activity.
They can be triggered by things like caffeine withdrawal, red wine, stress, extreme fatigue and smoking.
It therefore makes sense that cutting back on these things can help reduce their frequency and severity.
Paracetamol or aspirin can also help, as can triptans and prophylactic medications.
Contraception is only useful for menstrual migraines; it should be avoided in migraines with aura, the GP said.
"Soluble or nasal spray forms are better if vomiting occurs," Dr Desai added.
4. Cluster headache
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- How common: one in 1,000 people in the UK
- Cause: unknown
- Treatment: oxygen, triptans, beta blockers
Around one in 1,000 people in the UK get what are known as cluster headaches.
"These are extremely severe and come on suddenly - usually on one side of the head and around one eye," Dr Desai said.
"They mostly happen at night and are associated with a red watery eye, swollen eyelid or dropping of that eye, and a runny nose on the same side.
"The head throbs with a piercing pain behind that eye.
"These headaches are so severe people may feel they want to hit their head against a wall, and they get so restless they cannot sit still.
"This can last between 15 minutes and three hours, and sometimes occur up to six times a day, every day for weeks."
Because of their severity, cluster headaches, which are three to four times more common in men than women, require specialist management by a neurologist - a couple of paracetamol simply won't cut it.
Treatment can involve high flow oxygen, triptans, and prophylactic medications such as beta blockers, Dr Desai said.
Some people find reducing how much they smoke, drink and exercise can also help, as can not wearing perfume and staying away from strong-smelling paint, nail varnish or petrol.
5. Medication overuse headache
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- How common: one to two per cent of the UK population
- Cause: frequent painkiller use
- Treatment: alternative medications, decreasing painkiller use
Most people take over-the-counter painkillers to ease a headache.
But using them regularly can actually be the cause of headaches too.
"This might be an issue for people with regular episodes, where they rely on using painkillers 10 to 15 days of each month," Dr Desai said.
Medication overuse headaches (MOH), or rebound headaches, can be caused by frequent use of triptans, ergotamines, opiates, non steroidal anti-inflammatory drugs (NSAIDs) and paracetamol.
Sufferers should seek support from their GP to try alternative medications and slowly decrease their use of the problem drugs.
Who is most at risk of headaches?
Dr Unnati Desai, national GP lead at Nuffield Health, said: "Depending on the type, there are some people who are more likely to get certain types of headaches than others.
"Everyone is at risk of developing an infection and these can cause a headache due to a temperature.
"Some people are more likely to have an infection that affects their ears, nose or throat if they have narrow canals in their ears or sinus passages, and chronic inflammation affecting these areas.
"Certain conditions can run in families, such as hypertension and migraines, so some people are genetically predisposed to certain types of headaches.
"Lifestyle factors like excess alcohol consumption, smoking, poor posture when sitting at a desk or when lying down, eating processed foods, malnutrition or fasting, and side effects of medications are all contributing factors to experiencing headaches.
"Stress also affects people in various ways and to varying severity.
"Headaches are common with emotional stress and mood disorders.
"Poor sleep, poor diet, dehydration, increased alcohol intake, slouching and poor posture all result in headaches and can be associated with stress."
6. Nerve pain headache
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- How common: eight in 100,000 people
- Cause: pressure by an artery, tumour, talking, smiling, chewing, head movements, multiple sclerosis, shingles
- Treatment: prescription medication
If you would describe your headache as a sudden attack of severe, sharp, shooting facial pain that lasts from a few seconds to about two minutes, you may have one that's caused by nerve pain.
These can be excruciating - sometimes described as like an electric shock.
There are several different types, including trigeminal neuralgia (TN) and post-herpetic neuralgia (PHN).
"TN is a severe pain that affects a specific facial nerve with three nerve branches," Dr Desai said.
"It is usually on one side of the face and the pain is sharp, and it starts suddenly and then stops quickly.
"They occur several times throughout the day and can continue for months or years."
PHN headaches occur after a shingles infection.
This is much more common, and usually resolves within 12 weeks, the GP said.
TN affects around eight in every 100,000 people, while around one in five people with shingles will get PHN.
Treatment for both usually involves prescribed medications that cross the blood-brain barrier to slow down electrical impulses in the nerves and decrease the ability for pain signals to be transmitted, Dr Desai said.
You can also lower your risk of PHN by starting antivirals within 72 hours of shingles.
