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Headaches and Migraines

Headaches affect most of us at some point. For some, they are an infrequent and minor inconvenience, for others they can be debilitating. In this blog post, we will look at the different types of headaches, their causes and treatments.

Headaches and Migraines

A headache is defined as a pain or discomfort in any part of the head and/or face and can occur in one side (unilateral) or both sides of the head (bilateral). They can be described as a throbbing, stabbing pain, a dull ache, a gripping or squeezing pain. They can also be accompanied with other symptoms such as nausea, vomiting, light sensitivity (photophobia), dizziness or light headedness, pain behind the eyes, changes in vision, changes in sensation in other parts of the head and face or body. These additional symptoms often give us clues as to the origin and cause of the headache (John Hopkins Medicine, N.D).


Tension Headaches

Tension headaches are probably the most common presenting headaches in clinic. They are described as a dull, throbbing type pain, often in both sides of the head (although they can be one-sided too), discomfort behind the eyes and feel like a tight band across forehead and temples. Tension headaches may be accompanied by neck and shoulder pain and tension, as the muscles of the neck and shoulders refer pain up into the head (Fernandez-de-las-penas, et al., 2011).


Causes:

Stress and anxiety

Poor posture

Prolonged sitting

Eye strain

Fatigue

Dehydration

Caffeine withdrawal


Treatment and Management

Tension headaches respond really well to physical therapy such as massage, stretching (including active Isolated stretching), rehab to address poor posture, chiropractic adjustments or mobilisation, if the joints of the neck and thoracic spine are not moving as well as they could be, and lifestyle changes to reduce dehydration, fatigue and stress.


Migraine (with or without Aura)

Migraines are a more severe headache which can occur alongside symptoms of nausea, vomiting, light sensitivity (photophobia) and sound sensitivity, and can be accompanied by changes in vision in one or both eyes (an aura - often described as wiggling lines or flashes of light).


Causes:

Genetics

Hormonal fluctuations (more than half of those with menstrual cycles notice an increase in their migraines at certain times, usually the few days before their period starts or the first few days of their period, (NHS, 2021).

Certain food or drink triggers

Environmental factors such as flashing or flickering lights, humidity, changes in atmospheric pressure or strong smells

Stress or anxiety


Treatment and Management

Tracking migraine episodes can help patients identify and therefore avoid, any environmental and dietary triggers. It can also help patients with migraines linked to hormonal fluctuations start to recognise patterns, so that any underlying hormonal conditions may be investigated. Lifestyle adjustments to reduce stress and anxiety are also beneficial. NICE guidelines recommend consulting your GP to discuss medications for acute and chronic management of migraines and to rule out any differential diagnoses. Management of migraines varies according to your age, if you have migraines with or without aura, if you are pregnant/breastfeeding/chestfeeding, and how frequently you suffer from headaches (NICE, 2022). Physical therapy is also beneficial, as migraine headaches often overlap with tension headaches, so the same therapies and exercises to address muscle tightness and postural imbalances can help reduce any pain arising from these anatomical structures.

Sinus Headaches

Sinus headaches often present as a pain and/or pressure or throbbing over the sinuses of the face; the forehead (above the eyebrows), pain on bridge of the nose, under the eyes and over cheek bones. They are often mistaken as tension headaches and migraines without aura, as their distribution and severity of pain can be similar to both conditions. Sinus headaches are caused by inflammation and irritation of the sinuses as a result of infection, or allergic reaction (such as pet allergies or hayfever). Sinus headaches are often distinguished from other types of headache by a history of allergies or a current or recent illness such as a heavy cold, nasal congestion, sneezing and discharge.


Causes:

Sinusitis as a result of infection

Allergies

Environmental irritants


Treatment and Management

Treat the underlying cause of sinusitis and reduce inflammation of the sinuses. Home treatments may include rest, plenty of fluids to help you recover from infection, saline nasal spray, paracetamol for pain relief. Visit the GP if symptoms do not resolve, they are severe or recurrent. If caused by allergens, then reducing exposure and contacting the GP to discuss whether antihistamines may be beneficial. Some patients require surgery to unblock and drain their sinuses if other management strategies have failed (NHS, 2021).


Exertion Headaches

Exertion headaches are caused by or brought on during sustained exertion, such as exercise. They are often sudden, throbbing and last a few hours to a few days. There are two types of exertion headaches; primary - which are usually harmless, aren't connected with any underlying problems and can be managed with activity adaptation and improving posture, stretching, soft tissue work and medication and Secondary exertion headaches - caused by another underlying problem in the brain which requires medical attention. For example, bleeding or a brain tumour, or a result of systemic conditions such as coronary artery disease (Gonzalez-Quintanilla, et al., 2023 and Mayoclinic.org, 2022). They have all of the symptoms of a primary exertion headache but can be accompanied by vomiting, double vision, neck stiffness, dizziness and are often more severe (Mayoclinic.org, 2022).


