Understanding What Causes Headache: The Throbbing in Your Head

Headaches may be a common ailment, but it is not widely known that there are different kinds of headaches. Dr Loh Pei Kee, consultant neurologist at Subang Jaya Medical Centre (SJMC), breaks down headaches into two categories – primary and secondary.

Primary headaches including migraines

Primary headaches are the most common form of headache. Some common subtypes include tension-type headaches, migraines and trigeminal autonomic cephalalgias (TACs). Tension-type headaches are usually “band-like”, fairly diffused and often mildly to moderately painful.

Migraine is more severe, with the headache commonly throbbing over one side of the head and associated with nausea or vomiting and sensitivity to light and noise. TACs are characterised by attacks of moderate to severe unilateral pain in the head and face, commonly associated with symptoms such as nasal congestion, eyelid swelling, lacrimation and ptosis.

Secondary headaches caused by external sources

Secondary headaches occur when external sources cause the headache. Dr Loh classifies them as:

  • Trauma-related headaches, which are caused by trauma to the head and neck.

  • Vascular-related headaches, which stem from issues involving the blood vessels, including aneurysms, arteriovenous malformation, inflammation of the blood vessels or arteritis, artery dissection and haemorrhagic strokes.

  • Non-vascular-related headaches, which comprise a broader scope and can be caused by tumours, increased or low cerebrospinal fluid pressure or inflammatory processes.

  • Headaches attributed to infection, which include intracranial or systemic infections.

  • Headaches caused by a substance or its withdrawal, or analgesia overuse.

  • Headaches caused by other disorders, which include disorders of the eyes, ear, nose, neck and oral cavity

Separating normal from abnormal headaches

Because everyone has experienced a headache in his lifetime, it is easy to brush it off as something trivial. However, Dr Loh says that it is dangerous to believe that all headaches can be ignored. 

She says, “Most people don’t take headaches as seriously as other conditions such as chest pain. This is because people relate chest pain to heart attacks, whereas headaches may be caused by stress or lack of sleep. Thus, they do not usually recognise whether a headache is normal or not.”

Dr Loh lists some red flags and associated symptoms that people should look out for when experiencing a headache, as some symptoms may point to something more dangerous.

  • Sudden onset of the worst headache the patient has experienced

  • Progressive or recurring daily headaches

  • Age of onset is above 50 or below five years old

  • Fever

  • Drowsiness

  • Presence of focal neurologic symptoms such as visual disturbance, limb weakness or numbness, slurring of speech and incoordination

  • Vomiting and nausea

  • Pain worsens on exertion such as coughing and sneezing, or when it is more painful to lie down than sit

  • Onset during pregnancy

If these symptoms occur, Dr Loh’s advice is to see a doctor immediately to ensure it is not something more serious. “Even if you do not experience any of these symptoms, if your headaches are prolonged and so frequent that they start to interfere with your work and social life, you should still see a doctor to try and reduce the frequency of your headaches for better quality of life.”

Get a second opinion for constant headaches

According to Dr Loh, not all headaches need to be medically treated. There are some ways you can reduce the occurrence of some primary headaches. More importantly, you need to make sure it is not a secondary headache.

She says, “Sometimes, headaches, especially primary ones, are caused by external triggers. Therefore, try to identify and avoid these triggers, which may include lifestyle changes such as avoiding certain food, reducing stress and getting enough sleep.”

However, she notes that we cannot rely solely on lifestyle adjustments to resolve our headaches and occasionally may need to resort to medication. Headaches often go undertreated because people do not see it as life-threatening, but the lack of treatment can lead to other problems such as deteriorating quality of life.

On the other end of the spectrum, unusual and prolonged headaches may be a sign of more serious conditions such as tumours or abnormalities in the blood vessels, which can lead to something life-threatening. The dysfunction of the brain can also potentially affect movement, vision, speech, sensation and balance.

“If you notice that your headaches are unusual or prolonged, see a neurology doctor for early treatment as it could mean something more dangerous. As for parents, if your child frequently needs painkillers, it is best to send him to a doctor for further examination,” says Dr Loh.

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