Reviewed by Dr Reginald Odbert, GP

What is a headache?


There is no single cause for headaches and, while they are painful and annoying, the majority of headaches do not indicate that there is a serious problem.

Headaches involve mild to severe pain in one or more parts of the head as well as the back of the neck. There are many different types of headache patterns and a variety of causes. While painful and annoying, the majority of headaches do not indicate a serious disorder and, in non-chronic cases, may be relieved by medicines and/or changes in lifestyle.

What causes headaches?

There is no single cause of headaches. A number of causes have been identified which fall into two general categories.

Tension headache

This type of headache results from contraction of head and neck muscles. It is the most common form of headache and accounts for 70 per cent of headaches. It can occur in people of either sex and at any age but it is most common in adults and adolescents.

Tension headache usually occurs in isolated incidents but can become chronic for some people. Possible causes of muscle contraction associated with tension headaches include:

Migraine headache

Migraine is the cause of 20 per cent of all headaches. This type of headache occurs when blood vessels of the head and neck constrict, resulting in a decrease in blood flow to the vessels.

Migraine is usually experienced as a throbbing pain on one side of the head with an associated feeling of sickness and sensitivity to light and sound.

Migraines are known to affect more women than men and are often chronic. Below are some of the factors that have been identified as being associated with migraines:

  • family history of migraine.
  • prolonged muscle tension and stress.
  • alcohol use.
  • smoking or exposure to tobacco smoke.
  • lack of sleep.
  • for women, menstrual periods and the use of oral contraceptives.
  • certain foods such as chocolate, nuts and fermented or pickled condiments, as well as foods containing the amino acid tyramine (aged cheese, red wine, smoked fish) and foods containing preservatives and artificial sweeteners.

What are the symptoms of tension and migraine headaches?

Tension headache

  • Pain is often felt in the generalised area of the head and neck as opposed to on one side.
  • Pain may also be situated in the back of the head and neck and feel like a ‘tight band’.
  • Sometimes accompanied by muscle tightness in back of neck.
  • Of relatively short duration if treated in time.

Migraine headache

  • Throbbing, pulsating feeling usually worse on one side of the head.
  • Pain may be dull or severe and often begins in the morning, gradually worsening in an hour or so.
  • Pain may be accompanied by other symptoms such as nausea, vomiting, vertigo-like feeling and visual disturbances.
  • Sensitivity to loud noises and light.
  • Commonly lasts from a few hours to one or two days in some cases.

When should you consult a doctor?

Most people with isolated tension headaches usually avail themselves to over-the-counter pain relievers and anti-inflammatories, or self-treatment such as relaxation and sleep. However, for chronic headaches contact your GP to discuss possible causes and prevention.

If any of the below symptoms are present your GP should be contacted immediately:

  • a sudden, severe headache accompanied by nausea and vomiting.
  • persistent and recurring headaches accompanied by memory problems, difficulty concentrating and tiredness.
  • a high fever with neck stiffness (unable to bend the chin down to the chest).
  • convulsions (fits).
  • persistent vision disturbances (light flashes).
  • trouble controlling arms and legs.
  • loss of feeling in the arms and legs.
  • tiredness and apathy with difficulty communicating.

How does the doctor make a diagnosis?

An accurate history of any previous illnesses, family background, diet and lifestyle is crucial to help the doctor decide whether to perform further tests and to advise on treatment.

The doctor will ask for information about the headache, its length, duration, location, associated features, quality and causative factors.

For headaches with indication of a chronic or more serious disorder, the following diagnostic procedures might be performed, usually following assessment by a specialist:

What kind of treatment is available?

A ‘headache’ diary is very useful to help your doctor figure out what kind of treatment is most appropriate for your diagnosis.

The easiest way to do this is to write the dates of headaches on a calendar.

Make a note of when the pain started and how long it lasts. Note down any additional factors that seem important such as what has been drunk and eaten, the intake of medicines, daily activities, details about periods if you are a woman, and weather conditions.

It is a good idea to keep up the diary for between one and two months so that any patterns can be identified. By establishing what triggers the headaches, it is possible to learn to avoid factors that cause them.

If you are unable to find a connection it might be a good idea to show the diary to a doctor, who may be able to ask pertinent questions that will help identify a pattern.

While each person will require their own form of treatment, generally over-the-counter pain relievers such as paracetamol (eg Panadol), aspirin (eg Aspro clear) and ibuprofen (eg Nurofen) are quite helpful in relieving the symptoms of tension-like headaches. Prescription medicines may be helpful for other types of headache pain such as chronic migraines.

In migraine, the most effective treatment is an explanation of the problem and identifying and avoiding trigger factors. There are various treatments available for relieving acute attacks, starting with over-the-counter painkillers such as paracetamol or ibuprofen. These are most effective if taken as early as possible into the attack, preferably in a soluble form.

Some OTC medicines designed specifically for migraine also contain an antisickness medicine such as buclizine. If OTC painkillers are ineffective your doctor may prescribe alternative treatments containing different antisickness medicines, stronger painkillers, or one of a group of antimigraine medicines called triptans, eg sumatriptan (Imigran) or zolmitriptan (Zomig).

Your doctor may prescribe a preventive treatment if migraine attacks are especially frequent. The strongest evidence for preventive treatment of migraine is available for sodium valproate (eg Epilim) (unlicensed use) and beta-blockers such as propranolol (eg Inderal LA).

For people experiencing burning sensations in the stomach or for those already diagnosed with a stomach ulcer, NSAIDs such as ibuprofen and medicines containing acetylsalicylic acid such as aspirin should be avoided. Aspirin should not be given to children under 16 years of age, unless on the advice of a doctor.

NOTE: The above mentioned medicines should not be given to children unless you are advised to do so by your GP.

What can you do to help yourself?

If the doctor has examined you without finding any serious cause for the headaches, these tips should prove helpful:

  • avoid excessive use of alcohol and tobacco.
  • engage in correct posture while sitting and working. The type of chair you use is important. It should be one that maximises comfort and good posture and may need to be adjusted to suit your needs.
  • perform relaxation techniques on a consistent basis.
  • get plenty of fresh air and exercise.
  • some people find that taking the natural herbal treatment Feverfew is very effective at reducing or preventing their headaches occurring. This needs to be taken daily – even if no headache is present – to have an effect. Consult your GP before starting this.

For migraine headaches, symptoms may be reduced by:

  • resting in a quiet room with the lights turned off.
  • avoiding food or drink in your diet that have been identified as having possible factors associated with migraine headaches.

B Rasmussen. The epidemiology of headache. Cephalgia 1995; 15:45-68.

M Ferrari. Migraine. Lancet 1998; 351: 1043-51.


B Rasmussen. The epidemiology of headache. Cephalgia 1995; 15:45-68.

M Ferrari. Migraine. Lancet 1998; 351: 1043-51.

Based on a text by Dr Carl J Brandt, Dr Per Rochat and Dr Claus Madsen, specialist

Last updated 01.06.2005


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