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Headaches

Why they happen and what you can do about them

Headaches
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Anatomy of a tension headache

Headache prevention quiz

BY AUDRA KOLESAR
Winnipeg Health Region
Wave, Summer 2011

What is a headache?

A headache is generally described as pain or discomfort about the head, face or neck. It is one of the most common types of pain.

Does headache pain emanate from the brain?

No. Headache pain comes from outside the brain, since the brain itself does not have sensory nerves. But tension in or stretching of the outer lining of the brain, scalp, blood vessels, and muscles of the head can cause pain. Moreover, a headache may be an early and important symptom of a significant health issue, such as stroke, brain tumour, infection (abscess, meningitis), and sinus infection. Most of these causes are more common in older patients, as are headaches associated with confusion and change or loss of consciousness. Symptoms of concern with a headache are a sudden, severe headache and sudden headache associated with a stiff neck.

Do women get headaches more often than men?

Yes. Most categories of headaches are more common in women, with one exception. Cluster headaches are more common in men.

Are there many different types of headaches?

Yes. In fact, there are more than 150 diagnostic categories of headaches, but they tend to fall into two broader groups: primary and secondary. Primary includes migraine, tension, and cluster headaches. Secondary includes headaches from head trauma, vascular disorders, non-vascular intracranial disorders, substance use or withdrawal, non-cephalic infection or metabolic disorders.

What is a cluster headache?

Cluster headaches usually cause sudden extreme pain only on one side of the head and often around or behind one eye. Cluster headaches often occur at the same time of day, often at night, and last anywhere from 30 minutes to several hours. They may recur several times a day for weeks or months, then disappear for months or years. Related problems that occur with the headache include a stuffy or runny nose, the shedding of tears, and redness of the painful eye.

What causes a cluster headache?

We do not know what causes cluster headaches. They happen in men more often than women, and in middle-aged persons more than young or old people. They do not seem to run in families like some other types of headaches.

What triggers a cluster headache?

Cluster headaches may be triggered by:

  • Alcohol
  • Cigarettes
  • Stress
  • Bright or glaring lights
  • Certain foods
  • Lack of sleep

What can I do to avoid or treat a cluster headache?

It might help to avoid the triggers listed above if you have been having frequent headaches. Over-the-counter medicines may be used to relieve the pain, however, carefully review the label directions and precautions for other health considerations before taking these medications.

If I am suffering from cluster headaches, should I see a doctor?

Yes. These types of headaches can be very serious. Contact your physician before taking any pain relievers if you have high blood pressure. Taking aspirin, ibuprofen, or acetaminophen usually does not help because the headache often goes away before the pill starts working. Your physician may recommend oxygen for acute attacks. Other prescribed drugs may help prevent or treat cluster headaches. Cluster headaches are so severe that individuals may threaten suicide. Any suicide threat should be taken seriously. If there is any suicide threat, see the healthcare provider immediately. For pain in or around an eye that does not go away, see your provider to make sure that there is not a problem with the eye, such as glaucoma.

What is a migraine headache?

A typical migraine headache causes a severe throbbing pain on one side of the head. The pain builds up during an attack and can last for several hours. Sometimes migraine pain covers both sides of the head and is a dull pain.

What causes them?

We don't fully understand all the causes of migraine headaches. We do know that they are related to changes in the blood flow within the vessels that supply blood to the head and brain. Changes in the levels of certain chemicals in the brain may also play a part in migraine headaches. Migraines tend to run in families, and usually first show up in the teen or young adult years. They are more common in women and often occur during, or right before, a woman's menstrual period. It is very uncommon for migraine headaches to start in a patient over the age of 50.

What are the symptoms of a migraine?

Symptoms that accompany migraine headache may include:

  • Seeing stars, flashes or zigzags
  • Blurred vision
  • Photosensitivity (bright lights hurt the eyes)
  • Feeling sick to your stomach
  • Loss of appetite
  • Being at a loss for words
  • Numbness or tingling
  • Weakness or clumsiness

What are the triggers of migraine?

The changes or foods that bring on a migraine are likely to be different for each person. It helps to try to identify what happens before a migraine headache starts, what "happens" to start the headache, and then try to avoid those things in the future. Counselling or relaxation techniques for reducing stress may be useful in preventing attacks.

Here are some migraine headache triggers:

  • Stress
  • Lack of sleep
  • Skipping a meal
  • Using alcohol
  • Taking birth control pills
  • Changes in the weather
  • Chocolate
  • Red wine
  • Monosodium glutamate
  • Food preservatives
  • Caffeine

What can I do to avoid or treat a migraine headache?

