How do I know if my headaches are being caused by something serious?
As horrible as headaches are, they are rarely caused by something serious. But with that being said, it does happen and these are some of the things to look out for. If any of the following are relevant, please seek medical attention.
- A headache described as being the “worst” headache of your life
- A sudden onset of headache
- A headache accompanied by other neurological symptoms e.g. Confusion, impaired consciousness, trouble with balance or walking straight, pins & needles of the face or head
- New persistent headache that doesn’t go away after 10 weeks
- Positional headache e.g. comes on with laying down or bending forward
- Headache that wakes you from sleep
- Headache accompanied by neck stiffness, especially bending the neck forward
- Worsening pattern over time, or change in what your usual headache feels like
- Over 50 years of age and experiencing your first headache
- Headache accompanied by systemic symptoms, such as fever or weight loss
What are the most common headache triggers?
Headache triggers are anything which can lead to the onset of your headache or migraine. Headache triggers vary from person to person, and how much they contribute to your headache also varies. But headache triggers shouldn’t be confused with being the cause of your headache. The cause of most headaches is sensitivity of the lower brainstem (lower part of the brain). One or more triggers can increase this sensitivity and set off a headache or migraine (similar to water overflowing a bucket). Some of the most common headache triggers include:
- Stress (a trigger for 70% of people with migraines)
- Poor sleeping patterns (either reduced quality or quantity of sleep)
- Diet / foods e.g. the most common culprits are cheese (and other dairy), chocolate, alcohol, caffeine, artificial sweeteners, deli meats and foods containing MSG
- Dehydration (a trigger for up to 1/3 of migraine sufferers)
- Smells e.g. perfumes, chemicals, strong smelling foods
- Bright lights
- Medication overuse (regular use of acute headache medications more than 9 days per month can increase or perpetuate headaches)
- Fluctuating hormone levels
- Upper neck dysfunction (the top 3 levels of the neck contain nerves which set off referred pain into the head)
Keeping a headache diary can be a helpful way of tracking the involvement of triggers.
Did my parents give me their migraine genes?
While it’s a bit harsh to go blaming mum or dad for your migraines, there does seem to be an association between migraines and family genes. There are a number of genes (including KCNK18, CKIdelta, and CACNA1A) which appear to leave a person susceptible to a higher risk of developing migraines. If both parents suffer from migraines, there is up to 70% chance that their child will also suffer from migraines, but if only 1 parent has a history of migraines, then this risk drops to as low as 25% chance.
It needs to be stressed though that the inheritance of these genes DOES NOT mean that you will definitely go on to suffer from migraine attacks. Migraineurs also tend to have a number of environmental factors and lifestyle factors which can sensitise the brain and trigger migraines. Managing as many of these factors as possible will minimise the chance of migraines or decrease the intensity and frequency of attacks.
Why do my eyes go funny and experience other sensations before I get a migraine?
This is due to a phenomenon called an aura. An aura is a fully reversible (non-permanent) perceptual disturbance which occurs before a migraine, lasting between 5 and 60 minutes. Auras are experienced in a few different ways by migraineurs, but by far the most common is visual changes. Other sensations, such as a phantom unpleasant smell or confused thinking can also occur as part of an aura. Auras occur due to a slow moving wave of electrical activity in the brain, but at this point researchers haven’t been able to figure out exactly why it occurs. Auras don’t occur in all migraine sufferers, and tend to be more common in male migraineurs. The presence of an aura doesn’t indicate that you have a serious pathology or mean that your migraine will be more debilitating e.g. females who experience an aura often have less head pain during the headache phase of a migraine, and sometimes people will experience an aura and not go on to develop a headache at all.
Are changes in hormonal levels causing my headaches?
There are a number of triggers which can be involved in the lead up to a headache or migraine, and changes in hormone levels can be one of them. Estrogen and progesterone play an important role in regulating the menstrual cycle and pregnancy, but unfortunately they also interact with other chemicals in the brain involved in headaches. Headache / migraine sufferers often find that their headaches are worse or more frequent during times where there is a drop in the level of these hormones.
The good news though is that fluctuating hormone levels don’t necessarily have to lead to worsening migraines as they are just one of a number of factors / triggers involved in the onset of a headache. Managing your diet, maintaining good quality and quantity of sleep, ensuring adequate hydration, finding ways to help manage stress levels, physiotherapy for soft tissue and upper neck mobilisation, and pain medications around the time of lowered hormone levels are all good ways of minimising the impact of your hormones.
Is aerobic exercise good for headaches / migraines?
In recent years, there has been lots of research into headaches and aerobic exercise (exercise of physical activity which increases the heart rate). While more research needs to be done in regards to the effect of exercise as an acute treatment for headaches, there is some very promising findings that aerobic exercise is helpful as part of a preventative strategy for headaches / migraines, reducing the number of headaches days per months, as well as potentially headache intensity, duration and the psychological effects of headaches.
Aerobic exercise which seems to be most helpful includes walking, cross-training, jogging and cycling, and should be performed at a moderate intensity at least 3 times per week.
It should be noted that exercise can be a trigger for some people’s headaches / migraines, and this should be taken into consideration when exercising.
DISCLAIMER: You should seek medical advice before starting an exercise program.
What are the most common types of headaches?
While there are over 300 types of headaches (according to the International Headache Society), there are a few types of headaches which are very common.
Tension Type Headaches – These are the most common types of headache, with some reports indicating that as many as 2 out of 3 adults will experience this type of headache at some point in their lifetime. It is characterised by pain of moderate intensity on both sides of the head, with the sensation of pressing or tightening (with many patients describing the sensation of their head being squashed in a vice)
Migraines – Another common form of headache disorder, which is characterised by one-sided head pain (although can be on both sides) of moderate to severe intensity. These attacks of pain last between 4-72 hours, and are often associated with nausea, vomiting and sensitivity to light and sound. Migraines are often debilitating, and are categorised as with or without aura (temporary neurological signs such as visual disturbance before the onset of head pain).
Cervicogenic Headaches - These are headaches caused by an issue with the upper neck region. Dysfunction of the joints in the upper 3 levels of the vertebra of the neck are the most common cause but muscles, nerves and ligaments can also cause pain to radiate from the neck up into the head, which is then experienced as a headache. Cervicogenic headaches usually start as pain in the neck, and symptoms are usually on only one side of the head and often milder than with a tension type headache or migraine.