• Headaches are divided into two types: primary and secondary
• Headaches are common but often neglected
• Preparations before consulting a doctor for headaches
• Make healthy lifestyle choices to prevent headaches

Nearly everyone experiences headaches sometime in life. Headaches are usually not results of serious diseases, but signals indicated that the body has overloaded or not function well. Occasional headaches can be relieved by sleep or rest, pain medications, massage or simply wait until they go away. Persistent or recurrent headaches should seek medical help.

Headache pain is often come from stimulation of pain-sensitive structures surrounding the skull, such as nerves, blood vessels, and muscles.

The manifestations of headache are various. Individuals may experience like a tightening feeling, dull ache, distending pain, throbbing pain, stabbing pain or electric sharp pain; it may appear at the crown, forehead, back of the head, on one or both sides, or even all over the head. A headache attack, that lasts several seconds to a few days, may only be triggered on specific occasions, or may recur frequently for months to years. It can also be accompanied by nausea, change of vision, ear ringing, sensitivity to light, dizziness, teary eyes, stuffy nose and profuse sweating.

Headaches come in many forms and their causes are complex, any of the body system can be involved in the development of headaches. While most people suffer from mild headaches at times, some people are afflicted with recurrent disabling headaches, the frequent episodes disrupt their everyday lives significantly, they can do nothing but to resort to pain medications.

In recent years, extensive researches have made a remarkable breakthrough to headache management, the treatment has improved considerably. Headaches can now be effectively controlled by appropriate awareness, correct diagnosis and treatment, as well as lifestyle modifications.

1. Headaches are divided into two types: primary and secondary

Most people experience headaches may wonder what is going on inside the brain. Actually, brain tissues themselves cannot feel pain, they only process pain sensations received from the rest of the body. The pain is often come from stimulation of pain-sensitive structures surrounding the skull, such as nerves, blood vessels, and muscles, or from muscles of the head and neck. There are many diseases and conditions that may cause headache, doctors divide headache into two major types: primary and secondary.

Primary headaches refer to those without clear causes, such as:

• Migraine
• Tension headache
• Cluster headache

Secondary headaches refer to those induced by medical conditions, such as:

• Head or neck trauma
• Vascular disorders inside the brain and cervical spine
• Fluctuated blood pressure and tumors inside the brain
• Substance poisoning or overuse such as carbon monoxide, alcohol and
• medications
• Infections
• Imbalance of internal environment or metabolic disorders
• Disorders of the skull, neck, eyes, ears, nose, sinuses, teeth, mouth cavity or other structures
• Mental disorders
• Neuralgia (nerve pain), such as trigeminal neuralgia, glossopharyngeal neuralgia or occipital neuralgia

In clinical practice, patients are mostly diagnosed with primary headache disorders (over 90%), such as migraine, tension headache and cluster headache.

Clinical features of three common headache disorders

2. Headaches are common but often neglected

Various types of headache, properly called headache disorders, are extremely common, and are worldwide problems. Tension headache is the most common type of headaches. According to the report of the World Health Organization (WHO), tension headache alone affects two-third of men and over 80% of women in developed countries. Another less recognized type is chronic daily headache, up to 1 in every 20 adults experience a headache everyday or nearly everyday. In 2010, a survey of the epidemiology of headache disorders in China indicated that the incidence of primary headache disorders is 23.8% among people aged 18〜65 years, which mainly suffered from tension headache (10.77%) and migraine (9.3%); 85% of the interviewers claimed that headaches made them difficult to concentrate, affected work performance and quality of life; over 75% believed that headaches caused them having negative emotions; and surprisingly, over 60% just endured their headaches without taking any measures.

Since headaches are usually episodic, do not cause death and are not contagious, they are often neglected by people, who seldom turn to a doctor for effective treatment. Headaches are not simply treated by pain medications, the treatment must be appropriate to the type of headaches. It is difficult for the sufferers to differentiate from a wide range of headache types, and a mixed headache is also not uncommon on them. Finding an effective treatment is challenging, that can only be identified by professionals. You should consult a doctor, if the followings happen:

• Frequent headaches, twice a week or more
• Worsen headaches or don’t improve with appropriate use of over-the-counter drugs
• Change in headache features, such as more persistent or appear new symptoms
• Headaches become more severe and longer duration
• Headaches disrupt your work, sleep or daily activities

In rare occasions, headache may be a symptom of serious conditions, such as stroke, meningitis (inflammation of the protective membranes covering the brain and spinal cord), or encephalitis (inflammation of the brain). If you have a sudden, severe headache or a headache accompanied by following warning signs, you must go to the emergency room:

• Mental confusion or trouble to understand speech
• Vomiting, dizziness or fainting with unclear reason
• Muscle spasm, numbness, flaccidity or partial weakness of the limbs
• High fever (39℃ to 40℃)
• Stiff neck
• Visual disorder
• Trouble speaking
• head injury