Always try to avoid the triggers that seem to initiate a migraine. If a migraine should occur, it might be helpful to rest in a dark, quiet room. Cool compresses to the forehead may help. Over-thecounter medicines may be used to relieve the pain, however, carefully review the label directions and precautions for other health considerations before taking these medications. Contact your physician before taking any pain relievers if you have high blood pressure.

If simple measures do not help, a health-care provider can prescribe a medication that may help control the pain associated with a migraine headache.

What is a sinus headache?

The sinuses are hollow spaces in the skull bone located between the eyes and in the area of the cheek on both sides of the head. The sinuses connect with the nose through small openings. Sinus headaches can occur when the mucous membranes of the sinuses become swollen or infected.

How does that happen?

The sinuses are lined with a mucous membrane similar to the inside of the nose that keeps them moist and produces mucous. When you have a cold or allergies, these surfaces swell and produce too much mucous.

If the swelling goes unchecked, the sinuses become more and more clogged. The excess mucous gives the germs a good place to multiply. These germs could be viruses, bacteria, or even fungus. The pressure from this swelling inside the sinuses causes the headache. Most sinus problems follow a cold or a sore throat. Some occur after a dental infection. Sometimes irritation from dust or smoke will cause the swelling.

I sometimes get headache pain behind my eyes. Is that a sinus headache?

Yes. Sinus headache pain generally occurs in the face and forehead, and sometimes behind or between the eyes. It can be dull or severe. Often the pain is worse in the morning and improves by afternoon. The pain may also be worse when bending your head forward. It can feel worse on cool, damp days.

Are there other symptoms of sinus headache?

A fever may occur if there is a sinus infection. Other signs of infection are thick green or yellow nasal mucous or breath that smells bad even after brushing.

How can I avoid or treat a sinus headache?

Try to avoid air-borne pollutants, such as pollen, mold, animal dander, and house dust mites. Smokers should stop smoking and avoid other people's smoke and other irritants in the air.

To treat a sinus headache, you can try over-the-counter medicines. However, be sure to carefully review the label directions and precautions for other health considerations before taking these medications. Contact your physician before taking any pain relievers if you have high blood pressure.

Treatment of a sinus headache involves helping the sinuses drain and healing any infection. Inhaling steam or mist from a hot shower or putting moisture in the air with a vapourizer often relieves the clogging. Warm compresses to the face may also relieve pain.

Nasal sprays or pills that unclog sinuses (called nasal decongestants) can be purchased over-the-counter. The sprays usually work better than the pills. Carefully read and follow the directions and warnings on the labels. Sprays should not be used for more than three days at a time. Over-the-counter saline nasal spray can be used several times a day to help moisturize and clear the passages.

If you have sinus pain and a fever or foul-smelling nasal discharge, see your health-care provider. You will probably need to take antibiotic pills for at least 10 days if your sinuses are infected. Antibiotics require a prescription from a provider.

What is a tension headache?

As the name implies, a tension headache is one that is triggered by stress, fatigue, or noise. Tension headaches usually begin with a dull, aching pain on both sides of the head that gradually increases in severity. A tension headache is often described as, "My head feels like it is in a vise." The pain is usually worse at the back of the head.

These headaches are quite common. It is not easy to determine just what causes them in any one person. Muscle tension plays a role, as do the day-to-day pressures of life. Researchers now believe changes in the levels of certain chemicals in the brain can cause tension headaches.

What causes a tension headache?

Tension headaches may be triggered by:

  • Tiredness or fatigue
  • Eating too little or too much
  • Work stress
  • Eye strain
  • Poor posture
  • Noise
  • Lack of exercise
  • Major life changes
  • Depression or anxiety
  • Injury, such as a car accident

How can they be avoided or treated?

It is important to relieve tension and remove the stressors from your life. Selfcare to prevent and relieve muscle-tension headaches include:

  • Identifyng and avoiding those things that cause you stress
  • Resting in a quiet setting until symptoms improve
  • Avoiding tobacco and alcohol use
  • Eating regular, healthy meals
  • Getting regular exercise and adequate sleep
  • Learning to use relaxation techniques
  • Taking time out for fun

If simple self-care measures do not help, a health-care provider can prescribe a medication that may help control the pain associated with a tension headache. Over-the-counter medicines may be used to relieve the pain, however, carefully review the label directions and precautions for other health considerations before taking these medications. Contact your physician before taking any pain relievers if you have high blood pressure. Unusually severe headaches, or headaches associated with changes in nerve or muscle function, should be evaluated right away.

Audra Kolesar is a registered nurse and manager with Health Links - Info Santé, the Winnipeg Health Region's telephone health information service.

Wave: Summer 2011

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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