Tension headaches are the most common type of headache that many of us will have experienced at some point throughout our lives.
A tension headache feels like an aching type of pain. The onset of pain can be slow and creep up on you. It can feel as if there is pressure on your head, like it's being squeezed. The ache can be constant and can affect both sides of your head like a tight band has been stretched around it. Neck muscles can feel very tight too. The pain might radiate around the whole of your head or just the sides or back of your head; your neck could also ache.
These headaches only last a short while, but may occasionally continue for several hours. However, tension headaches are not usually severe and mostly you can get on with what you're doing.
Causes and triggers of tension headaches
When you get a tension headache it can feel like the pain is coming from your head. The source of the pain however, could be due to muscle strain. The muscles in your face, neck and around your head can all be involved. When muscles are strained, substances called prostaglandins can be released at the site of the injury. Prostaglandins stimulate pain receptors, which in turn can cause you to feel the pain in and around that area.
Several triggers can be linked to the cause of strained muscles:
- Stress and anxiety may cause you to feel tense and tight muscles
- Poor posture may cause the muscles in your neck, face and head to be tensed when working at your desk
- Squinting whilst staring intensely at your computer screen can also be associated with straining muscles in your face, head and neck
- You can sometimes feel tense when tired and muscles can be strained as a result
- Loud noises, dehydration and some smells could cause tension and lead to muscle strain
Treating a tension headache
Treatment can be aimed at preventing the production of prostaglandins when muscles are strained. Nurofen, for example, is a well-known treatment for tension headaches. It contains ibuprofen, which inhibits the formation of prostaglandins in muscles.
Other treatments for tension headaches include paracetamol and aspirin.
Migraine headaches, usually referred to simply as "migraines", are also reasonably common headaches. If you're not a migraine sufferer, then you probably know someone who is. About one in five women and one in fifteen men are thought to be affected by migraines.1
Migraines can often feel like a severe throbbing pain at the front or the sides of your head and can typically be on just one side of the head. However, for some, it doesn't just involve a feeling of pain in and around the head. Migraines frequently have a wider range of symptoms. These can include being sensitive to light and/or to sound. Migraine sufferers or "migraineurs" can also feel nauseous and may vomit during a migraine attack. Migraines can have four different phases:2
1. Aura phase – this may or may not happen, but can be a warning sign
2. Headache pain phase
3. Resolution phase - where the pain either fades slowly or stops abruptly
4. Recovery period - this might take hours or even days and has been referred to as a "hangover" type feeling
It's possible to have migraine with aura or without aura. It's also possible to have the migraine-associated aura and other symptoms - but without the headache. In this case, it's called a silent migraine.
Causes and triggers of migraines
The cause of migraines may be linked to abnormal brain activity, which can temporarily affect nerve signals, chemicals and blood vessels in your brain. This is possibly associated with genes that respond to certain triggers.
Some migraine sufferers know what triggers their migraine and try to avoid it. Then again, there are so many possibilities and these vary widely for each sufferer. Certain foods, lack of sleep and hormonal changes can be triggers. Some migraine sufferers keep a diary in order to try to find out what their particular trigger(s) might be.
There are a variety of treatments that can help migraine sufferers. These may include preventative medication, which is aimed at trying to stop attacks happening in the first place. Most sufferers, however, will need to take acute medication as soon as they feel the migraine is beginning. Painkillers like Nurofen or other non-steroidal anti-inflammatory drugs (NSAIDs) can be used. Migraine sufferers may also need to take anti-sickness medications, in addition to those aimed at pain relief. Ice packs, hot water bottles and pressure to the pulse points on the body can also prove helpful to some sufferers.
At times, migraine can be so severe that sufferers can't carry on with their work or other activities. For some, resting or sleeping for an hour or two, or even a few minutes, can help to relieve, or start to subdue, the pain of a migraine attack.
Cluster headaches are quite rare. Only about 1-2 in every 1000 people suffer from this type of headache.3 They can be even more painful and debilitating than migraines. More men than women suffer and it has been found to be more common in those who smoke heavily.3
Cluster headaches are experienced in groups or "clusters". The clusters can involve something like one to eight headaches each day over several weeks or months.3,4 A headache will often begin during the night, perhaps an hour or two after the sufferer has fallen asleep. Following a period of these headaches, a sufferer may then go for a while with none at all.
How cluster headaches feel
The intense pain is usually focused on the area around and behind one eye. For many sufferers this involves the same side each time. But for others it can vary, sometimes left, sometimes right. But always just on one side.