3. Preparations before consulting a doctor for headaches

Since your time with the doctor is limited, and there often a lot to discuss about. When you are seeing a doctor for the first time, you should prepare to answer the following questions:

• When did your headaches first appear? How often do they appear? How long do they last each time?
• How bad is the pain? Did you stop working immediately and lie down for rest?
• Any warning signs like above mentioned?
• Where is the pain? The front or back of head, crown, one-sided or two-sided, around one eye, or all over the head? If it appears in several locations, where is the worst?
• Nature of the pain: pricking, dragging, distending, heaviness, tightening, throbbing or splitting? Try to describe it as accurately as possible.
• Other accompanied symptoms such as sensitivity to light or noise, nausea, vomiting, runny nose or red eye? Do they occur before or after the headaches?
• Do the headaches tend to occur on specific occasions such as particular seasons or during menstruation?
• Any special factors may trigger or worsen your headaches? For example emotions, poor sleep or certain foods?
• Are you under stress or during life changes recently?
• Is there a history of headaches in your family?
• Do you have other medical disorders? What medications including vitamins and supplements are you taking?
• Have you been examined at other places?

Unlike other disorders, headache diagnosis is typically based on a person’s medical history and his descriptions on the signs and symptoms, clinical tests are not very helpful. If your headaches are recurrent or persistent, you have to recall and organize your headache history, describe the headache symptoms and characteristics as completely as possible to your doctor. Preparation is very important for an appointment. Keeping a headache calendar for two to four weeks, record the details of every headache episode, the information help your doctor evaluate your headache pattern and make appropriate treatment decisions. See some samples (1) & (2). Remember to bring the completed headache calendar to the follow-up appointments too.

By keeping a headache calendar, you are able to identify the pattern of occurrence and the treatment outcomes, recognize the aggravating factors or triggers of your headache, and eventually you can work closely with your doctor to find the right treatment plan. If the headache symptoms become worse or more frequent despite treatment, ask for a referral to a neurologist or a headache specialist.

Finally, you should prepare questions to ask your doctor, so that you can have the information you need for better understanding and managing your headaches. For example:

• What is the most possible cause for my headaches?
• Is there any other causes leading to my headaches?
• What kinds of tests do I need?
• Is my condition temporary or persistent?
• What is the best course of action?
• Besides the therapy you suggested, are there any other choices?
• I have other health problems, how can I manage them together?
• Are there any restrictions that I need to follow?
• Can you recommend some brochures or web sites for me to know my condition?

4. Make healthy lifestyle choices to prevent headaches

Many people note that headaches tend to be triggered or aggravated in certain situations. Headaches are closely linked to personal lifestyle, and a wide range of factors can contribute to them. There are environmental factors such as exposure to bright light, loud noise and strong odors, windy or cold weathers; life habits such as irregular meals, inadequate sleep, heavy smoking or drinking, excess tea or coffee, medications and too much exercise; certain foods may trigger headaches such as chocolate, alcohol or cold drinks; psychological factors such as stress, anxiety and fatigue; even factors like social turmoil, unstable life, or interpersonal problem may also contribute to headaches. Everyone has his own way of life, and so the triggers of each sufferer are not the same. A factor that works for one may not work for another. It is also possible that headaches are due to cumulative effects of multiple factors, which are almost unidentifiable and unavoidable.

With the help of a headache calendar, you can keep track of the foods, stress level, weather condition, activities during the attacks. You will begin to notice patterns in your daily life that may contribute to your headaches, and are able to take steps for relief. Lifestyle changes can greatly reduce the frequency and severity of your headaches. Below are some general tips for those with headache disorders.

• Most headaches are nothing to worry about, they are not life-threatening, and can be controlled by proper treatment.
• Life is not always a smooth journey, it is common to have “headaches” at some point, so live with a positive attitude.
• Eat healthy foods, don’t skip meals especially breakfast, and drink plenty of water. If you know that certain foods may trigger your headaches, avoid eating them. Common food triggers include chocolate, cheese, monosodium glutamate (MSG), alcohol, caffeine, pickled, fermented or marinated products.
• Get enough sleep, pay attention to your sleeping position, find a right pillow, or make some changes to your bedroom. Wake up and go to bed at regular times, either too much or too little sleep can cause headaches.
• Find ways to relax and reduce stress, such as meditation, relaxation exercises, yoga, massage, listening to music, reading a book or taking a hot bath.
• Regular physical activities can improve physical and mental well-being. Exercise also helps reduce stress. It is important to avoid strenuous exercises and warm up, moderate types like walking, cycling, swimming or taichi are suitable.
• Headache medications should be taken as instructed. Over-the-counter medications can only be taken twice a week, otherwise they may increase the severity and frequency of headaches.
• Stay away from crowded and polluted environments, loud noises, cigarette smoke or perfume are common headache triggers.
• Poor posture creates muscle tension around the shoulders and neck that also trigger headaches. Spending hours in front of computer will cause eyestrain and neck strain, remember to take a break every hour, getting up and stretching to relieve the tension.

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