7. Thunderclap headache
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- How common: 50 in 100,000 adults
- Cause: brain bleed, blood clot, stroke, meningitis, encephalitis
- Treatment: urgent care in A&E
As the name suggests, thunderclap headaches are dramatic.
These start with very severe pain out of the blue and can be accompanied by vomiting, fever, seizures and an altered mental state.
They can signify an underlying neurological condition that may be life-threatening - such as a rupturing aneurysm (bleeding between the brain and the thin tissues covering it), a subarachnoid haemorrhage (bleeding on the surface of the brain), or severe hypertension (blood pressure higher than 180/120mmHg), Dr Desai said.
Other potential causes include stroke, meningitis, encephalitis, a blot clot, tissue death and leaking cerebrospinal fluid.
"Treatment of thunderclap headaches will always require emergency assessment in A&E with an urgent scan," Dr Desai said.
8. Pressure headache
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- How common: fairly common
- Cause: coughing, exercise, sex, hypertension, space-occupying lesion
- Treatment: GP appointment, avoiding triggers
"If an intense activity such as coughing, sneezing, sexual intercourse, orgasm or exercise increases the pressure of the blood vessels in the brain, it can result in a sudden headache," Dr Desai said.
"Masses in the brain tissue, known as space-occupying lesions, can also cause increased pressure and might result in a headache."
This might feel like a pulsating sensation that comes on quickly and lasts for short periods.
Space-occupying lesions can be benign, such as an infection, haematoma, benign cancer or a malignant cancer.
Headaches are often one of the last symptoms to present themselves in isolation, the GP added.
"It is likely that you would be experiencing other neurological symptoms first, however, it is important to see your doctor to ensure that there is no underlying pathology."
9. Infection headache
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- How common: 60 to 100 per cent of people with infections
- Cause: infection (e.g. flu, sinusitis), fever
- Treatment: over-the-counter painkillers, antipyretics
Do you get headaches when you're struck down by a cold or Covid? That's quite normal.
"Any infection can cause a headache due to a temperature," Dr Desai said.
In fact, between 60 and 100 per cent of people with infections experience some kind of headache, according to the International Headache Society.
Some people are more at risk than others though.
"You are more likely to have an infection that affects your ear, nose or throat if you have narrow canals in your ears or sinus passages, or chronic inflammation in these areas," the GP added.
Inflammation directly affecting the brain and its structures will also cause severe headaches, such as meningitis and encephalitis.
For common infections, painkillers and antipyretics will help to dull your headache and bring your temperature down.
For more serious conditions, like meningitis, you should call 999 or visit your nearest A&E.
10. Trauma headache
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- How common: 30 per cent of people with head injury
- Cause: head injury
- Treatment: paracetamol, avoid alcohol, rest
Following a head injury, it's normal to have a headache.
"This is often associated with feeling nauseous, dizzy and lethargic," Dr Desai said.
You may also have trouble concentrating, memory problems and be sensitive to light and sound.
Generally, the advice is to: take paracetamol, avoid alcohol and sedatives, have regular small meals, and rest.
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But because there is a rare risk of developing internal bleeding affecting the brain, you should always seek medical help if your headache gets worse despite painkillers.
Persistent vomiting after 12 hours, significant drowsiness or not waking up, slurred speech, confusion, weakness, poor coordination or balance, convulsions, and hearing problems are also signs you should call 999.
When a headache can be dangerous
Dr Unnati Desai, national GP lead at Nuffield Health, said: "If you are experiencing the symptoms of a thunderclap headache, seek urgent care as this requires emergency assessment in A&E with an urgent scan.
"If you experience a headache that is triggered by increased pressure - e.g. from coughing, exercise, intercourse, hypertension or a known space-occupying lesion (a mass in the brain tissue that could be either benign or malignant), seek medical advice.
"This is to check for any underlying conditions, which are rare.
"Post head injury, if your symptoms are worsening, this may be a sign of an internal bleed in your brain so it is important to seek emergency care as you may need a scan.
"If you have an infection and develop a severe headache with neck stiffness or neurological symptoms such as seizures, confusion, difficulty speaking, loss of movement in parts of your body or loss of consciousness, then it is important to be assessed for meningitis and encephalitis.
"There are several forms of meningitis outside of meningococcal meningitis which presents with its typical rash, so the absence of this rash doesn’t exclude you from having another form of meningitis."
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