Headaches… we have all suffered from them, from persistent long lasting migraines to daily tension headaches caused by many hours staring at a computer screen. You may ask yourself ‘ why do I keep getting headaches?’ Diagnosing the cause of a headache can be a complicated matter due to there being over 150 different types of headache!
To put it simply headaches are generally classified by their cause and can be categorised into two main groups: primary headaches and secondary headaches.
Primary headaches are headaches that have not been caused by any other medical condition. Whereas, secondary headaches are headaches that are caused by an underlying medical condition. This blog will explain the main types of primary headaches and their causes.
Primary headaches can occur at any age and are one of the most prevalent neurological conditions. There are two main types of primary headaches: migraine and tension type headache.
What is a migraine? A migraine is described as a moderate to severe one-sided headache. It is normally pulsating in nature and can last anywhere from 4-72 hours.
There are several different types of migraine:
Migraine with aura – A aura migraine is when an individual has sensory warning signs prior to the headache. These warning signs may include visual disturbances, dizziness, blind spots, flashing lights, tingling in the face or hands.
Migraine without aura – this is the most common type of migraine and as the name suggests, it is a migraine that occurs without any of the sensory warning signs.
Chronic migraine – This is when an individual experiences a migraine headache on 15 or more days a month over a period of three months.
Menstrual migraine – This is a condition in which an individual is likely to experience a migraine shortly before or during menstruation. This is due to the sudden natural drop in oestrogen whilst menstruating.
Hemiplegic migraine – This is a rare condition in which there is temporary weakness on one side of the body.
Abdominal migraine – It is more common to see this type of migraine in children. Symptoms include abdominal pain with loss of appetite, nausea and vomiting and headache.
Vestibular migraine – This is a condition in which there is a problem within the nervous system that causes repeated dizziness in people who have a history of migraine symptoms.
Visual migraine – Also known as optical migraine, ocular migraine or retinal migraines is a rare condition in which an individual may suffer from visual disturbances such as; temporary visual loss, blind spots, zig zag lines or seeing stars.
What are the symptoms of a migraine?
As well as having a headache, individuals may also experience other symptoms, including:
Nausea and Vomiting
Photophobia – sensitivity to light
Phonophobia – sensitivity to sound
Symptoms may be aggravated by normal routines such as walking or climbing the stairs
What are the causes of migraine?
The exact migraine causes still remain to be unknown, however researchers believe that migraines occur as a result of abnormal brain activity. This can affect the brain’s chemicals, blood vessels and communication between the nerves.
Research has also demonstrated genetics to play a role in migraines. It has been shown to make individuals more sensitive to certain triggers that are likely to set off a migraine. There are many possible migraine triggers, including;
Hormonal changes – females are more likely to experience migraines than males, hormonal changes during menstruation have been shown to trigger migraine episodes.
Environmental triggers – including anxiety, depression, stress and shock.
Physical triggers – poor posture, neck and shoulder tension, tiredness or lack of sleep
Food and Diet triggers – alcohol especially red wine, coffee, dehydration, and skipping meals have all been linked to migraine.
How is a migraine diagnosed?
It is recommended to seek advice from your GP if you think you are suffering from migraines. Your GP may perform a range of tests to exclude any other cause of headache, this may include but is not limited to:
CT or MRI scan
TOP TIP– in order to help identify a migraine headache it is really useful to keep a headache diary. The diary should include:
The frequency, duration and intensity of headache
Any other symptoms you experienced with the headache i.e. nausea, photophobia
Any medication you took to relieve the headache
Any possible triggers
For females, it may be worth noting at what point in your menstrual cycle you were when the headache occurred.
What are the treatment options for migraine?
Currently, there is not one single cure for migraine. Therefore, the main aim of treatment is to reduce the frequency of migraines and to control the symptoms of the migraine. There are many different types of treatment for migraine, these include:
Lifestyle alterations: reduce stress, avoid certain foods, keep hydrated, get enough sleep, regular physical activity, and reduce screen time.
Medication: There are a few options when it comes to the type of medication available for treating the symptoms of a migraine – always make sure to speak to a doctor before taking new medication.
Over the counter pain relief medication such as paracetamol, ibuprofen or aspirin can help to reduce migraine symptoms.
A newer class of drugs known as Triptans can be prescribed by your GP. Triptans work by increasing serotonin levels and reducing inflammation in your brain.
Anti-nausea medication can help with reducing nausea and vomiting. These drugs are usually taken along with painkillers.
Physical therapy: including Osteopathy, can help with treating the symptoms of migraine. Poor posture and tension in the neck and shoulder area have been linked to migraine triggers. Osteopaths can work with the patient to reduce tension in the neck and shoulder area using soft tissue massage and gentle articulations of the neck and upper back. Your Osteopath may also give postural advice and may prescribe a few exercises to help increase the strength and flexibility of your neck and shoulders.
Tension Type Headache
What is a tension type headache?
A tension type headache is described as a mild to moderate bilateral (both sides) headache. It is the most common type of primary headache and it is usually dull or squeezing in nature, lasting anywhere from 30 minutes to several days.
There are two main types of tension headache:
Episodic tension type headache – when headaches occur less than 15 times per month.
Chronic tension type headache – When an individual experiences a tension type headache more than 15 times a month for more than 3 months in a row.
What are the symptoms of a tension type headache?
As well as having a bilateral headache individuals may also experience pressure behind the eyes and tension in the neck and shoulders. The headache is not usually affected by normal daily routines and there is no nausea or visual disturbances associated. Photophobia and phonophobia may be experienced.
How is a tension type headache diagnosed?
Tension type headaches are diagnosed mainly through the patients reported symptoms. Sometimes physical examinations and tests may be taken to exclude any other cause of headache.
On physical examination of the neck there may be tenderness on palpation of the neck and scalp muscles which may elicit or increase headache symptoms.
What are the causes of tension type headache?
There is not one single cause of tension type headache. It is multifactorial in nature, meaning there are many different causes. Certain factors have been shown to trigger tension type headaches and are mainly linked to increased strain of the muscles of the head and neck. Triggers include:
Jaw or dental problems
What are the treatment options for a tension type headache?
There are various different treatment options for Tension type headaches. These include:
Osteopathy and other types of manual therapies including Deep Tissue massage can help with treating the symptoms of tension type headache. Therapists will use a variety of soft tissue techniques and spinal articulations to help reduce the tension in the neck and shoulder muscles.
Postural improvement – poor posture can increase the amount of strain on certain muscles and joints around the head and neck. Improving your posture when sitting and standing is a great way to relieve pressure on the neck and shoulders. Pilates is a great way of using exercises to help improve your posture and increase the strength of the muscles surrounding your upper back and neck.
Hot compress – using a heat pack on your shoulder muscles is another great way to help relax the muscles around your shoulders.
Relaxation techniques – Stress and anxiety is one trigger for tension type headaches. Meditation or taking time out of your day to concentrate on deep breathing are great ways to help reduce stress.
Acupuncture – is classed as an alternative therapy and may reduce stress and tension in the body. Fine needles are placed in certain areas of the body, including the neck and shoulders.
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