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    HEADACHES (GENERAL)

    Headaches are very common. Most are not serious and usually go away on their own within minutes-days.

    Types of headaches:

    Headaches can be caused by several factors, but they are typically put into three main groups (ICHD):

    (1) Primary headache

    • This is the majority of headaches.
    • Headaches not attributed to an underlying condition.
    • Eg: migraine, tension headache, cluster headache

    (2) Secondary headache

    • Caused by another disorder or incident
    • eg: head or neck injury, stroke, substance overuse or withdrawal, mental health disorders, issues with eyes, ears, teeth, sinuses or neck

    (3) Other headaches, nerve and facial pain

    • Eg: Trigeminal neuralgia, post-herpetic neuralgia

    Causes of headaches include:

    • Illness – especially illnesses affecting the sinuses such as cold and flu
    • Substance use
    • Alcohol excessive
    • Stress
    • Pregnancy – especially in the earlier stages is common
    • Overusing pain medication (medication overuse headache)
    • Hormonal causes – during period or menopause
    • Poor posture
    • Eye problems
    • Mental health problems
    • Not eating or drinking enough
    • Lack of sleep or sleeping too much

    Assessing a headache:

    Factors to take into account:

    • Any “red flags” – signs of a more serious cause that would need to be referred to more urgent specialist care (eg: significant head injury from impact of falling)
    • Pain characteristics – duration, pattern, severity. Anything that makes it better or worse. Worse in morning or evening?
    • Other symptoms – eg: vomiting, tingling (pins and needles), inability to look at light, confusion are all symptoms of migraine.
    • Other medical conditions
    • How is their daily life impacted? Are they able to do tasks they normally do as efficient as they usually do.
    • Headache diary recommended to help identify triggering and relieving factors.

    Head injuries should be checked out by a doctor or emergency department IMMEDIATELY

    • Any head injury of significant force (moderate-severe) should ALWAYS be seen by the emergency department IMMEDAITELY. Regardless of what is felt after (symptoms or not). Sometimes headaches can come on after a delay of a few days or injuries that could be severe can take a few days after the trauma to appear.

    See a doctor if:

    • Headaches around the time of your period.
    • Persistent headache (more than 3 days)
    • Painkillers are not helping
    • Headache continuing to get worse
    • Signs of migraine – Feel sick, difficulty with light and noise, pain at front or one side of head moderate-severe and throbbing

    Seek an URGENT doctors appointment if a bad headache is experienced along with (call 111 in UK):

    • Numbness/weakness in arms or legs
    • Vision changes – especially blurry and double vision
    • Pain and soreness in scalp
    • Painful eating
    • Jaw pain

    Or if a child 12 or under has:

    • Worsening headache
    • Headache with vomiting
    • Headache with eye issues. Eyes pointing different directions or inability to look up.
    • Headache waking them up at night
    • Headache in the morning shortly after waking up
    • Worsened by bending down, coughing or sneezing

    Go to the hospital or call 999 (UK) IMMEDIATELY if a severe headache is accompanied by:

    • Head injury
    • Sudden extremely painful headache “worst headache of my life”
    • Problems with speech or memory; confusion
    • Severe drowsiness
    • Very high temperature
    • Changes in breathing
    • A rash (especially one that does not fade under glass)
    • Reddening of the eye whites

    If a child 12 or under has a bad headache with:

    • Difficulty speaking, swallowing, with balance, vision issues, walking
    • Persistent lack of energy
    • Headache starting within 5 days of a head injury

    TREATMENT

    Self-management of headaches without medication:

    • Hydration and rest
    • Manage stress
    • Avoid alcohol
    • Avoid skipping meals
    • Enough sleep but not too much. Sleeping too much or too little can worsen headaches.
    • Take regular screen breaks to avoid eyestrain

    PAINKILLERS FOR HEADACHES:

    The main two recommended painkillers for headaches and other general mild-moderate pain are Paracetamol and Ibuprofen.

    PARACETAMOL

    Paracetamol tablet (10+ years)

    Calpol (Paracetamol liquid for under 12s and those unable to swallow tablets)

    IBUPROFEN

    Ibuprofen tablets (regular)

    Nurofen express (fast-acting ibuprofen)

    Nurofen liquid (for under 12s and those unable to swallow tablets)

    Only use the below if paracetamol and/or ibuprofen has not worked:

    Moderately strong painkillers (for mild-moderate pain):

    CO-CODAMOL (CODEINE WITH PARACETAMOL, 8mg/500mg)

    • MAXIMUM 3 DAYS USE. CAN CAUSE ADDICTION.
    • 12+ years

    PARAMOL (CO-DYDRAMOL; DIHYDROCODEINE WITH PARACETAMOL)

    • MAXIMUM 3 DAYS USE. CAN CAUSE ADDICTION.
    • 12+ years

    NUROFEN PLUS (IBUPROFEN AND CODEINE)

    • MAXIMUM 3 DAYS USE. CAN CAUSE ADDICTION.
    • 12+ years

    Please see a doctor if these stronger painkillers have not helped to relieve the pain after 3 days. Do not start another course of these painkillers unless doctor has advised to do so. Doing so can result in headaches and other pains being worsened due to medication overuse.

    SOURCES:

    https://cks.nice.org.uk/topics/headache-assessment/

    https://www.nhs.uk/symptoms/headaches/

    https://ichd-3.org/