A headache is widely known as a pain or discomfort in the head or upper neck region. Technically speaking, a headache is not literally a pain in the brain but the brain telling us that something is wrong. Are you a victim of regular headaches? Headaches come in different forms, and the most common types of headaches include migraines, tension, and cluster headaches. 

Migraines affect up to 15% of the general population. They are typically one-sided severe headaches that are throbbing or pulsating in quality, can be accompanied by nausea or vomiting, and are usually made worse by sharp head movements, loud or bright environments. Migraines are chronic, episodic and recurrent headaches, and each attack usually lasts between 4 and 72 hours. 

A migraine can be preceded by a prodrome or associated with aura. A migraine prodrome means that a person may experience characteristic symptoms 1 to 2 days prior to the start of a migraine. These symptoms include mood variation (depression, irritability or euphoria), yawning, constipation and neck stiffness. A migraine aura is less common and it refers to a specific set of symptoms either starting just prior to, or during the migraine. Aura is temporary, lasts between 5 minutes and an hour, and should resolve completely thereafter. Some examples include changes in vision (seeing bright lines and shapes, or loss of vision), hearing (hearing additional sounds or loss of hearing), sensation (feeling pain, tingling or numbness) and movement (jerking movements or even weakness). 

Migraines tend to affect females more often than males, and usually occur between 30 and 39 years old. Migraines also have a genetic predisposition and run in the family. Other factors that can trigger a migraine attack include stress, menstruation, alcohol, fasting, weather changes or poor sleep. 

The pain intensity and other associated symptoms of a migraine can be quite severe and can impact a person’s function or quality of life if the attacks are frequent. However, migraines are not caused by structural brain abnormalities, and usually do not result in serious complications. 

Tension-type headaches are the most common and they feel like a pressure or pressing sensation over both sides of the head, which some describe as a band-like tightening sensation. Unlike migraines, tension headaches usually cause pain at both sides of the head (vs. migraines which are one-sided), do not have a throbbing quality or other characteristic features such as nausea, vomiting, photophobia (fear of bright lights) or phonophobia (fear of loud sounds). Commonly triggered by stress, anxiety and fatigue, tension headaches are slightly more prevalent in females without conclusive data about the most affected age group. 

Cluster headaches are much less common, affecting less than 1% of the general population. They are severe, one-sided headaches with pain classically situated near the eye or temple, and occur together with at least one of the following symptoms - eye redness, increased tearing, nasal congestion, runny nose, forehead and facial sweating, eyelid swelling or drooping. They typically last between 15 minutes and 3 hours, and the person may feel agitated and restless during the attack.

Cluster headaches are more common in males and typically affect those aged between 20 and 40 years old. Cluster headaches also have a genetic component and may run in the family, and smoking is an associated risk factor. 

A headache may sometimes be the presentation of an underlying serious condition such as a stroke, brain bleeding, tumour or infection. It can be difficult to differentiate between a benign and a sinister headache, but there are some ‘red flag’ symptoms that can alert one to seek medical attention immediately. These symptoms include: 

• Sudden onset of severe headache, typically described as a ‘thunderclap’ headache and feels like ‘the worst headache of your life’ 

• Nausea or vomiting 

• Confusion, blurred vision, slurred speech, weakness or numbness in the face or limbs, unsteadiness in walking 

• Persistent fevers or neck stiffness 

• Progressive loss of weight or appetite 

• Headaches that occur after head injury or trauma 

• Headaches that do not improve, or increase in severity and frequency 

• New onset of headaches in an older person (age 50 years and above) 

In general, a chronic headache should be one that recurs over a prolonged period of time (for example, three months or longer), and each episode of headache should share similar characteristics with the previous headaches in terms of the location, type and severity of pain. 

Headaches can be self-medicated if the pain is mild and if there are no ‘red flag’ symptoms. One can take common painkillers such as Paracetamol to relieve the pain. Resting, reducing stress and sleeping may also help, especially if it is a tension-type headache. 

One should see a doctor if the headache is severe, or if it does not improve, worsens in severity or becomes increasingly frequent. In some instances, a referral to a specialist may be needed, especially if there are any ‘red flag’ symptoms or if one is not responding to primary care treatment . 

More serious symptoms may require immediate evaluation at the Emergency Department instead of waiting for a specialist review. These include a sudden onset of thunderclap headache, headaches that occur after a head injury or in association with other concerning symptoms such as severe vomiting, blurred vision, confusion, weakness, numbness or unsteady gait.