Headaches, what's causing them?

How do you figure out what’s causing your headaches and when should you seek help?

A headache is one of the most common health-related conditions globally and it is likely all of us will experience a headache in their lifetime. People of any age can be affected, but people between the ages of 25 and 44 years are more likely to report having a headache.

Most headaches have more than one contributing factor. Some of the more common triggers for a headache are lifestyle-related, such as poor diet, stress, muscle tension, and lack of physical activity and pain can range from mild to severe.

A headache can be classified into two broad categories: primary and secondary. Examples of a primary headache include a migraine, cluster and tension headaches. Secondary headaches are triggered by an underlying disorder such as infection, injury or a tumour and are a side effect of the main illness which can be ruled out by your doctor.

Headache pain results from signals interacting between the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain. It's not clear, however, why these signals are activated in the first place.

Please Note: Serious underlying disorders such as brain tumours, are rarely the cause of a headache, although a persistent headache should always be investigated by a doctor.

Causes of A Headache – Common causes of tension headaches or chronic non-progressive headaches include emotional stress related to family and friends, work, or school, alcohol use, skipping meals, changes in sleep patterns, excessive medication use, tension and depression. Other causes of tension headaches include eyestrain and neck or back strain due to poor posture. Headaches that occur suddenly (acute-onset) are usually due to illness, infection, cold, or fever.

Headaches can also be triggered by specific environmental factors that are shared in a household, such as exposure to secondhand tobacco smoke, strong odours from household chemicals or perfumes, exposure to certain allergens, or eating certain foods. Stress, pollution, noise, lighting, and weather changes can trigger headaches for some people.

Common Types of Headaches -

It's important to work out with your doctor what type of a headache you are experiencing so you can get the right treatment. The most common types of headaches are:

Migraine – Migraines are intense, sometimes debilitating headaches. The pain is severe and throbbing, and usually on one side of the head. A migraine attack can last from four hours to three days and is associated with a spasm of the blood vessels leading to the brain. Three times as many women as men suffer from a migraine, and scientists believe that hormones play a large role. For around half of these women, migraine occurs in the few days prior to or following their menstrual period. The exact causes of migraines are unknown however a popular theory is that various triggers cause abnormal brain activity, which in turn causes changes in the blood vessels in the brain. Migraine symptoms are different from other types of headache and can include: nausea and vomiting, sensitivity to light and sound, affected vision, such as an aura, sensitivity to smell and touch, numbness of the face or extremities (hands and feet). There is no cure for a migraine and prevention is difficult, but treatments can help reduce the number of attacks if you think you are experiencing migraines see your doctor.

Tension Headaches - the most common type, feels like a constant ache or pressure around the head, especially at the temples or back of the head and neck. Not as severe as migraines, they don't usually cause nausea or vomiting, and they rarely halt daily activities. Over-the-counter treatments are usually sufficient to treat them. Experts believe these may be caused by the contraction of neck and scalp muscles ( in response to stress), and possibly changes in brain chemicals. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period.

Cluster Headaches – The least common but most severe type of primary headache affect more men than women and are recurring headaches that occur in groups or cycles. These headaches appear suddenly and are characterized by severe, debilitating pain on one side of the head, and are often accompanied by a watery eye, nasal congestion or a runny nose on the same side of the face. During an attack, people often feel restless and unable to get comfortable.

Sinus Headaches -  When sinuses become inflamed due to an infection, it can cause pain in the cheekbones, forehead, or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling. Headaches due to sinus infection can be treated with antibiotics, as well as antihistamines or decongestants.

Rebound Headaches - Overuse of painkillers for headaches can lead to rebound headaches. Culprits include over-the-counter medications like aspirin or ibuprofen, as well as prescription drugs. One theory is that too much medication can cause the brain to shift into an excited state, triggering more headaches. Another is that rebound headaches are a symptom of withdrawal as the level of medicine drops in the bloodstream.

Top Headache Triggers

If you’ve noticed that your headache always occurs after you’ve eaten certain foods or if you’re tired, you may be right to think they are linked. Some people find these ‘triggers’ set off a new headache or make an existing headache worse. Once you know what your triggers are and how to avoid them, you should have fewer headaches.

Weather – When the weather changes, the temperature rises and the pressure changes in the atmosphere this can alter chemical production in the brain which can trigger a headache.

Handling Stress - Around two-thirds of people with a headache blame stress for their attacks, try to find ways to keep your stress under control. Try relaxation techniques, such as breathing exercises or going for a walk.

Hormones - For a woman you might find that your headaches are more frequent and severe in the days around your menstrual period. Headaches in women are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Chemically induced hormone changes, such as taking birth control pills, can also trigger headaches in some women, (if you are taking birth control pills and think this may be the cause of your headaches see your doctor before stopping your medication).

Diet - What you eat can play a huge role in your overall health and wellbeing and can also be important when it comes to setting off a headache. Common foods that seem to be triggers include cheese (especially mature cheese), chocolate, citrus fruits, cured meats, nuts, onions, salty foods and ice cream. If you are experiencing headaches, regularly keep a food diary and start to cut down or cut out foods that are causing a headache.