Causes:

Prolonged exertion or strenuous physical activity such as running, swimming, rowing or weightlifting

Dehydration

Hot or humid conditions

Poor posture and pre-existing muscular tension and/or joint stiffness

As a result of secondary causes which increase intracranial pressure, such as a brain tumour, a bleed, brain swelling, coronary artery disease, high blood pressure.


Treatment and Management

Primary exertion headaches can be managed in a similar way to tension headaches by adapting activities, improving posture, reducing musculoskeletal tension, staying hydrated and taking pain relief. However, secondary exertion headaches require a medical referral to determine the underlying cause.


Rebound Headaches

Rebound headaches are caused by the over-use or chronic use of medications such as certain pain-relievers or caffeine. They occur in people who regularly take analgesics to relieve pain and results in headaches for more than 15 days a month, for longer than 3 months.


Causes:

Overuse of certain medications such as analgesics, especially opioids and tryptans (Saper and Neves Da Silva, 2013).

Overuse of caffeine


Treatment and Management

Consulting a GP to carefully manage the reduction of medications whilst managing headaches in a more conservative way, to reduce discomfort during the process.


Cluster Headaches

A rare and debilitating type of headache that usually occurs behind one eye, and in clusters or cycles of episodes, usually at the same time of day or night, for days/weeks at a time. They are described as an intense stabbing, burning, searing pain behind one eye. They may be accompanied by eye redness, eye watering or drooping of the eyelid on the affected side (NHS, 2023).


Causes:

No known cause, but may run in families

More common in men in their 30s and 40s

Possibly triggered by alcohol, exercise, strong smells such as perfume or paint, smoking


Treatment and Management

Over the counter pain medication of doesn't work so consulting a GP for treatment and management strategies is essential. Treatments are available to try and prevent episodes from occurring and avoiding known triggers can help. It is important to get a medical diagnosis to rule out other causes of severe and sudden headaches (NHS, 2023).


Conclusion

As you can see, there are many different types of headaches, caused by for many different reasons. It is important to get an accurate diagnosis of the type of headaches you are experiencing, so that treatment and management strategies can be tailored appropriately. The most common types of headache are tension headaches, migraines and sinus headaches which all benefit from physical therapies such as massage, mobilisation and/or chiropractic adjustments, stretching and rehab to address postural imbalances. Lifestyle adaptations such as staying hydrated, reducing stress and anxiety, improving sleep and relaxation, and keeping active help most types of headache. If you are unsure what is causing your headaches, it is a new or severe headache, they are accompanied with other symptoms such as dizziness and nausea or vomiting, then seek out medical attention.



References:


Fernandez-de-las-Penas, C, Fernandez-Mayoralas, DM., Ortega-Santiago, R., Ambite-Quesada, S., Palacios-Cena, D., Pereja, JA. (2011). Referred pain from myofascial trigger points in head and neck–shoulder muscles reproduces head pain features in children with chronic tension type headache, The Journal of Headache Pain 12(1) pp35-43 [Online] Available at: Referred pain from myofascial trigger points in head and neck–shoulder muscles reproduces head pain features in children with chronic tension type headache - PMC (nih.gov) (Accessed 07.09.23)


Gonzalez-Quintanilla, V., Madera, J., Pascual, J. (2023). Update on headaches associated with physical exertion. Cephalagia 43(3). [Online] Available at: Update on headaches associated with physical exertion (sagepub.com) (Accessed 08.09.23).


John Hopkins Medicine, (N.D), Headache, [Online] Available at: Headache | Johns Hopkins Medicine (Accessed 07.08.23).


Mayoclinic, (2022). Exercise headache symptoms [Online] Available at: Exercise headaches - Symptoms & causes - Mayo Clinic (Accessed 08.09.23).


NHS (2023). Cluster Headaches [Online]. Available at:Cluster headaches - NHS (www.nhs.uk) (Accessed 11.09.23).


NHS (2021). Hormone Headaches [Online]. Available at: Hormone headaches - NHS (www.nhs.uk) (Accessed 07.08.23).


NHS (2021). Sinusitis [Online]. Available at: Sinusitis (sinus infection) - NHS (www.nhs.uk) (Accessed 10.09.23).


NICE (2022). Migraine [Online]. Available at: Migraine | Health topics A to Z | CKS | NICE (Accessed 10.09.23).


Saper, JR., Neves Da Silva, A. (2013). Medication overuse headache: History, features, prevention and management strategies. CNS Drugs [Online] Available at: Medication overuse headache: history, features, prevention and management strategies - PubMed (nih.gov) (Accessed 08.09.23).

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