Not All Headaches Are the Same

Headaches are one of the most common medical complaints worldwide, but the term covers a wide spectrum. Understanding which type you have is the essential first step to effective treatment.

Tension-Type Headache

The most common type — a dull, pressing or tightening sensation, often described as a band around the head. Usually bilateral (both sides). Triggered by stress, poor posture, eye strain, and dehydration. Responds well to over-the-counter analgesics and simple lifestyle adjustments.

Migraine

A neurological disorder affecting 1 in 7 people (and 3 times more women than men). A migraine attack typically has four phases:

  • Prodrome (hours to days before): mood changes, food cravings, neck stiffness, yawning, increased urination
  • Aura (30% of migraineurs): visual disturbances (zigzag lines, blind spots), tingling in face or hands, speech difficulty — lasting 20–60 minutes
  • Headache: moderate to severe throbbing pain, usually one-sided, worsened by movement, accompanied by nausea and/or sensitivity to light and sound — lasting 4–72 hours untreated
  • Postdrome: fatigue, difficulty concentrating, mild confusion — lasting up to 24 hours

Cluster Headache

Rare but extremely severe — described by sufferers as the worst pain imaginable. Occurs in clusters (daily for weeks or months) then disappears for months or years. Always one-sided, around the eye, with tearing and nasal congestion. Requires specialist treatment.

Common Migraine Triggers

Triggers vary between individuals — identifying yours through a headache diary is one of the most useful things you can do.

  • Hormonal changes — menstruation, oral contraceptives, pregnancy
  • Sleep disruption — too little OR too much sleep
  • Stress — and the "let-down" period after stress resolves
  • Dietary — skipped meals, dehydration, alcohol (especially red wine and beer), caffeine withdrawal, processed meats, aged cheeses
  • Sensory stimuli — bright lights, flickering screens, strong smells, loud noise
  • Weather changes — barometric pressure drops
  • Neck and posture issues — particularly common in people who work at screens

Effective Treatments

Acute (Attack-Aborting) Treatment

  • NSAIDs (ibuprofen, aspirin) — most effective when taken early at the onset of pain, with a glass of water
  • Triptans (sumatriptan, rizatriptan) — the gold standard for moderate-to-severe migraine; target serotonin receptors specifically involved in migraine. Prescription only.
  • Anti-nausea medication — metoclopramide improves gastric motility (emptying slows during migraine, reducing drug absorption) and relieves nausea
  • Lying in a dark, quiet room with an ice pack or cold compress

Preventive Treatment

Recommended when migraines occur 4+ days per month. Options include beta-blockers, topiramate, amitriptyline, CGRP antagonists (a new class), and Botox injections. The right choice depends on other health conditions and side-effect profiles.

Non-Pharmacological Approaches

  • Magnesium supplementation — magnesium deficiency is common in migraineurs; 400mg of magnesium glycinate or citrate daily has good evidence for prevention
  • Riboflavin (B2) — 400mg daily reduces migraine frequency in multiple trials
  • Consistent sleep schedule — irregular sleep is one of the most potent triggers
  • Regular aerobic exercise — as effective as preventive medication in some studies
  • Mindfulness-based stress reduction (MBSR) — reduces both frequency and perceived severity

When to See a Doctor Urgently

Most headaches are benign, but seek immediate medical attention for: a headache described as the "worst of your life" (could indicate subarachnoid haemorrhage), headache with fever and neck stiffness (meningitis), sudden onset after exertion, headache after head injury, or new headache over age 50.