What You are Drinking - If you are not drinking enough water you can become dehydrated, and this can trigger a headache. Drinking too much of certain liquids, such as caffeinated drinks, can also trigger headaches. Make sure you limit the amount of caffeine you drink and drink plenty of water every day.

Do You Eat Regularly? – Skipping meals can lead can cause your blood sugar to drop causing a headache, this can be fixed by eating healthy meals regularly.

Sleep - A lack of sleep can also be a headache trigger, so try to follow a good sleep regime: go to bed and wake up at the same time every day, including on weekends.

Alcohol Abuse – this type of headache can also be called a hangover, and occurs after excessive consumption of alcohol. Headache is only one of the symptoms these can include, nausea, vomiting, diarrhea, excessive thirst, depressed mood, anxiety, irritability, fatigue, and weakness. These symptoms can occur anytime after the intoxicating effects of alcohol have subsided. This type of headache can be avoided by drinking alcohol in moderation.

Meningitis – A potentially life-threatening infection of the meninges, the tough layer of tissue that surrounds the brain and the spinal cord. If you are experiencing Fever, headache, neck stiffness, and any change in a person's thinking (for example, unusually sleepy, acting "goofy," talking nonsense) this may suggest meningitis, and it is important to seek medical help immediately. If not treated, meningitis can lead to brain swelling and cause permanent disability, coma, and even death.

Poor Posture – Slouching or bending over a lot can increase the tension in your upper back, and neck and is a leading cause of tension headaches. Try to avoid being in the same position for long periods and practice sitting up straight and supporting your back.

Exercise in Moderation - Exercise is great for your overall health, but too much can be a bad thing when it comes to headaches. When we exercise, there’s increased blood circulation in the head and neck, making the blood vessels swell which can trigger a headache. Try and exercise in moderation – around three to five times a week.

Headache Caused by Infection - Many infections of the nose, throat and ear can cause a headache. Depending on the disorder, treatment can include medications such as antibiotics, decongestants or antihistamines.

See Your Dentist - Some people find grinding their teeth at night can cause a dull headache. Talk to your dentist about getting a mouth guard.

Eye Problems and Headache - If a person has difficulties with their vision, such as long-sightedness, they tend to squint and strain their eye muscles in order to better focus their vision this may cause a headache. Many of the eye problems can be treated with prescription glasses or contact lenses. Eye diseases such as glaucoma can cause a headache by referring pain into the structures of the head, so it's always best to get regular headaches checked by a doctor.

TIP:  If you’re not sure what your triggers are, try keeping a diary that documents what the weather was like that day, what you had to eat or drink or if you did any exercise when you developed a headache. Keep this diary for several headaches to see if you can identify a pattern. Once you know what your headache triggers are, you can start to avoid these and get back on track to living your life headache-free.

Diagnosis of Headache –

If you have headache symptoms, the first step is to go to your doctor. The good news for headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started. He or she will perform a complete physical exam and a headache evaluation. During the headache evaluation, your headache history and description of the headaches will be evaluated. You will be asked to describe your headache symptoms and characteristics as completely as possible. It is important to provide your doctor with a list of things that cause the headache, aggravate the headache, and things that you have done to relieve a headache. Keeping a headache diary can help your doctor diagnose your headache type. Include, where the pain occurred, the severity of pain, was there any other symptoms? What did you eat that day? Take this diary with you to your appointment.

Factors that are considered when diagnosing a headache include:

- Location of the pain, such as around one eye or over the scalp

- Degree of pain experienced

- Duration of the headache

- Other symptoms, such as visual disturbances or a sore neck

- How often the headache recurs

- Factors that worsen the headache, such as certain foods

- Factors that improve the headache, such as a massage.

Treatment for Headaches - Treatment will depend on several factors, including the type and frequency of the headache and its cause. Some of the various treatments include: Over-the-counter pain-relieving medications, relaxation techniques such as massage, changing your diet, alternative therapies, such as acupuncture or chiropractic, stress management, eliminating any medications that may be causing headache as a side effect such as birth-control pills or treatment for any underlying disorder, such as high blood pressure, (talk to your doctor before ceasing any medications) neck problems or jaw problems. Not all headaches require medical attention, but it's important to have any headache symptoms checked out by a doctor.

Remember: Unwanted side effects or adverse reactions are possible with all medications, including prescription and over-the-counter medications, herbal preparations, and vitamin pills. Suggestions for reducing the risk of medication-induced headache include: Following the dosage directions on the label, Don’t mix prescription medications with alcohol, Avoid dependence on painkillers, Report any side effects or unusual symptoms to your doctor immediately.

When to Seek Medical Care for a Headache –

It is important to call your doctor if the following occur:

- You experience a change in the severity, frequency of pain experienced.

- You started experiencing headache and migraine

- Your headache is brought on by coughing, sneezing or straining during bowel movements.

- You have lost weight

See Your Nearest Emergency Department if you Experience:

- Weakness or paralysis

- Headache associated with trauma to the head

- Trauma to the head with loss of consciousness

- Fever or stiff neck associated with a headache

- Decreased level of consciousness or confusion

- Seizure

Remember: If your headache symptoms become worse or more frequent despite treatment talk to your doctor.