Headache types

Headaches are described as being either primary or secondary.

Primary headaches include:

-  Migraine

-  Cluster headache

-  Chronic daily headache

-  Tension-type headache

-  Medication overuse headache

Secondary headaches are usually a symptom of something else that's wrong, they are related to specific conditions. For example, if you have influenza, one of the symptoms is a headache; if your sinuses are blocked, this can result in a headache.

* Less than 5% of people who consult a GP about their headache have a sinister or life-threatening condition, and, in these cases, often there are other symptoms as well as the headache (for example: a headache accompanied by a rash and a very high temperature could be meningitis).

* If your headache occurs suddenly and severely, especially after a blow to the head, if it is accompanied by a fever, feelings of drowsiness or any neurological deficiency, or if you notice a dramatic change from your normal headache pattern, you should seek medical advice urgently.

Migraine

Migraine affects up to 15% of the UK population and around two thirds of sufferers are women. An attack can last from 4 hours to 72 hours, although sufferers may feel drained for a couple of days after that. A migraine sufferer can experience an average of 13 attacks a year, but this can vary from person to person, sufferers are completely symptom-free between attacks.

·  Migraine without aura (common migraine).

An intense, throbbing headache, often only on one side of the head accompanied by 2 or more of the following symptoms:

- nausea and / or vomiting

- photophobia (increased sensitivity to light)

- phonophobia (increased sensitivity to sound)

- osmophobia (increased sensitivity to smell)

The pain is made worse by movement, and sufferers want to rest and keep still, preferably in a quiet, darkened room.

·  Migraine with aura (classical migraine)

In addition to the above, around 10% of sufferers also experience aura symptoms: neurological disturbances, lasting between 15 minutes and one hour before the commencement of the headache. Typically these disturbances are visual such as blind spots, flashing lights, or zigzag patterns in the vision, but can also include tingling, pins and needles or numbness in the limbs on the affected side or problems with co-ordination and articulation.

Some people experience the aura only, without the development of other symptoms or with only a mild headache.

·  Abdominal migraine

Often occurring in children, this form of migraine is characterised by recurrent, episodic attacks of abdominal pain lasting for several hours. The pain may be accompanied by nausea or vomiting and / or aura symptoms, but no, or very mild, headache. Often this evolves to the more common migraine pattern when the child reaches adolescence.

·  Hormonal migraine

Migraine in women can often be linked to hormone changes. Many women say they experienced their first migraine in the same year as their first menstrual period. Most female sufferers are more susceptible to an attack around the time of their period but true menstrual migraine is defined as occurring within two days either side of the first day of a monthly period and at no other time. Hormonal factors are one of many triggers for migraine and attacks may be prevented if other triggers are avoided around the time of their period.

·  Other rare forms of migraine

Hemiplegic migraine: this is a very rare condition which has been linked to a genetic abnormality. Symptoms include temporary paralysis down one side of the body, which can last for several days. Other symptoms include vertigo or difficulty walking, double vision or blindness, hearing impairment, numbness around the mouth leading to trouble speaking or swallowing. This form of migraine may be confused with a stroke, but the effects are usually fully reversible.

 

Basilar artery migraine: in some cases during a migraine attack, the basilar artery, a blood vessel at the base of the brain, goes into spasm causing a diminished blood supply to parts of the brain. This can cause giddiness, double vision, unsteadiness, fainting or even loss of consciousness.

Ocular / Opthalmoplegic migraine: another rare form of migraine with lateralised pain (often around the eye), accompanied by nausea, vomiting and double vision.

Cluster migraine: this is a misnomer, which is sometimes incorrectly applied when sufferers experience frequent migraine attacks over a short space of time.

Cluster headache

This is a rare form of headache, which affects less than 1% of the UK population. It is more common in middle-aged men, although women can also have it, and sufferers range in age from 4 years old to over 80 years old.

It is known as the "demon of headaches" because the pain is so intense. The excruciating, knife-like pain tends to be centred around one eye, and sufferers are agitated, unable to sit still. Individual attacks last only a short time, between 15 minutes and 3 hours, but the attacks occur in clusters of up to 8 attacks per day. These clusters usually last for 6-8 weeks, with attack-free periods lasting months, or even years.

Chronic daily headache

This is estimated to affect 3-4% of the UK population and is defined as headaches that occur on more than 15 days each month. It is a syndrome and can consist of several different types of headache occurring throughout the month, such as tension-type, muscle contraction and medication misuse, sometimes with superimposed attacks of migraine.

Tension-type headache

This form of headache affects both sides of the head and is characterised by a constant feeling of pressure or a tight band around the head.

Medication overuse headache

Although medication can be very effective in relieving headache, it is possible to develop a tolerance to it, causing rebound headaches. The condition can develop with overuse of any acute medications for headache, leading to sufferers experiencing more and more headaches, often daily.

If you are regularly taking medications to treat headaches on more than 2 days each week for 3 months or more, you are at risk of medication overuse headache and should consult your GP to check the diagnosis and discuss other treatment options.

Symptoms

If you have two or more of the following symptoms during an attack it is probable that you are suffering from migraine:

-   Intense throbbing headache, often on one side of the head only

-   Visual disturbances (blind spots, distorted vision, flashing lights or zigzag patterns) - these symptoms are often called aura

-   Nausea and/or vomiting and/or diarrhoea -·   Increased sensitivity to light (photophobia)

-   Increased sensitivity to sounds (phonophobia)

-   Increased sensitivity to smells (osmophobia)

 

You may also experience other neurological symptoms (also known as aura), including:

- stiffness of the neck and shoulders

-  tingling or stiffness in the limbs

-  an inability to concentrate

-  difficulty in speaking

paralysis or loss of consciousness (in very rare cases)

A general rule of thumb is that if a headache and/or other associated symptoms prevent you from continuing with normal daily activities it could be a migraine.