Cluster headache pain comes on very quickly. It usually hits its peak within 5 to 10 minutes and stays at this level for 30 and 60 minutes.3 They can have a longer duration, but don't usually last for more than three to four hours.3,5 When the pain stops, it can be quite abrupt and a great relief to sufferers.
People with cluster headaches can feel very agitated and restless during the attack. They sometimes don't know what to do with themselves, because the pain is so severe. They may feel the need to pace up and down or walk around in an effort to bear the pain better. Sufferers may also take drastic measures in order to try to cope with the pain, resorting to methods that are rather more painful than soothing.
As though the intense pain itself were not enough, a cluster headache often comes with other symptoms too. These include a blocked or runny nose, usually just one nostril, a red watery eye, or a drooped and swollen eyelid on the same side as the pain. And perhaps unsurprisingly, a flushed and sweaty face too.
Causes and triggers of cluster headaches
The exact cause of cluster headaches is the subject of much research. But it has been is linked to the part of the brain called the hypothalamus, which plays an important role linking the body’s nervous system to other bodily functions.4 There is also some suggestion of a genetic link, since 1 in 20 people who suffer cluster headaches have a family member who are also sufferers. 3
Alcohol is a well-known trigger for cluster attacks and sufferers are advised not to drink alcohol, particularly during a cluster headache period. Other causes include strong smells such as petrol and paint fumes. Being overheated, exercise and smoking are other well recognised triggers. So it's advisable to stop smoking, or at least cut down.
Treating and preventing cluster headaches
Regardless of the duration of cluster headaches, medicines that act quickly are always the and specialist treatment is normally required. Inhaled oxygen can bring relief too, but needs to be prescribed by doctors and for practical reasons, may only be available to use at home.
As with migraines, preventative treatments are available for cluster headaches. These are only available on prescription from a doctor.3
Sinuses are the cavities behind your nose, eyes and cheeks. Sinus headaches can occur as a result of inflamed sinuses and the build-up of mucus. This causes pressure in the cavities which can then lead to pain. For those who suffer, these headaches may be more severe in the mornings. This is because mucus drainage is poor at night, so more can build up over this time.
How sinus headaches feel
Sufferers can feel tenderness in the area around their faces and a headache in the forehead above their eyes. This can be accompanied by pulsating pains that can be made worse when moving around. There may also be facial swelling. Mucus may drip from the nose since so much can build up.
Causes of sinus headaches
An infection, such as a cold or flu virus, can be a cause of inflamed sinuses. Facial pain and headache may both result when there is an infection.
Treatment for sinus headaches
Treatment is usually aimed at the cause of the sinus infection. This may be achieved with antibiotics, although they're not effective against viral infections. Mucus drainage can be achieved by using saline nasal sprays and inhaled decongestants. A dehumidifier in the bedroom can also help loosen mucus and enhance drainage. However, surgery may be needed if a structural nasal blockage is present.
We've already mentioned prostaglandins and their action that can lead to pain, fever and headaches. Additionally, they can also make tissues inflamed and swollen. So taking Nurofen can help sinus pain too.
Some headaches suffered by women are hormone-related headaches. These can include menstrual migraines. In fact, more than 50% of women who suffer migraines have noticed a link with their periods.6
Hormone headaches can occur during a women’s period as a result of falls in the level of the hormone oestrogen. There can be other hormone-related reasons too:6
- Some women have fewer headaches when on the combined oral contraceptive pill, although others may experience headaches more frequently
- As women get closer to the menopause, they may find that headaches can worsen. This might come as a result of more frequent periods and disruption in the normal hormone cycle
- In pregnancy, headaches may worsen in the early weeks, but usually improve or even stop in the last months of pregnancy
Preventing and treating hormone headaches
Migraine type hormone headaches may be prevented by attention to diet, a regular sleep pattern and avoiding stress.
Migraine treatments, as detailed above, can provide pain relief. But treatment needs to be suited to a woman's individual requirements. So for further advice, consult your doctor if you think you may have hormone-related migraine or other types of hormone headache.
What other factors can cause headaches?
These include headaches associated with excessive alcohol intake, colds and flu, a ‘temporomandibular disorder’ affecting the chewing muscles in your jaw, and also obstructive sleep apnoea (OSA). A head injury, concussion and carbon monoxide poisoning may also be causes of headaches.
When to consult a doctor
We have looked at several different types and causes of headaches here. But if you are ever in any doubt about your headaches, always get advice from a healthcare professional. If your headache has come on following a head injury, if it becomes severe, or if you experience visual problems, fever, nausea or slurred speech, seek medical assistance immediately.