In the past month I have seen a few clients for troublesome headaches. Do you suffer from headaches too? I have certainly struggled with them at times. Headaches are a very common problem for children, teens and adults, and one of the commonest seen in General Practice. In fact, 38% of adults will have had a headache within 2 weeks (1). When clients come to see me, their GP has usually done a lot of work trying to identify the cause of the headache. They refer on to me when they believe stress or tension is contributing.
Let’s talk generally about headaches, and then we will look at tension type headaches. The common causes of headaches are:
1. Respiratory tract infection e.g. URTI, sinusitis, influenza….
3. Tension-type headaches
4. Vascular (blood vessel) headaches e.g. migraines, cluster headaches
5. These can be triggered by food or drink e.g. amines in cheese or red wine
6. Combination headaches e.g. grinding teeth triggering tension headache or neck problems triggering migraines
7. Neck or cervical spine problems
8. Hormonal headaches e.g. pre-menstrually or in menopause
9. Eye problems e.g. glaucoma, visual problems
10. Depression or antidepressant medication
11. Drugs and alcohol
12. Anaemia (low iron levels) or
13. Not so common but not to be missed – serious problems such as brain tumours, infections such as meningitis, high blood pressure, sleep apnoea, shingles, hypoglycaemia (low blood sugar), post-trauma headache (concussion), temporal arteritis.
A GP will ask questions about the nature of the headache, such as ‘how would you describe the headache, where is the pain located, how often are the headaches occurring, does anything trigger them, or make them better or worse’, and ‘is there a family history of (e.g.) migraines ….?’ They will ask about any history of health problems such as high blood pressure or glaucoma, and they will carry out an examination of the blood pressure and pulse, eyes, neck and nervous system generally. Sometimes investigations are necessary including Xrays or blood tests, but not always.
Different drugs can trigger headaches including caffeine in coffee and tea, or withdrawal from caffeine, or withdrawal from nicotine in cigarettes. The Pill and blood pressure medications , and some antidepressants can trigger headaches. It is important, too, to be aware of a phenomena called ‘rebound’ headaches. This refers to headaches occurring when analgesics and anti-inflammatory drugs are over-used, and then a headache occurs when the drugs levels are lowering in the body.
Migraine headaches affect one person in 10 (2). Pain usually occurs over one side of the head, and may be associated with an aura (e.g. visual disturbance) before the headache, aggravation by light (photophobia), and nausea and vomiting coinciding with the headache. The headaches may last a few hours or a few days. Some people experience other neurological symptoms with migraine such as weakness of a limb or sensory changes. In this instance the GP will often refer the person for review by a Neurologist.
Tension-type headaches are due to muscle contraction, and the pain is usually symmetrical i.e. on both sides of the head. These headaches last half an hour or even up to a week or so. There is no nausea or photophobia.
Management of headaches includes:
– Education about the type of headache
– Rest or sleep
– Cold or warm packs depending on the type of headache
– Avoidance of triggers e.g. certain foods or alcohol might trigger migraines – start with a diary recording when headaches occur and what eaten or drunk
– Having a healthy lifestyle, including fresh food and exercise
– Stress reduction, relaxation therapy, meditation yoga, counseling
– Acupuncture or hypnotherapy
– Physiotherapy or massage if muscle tension or neck problems
– Managing any underlying causes such as high blood pressure, anaemia or sleep apnoea
– Dental assistance for teeth –grinding, including a night guard
– Simple analgesia, such as paracetamol or other over-the-counter medications
– Specific medications for migraine, either to prevent attacks or to manage attacks
Coming back to the clients that I see, I focus on understanding how different factors might be involved in causing headaches. For example, with a young woman with recurrent headaches, there might be a combination of issues, such as neck problems, teeth-grinding and tension. It is important to look at all of these factors, plus explore the causes of tension in life. I recently saw a young woman with troublesome headaches and in the course of talking about causes of tension, she raised issues in her relationship which were causing significant stress. Treatment included counseling individually and later with her partner.
I encourage holistic treatment which may involve work on prevention, lifestyle, treatment of underlying causes, self-care, relaxation or meditation, medication if needbe, counseling and hypnotherapy at times. I am a great advocate of massage and reiki. If stress or anxiety are part of the picture I will often utilize ‘Release Your Worries’ and the associated relaxation CD as part of the therapy.
(1), (2) Murtagh, J. (2012). John Murtagh’s General Practice. 5th Edition. McGraw-Hill Australia Pty Ltd, NSW.