Headaches & detecting the source

Headaches are one of the most common ailments we experience, the symptoms and pain of which vary greatly. Whether short term or a regular occurrence, this pain has little to do with the brain. This is because although the brain receives pain signals from the nervous system, this is the only organ of the body that is without pain receptors. So the pain felt with a headache is due to signals from the structures in the head, neck or elsewhere, rather than the brain itself.

Although types of headaches are classified into groups, this is only a rough guide. Instead there is much crossover regarding symptoms between one category and another, which makes headaches difficult to diagnose. Value though, still lies in attempting to differentiate one type of headache from another, especially considering classifications now number just over two hundred.

Headache classification

In broad terms there are two main classifications of headaches, primary and secondary. Primary headaches are where the headache itself is the main problem, even though there may be other things influencing the headache such as muscle strain or dehydration.

Secondary headaches arise from an underlying medical condition, and as such the pain originates from another source. Less serious causes of these headaches can arise from soft tissue injury in the neck or issues with the vertebrae immediately below the skull. They can also be due to medication overuse or problems with the eyes, jaw or teeth. More serious conditions involve meningitis, bleeding or a variety of other causes that place pressure on the brain. Infection, disease and disorders of the the stomach and intestines may also cause headaches.

Some of the most common types of headaches are identified as tension, migraine and cluster. A tension headache is the most common, often bought on by stress, muscle contraction in the head region as well as from smoking, alcohol or caffeine. With a dull throbbing spread over both sides of the head, a tension headache feels like a tight band. These are usually mild to moderate compared with a migraine or cluster headache, and can be chronic or occur once or twice a month.

A migraine could be confused with a tension headache, yet they are often moderate to severe, are accompanied by nausea and vomiting, and typically effect only one side of the head. Migraines can be a headache with or without an aura, or even an aura without the headache. The aura being a visual disturbance such as dots, sparkles, sensitivity to light or other sensations effecting the stomach or limbs, and even feelings of anxiety or confusion.

Often an aura precedes a migraine helping to predict its onset, in contrast a cluster headache comes on suddenly. Although not common, they are one of the most painful conditions, presenting as a burring or piercing sensation, typically around the eye or temple. Mostly one sided, these headaches depart as quickly as they arrived. The name derives from these headaches occurring as a cluster of short, intense headaches over a period of a few weeks or months. As the symptoms are sometimes combined with a blocked or runny nose on the same side of the head, they can be confused with sinus headaches.

For those who have a cold or flu, then inflammation of the sinuses can cause headaches in the forehead and around the nose or eyes, but resolves once the infection clears. Other types of headaches can arise from something as simple as strenuous exercise or cold food, commonly known as an ‘ice-cream headache’. Names for these specific conditions are prolific, with caffeine, hangover, menstrual and pregnancy being some common types that describe the root cause. Rebound headaches are due to medication overuse which hampers the way the brain sends pain messages.

Some headaches are related to damage or degeneration to other structures in or around the head, such as a whiplash injury, a pinched nerve in the neck or a degenerative disc disease of upper vertebrae. This can result in a cervicogenic headache, where pain is felt in the back of the head and may spread further to the temple or forehead.

With so many varieties of headaches, it it hard to differentiate one headache from another. This is especially so if two types of headaches are co-existing, for example a migraine experienced the same time as a neck injury related headache. That is where some deductive reasoning comes into play, using evidence sourced from our own experience, combined with the knowledge of our doctor, while utilising the marvels of modern medicine.

Dealing with headaches

For some types of headaches there is a clear cause and effect pattern. For example overindulging in wine over the weekend or working on a laptop for several hours without a break, are causes that are self apparent. In cases such as these avoiding or minimising the effect of these triggers is the best prevention, and over the counter medicines can be used for management of a mild headache. For more serious headaches, a diagnosis it not always clear cut and therefore an evaluation may be required.

To assist in this evaluation by a doctor, it is a good idea to keep a diary that records the history of your headaches. This will help identify any patterns as to how much the headaches hurt and the frequency which which they are experienced.

The start date and time of the headache and when it ends is helpful, as is any symptoms that precede the episode such as vision changes, muscular aches or mood changes. Also where and what type of pain is felt is important, for example throbbing across the forehead, as well as the severity of pain on a scale of one to ten. Any other information such as whether vomiting, nausea, fever or an upset stomach occurred during or after the headache, can be added to your notes as can how it affected your day, for example needing to stay in bed and take the day off work.

This documentation can be taken further by recording information that could help pinpoint any potential triggers to the headaches. These can include what food or drink is consumed along with medication or supplements that are taken, daily activities including any stressful or unusual events, and finally the amount and quality of sleep. The more detail, the better, as this additional information can provide a complete picture of potential headache causes for a doctor to review.

Consulting your doctor can mean that a proper headache diagnosis can be conducted, taking into account your current medical history, including medication that is being taken. By looking at how the headache presents your doctor can then advise the best course of action, whether that be medication, further examination or referral to a specialist. In the event that a headache is accompanied by more serious symptoms such as shortness of breath, muscular weakness, nausea or disorientation, then medical assistance should be sought immediately.

Also worth examining are lifestyle factors such as diet to see if there are any foods that are contributing to headaches, or if stress is suspected then including meditation and exercise into a daily routine could be helpful. If the source is found to be muscle or neck joint related, then treatment referral to a physiotherapist or massage therapist can be arranged.

In the end the source of your headaches may be easily identified. For those that are difficult to diagnose, such clever sleuthing will at the very least enable some causes to be ruled out.