Headaches: When should you take a painkiller or see a doctor?

CATEGORISING HEADACHES

Migraine is just one of more than 150 types of headaches that affect both men and women, according to the International Classification of Headache Disorders. Headaches can be generally categorised into three types: Primary, secondary, and pain caused by nerve abnormalities as well as facial pain, said Dr John Ng, a neurologist from Mount Elizabeth Novena Hospital.

“Examples of primary headaches would be migraine and tension type headaches, where the pain is not caused by a structural abnormality in the brain,” explained Dr Ng. 

Examples of secondary headaches include sinus headaches, dental pain from infected teeth, and life-threatening conditions like bleeding in the brain or infections like encephalitis or meningitis.

The last category would include conditions such as trigeminal neuralgia. This chronic pain condition affects the trigeminal nerve found on the side of the face. The result is excruciating, one-sided facial pain that can be triggered by the lightest touch, such as brushing your teeth or applying makeup.

IS THE BRAIN IN PAIN?

Your brain isn’t in pain when you have a headache. But what can contribute to the headache is the pain felt by the membrane covering the skull, the blood vessels in the membrane, some of the nerves in the brainstem, the eyes, ears, nasal cavity, paranasal sinuses (the spaces surrounding the nasal cavity) as well as the skin, the tissue just beneath the skin, muscles, and blood vessels, said Dr Ng.

When these cranial structures experience traction or compression, are exposed to sensitisation that makes them more susceptible to pain, and/or subjected to inflammation, you have a headache, said Dr Ng.

Headaches aren’t all that unusual. In the latest community-based study in 2003 on 2,096 respondents in Singapore, the overall lifetime prevalence of headaches was 82.7 per cent. Nearly 40 per cent of these cases are episodic tension type headaches, which refers to those that occur fewer than 180 days a year. 

“In my practice, the most common headaches that patients seek medical help for are migraine and tension type headaches,” said Dr Ng.

POP A PAINKILLER OR SEE A DOCTOR?

Most headaches can be tamed with a painkiller and rest. But there are some that warrant immediate medical attention, said Dr Ng:

• It is the first or worst headache in your life.
• The headache started very abruptly.
• It feels different from your usual headache or it worsens.
• The headache caused you to faint or have seizures.
• New headache in those younger than five years old, or older than 50 years old.
• New headache in those with cancer, on immunosuppression therapy, or are pregnant.

The frequency of the headaches could be another cause for concern, said Associate Professor Helen Tjia Tjoei Lian, senior consultant from the Department of Neurology at the National Neuroscience Institute, when the headaches start to occur twice or more times a week. 

"Painkillers alone may not be enough. These patients may need daily medication to control their headaches,” she said.

Having said that, painkillers such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen should be taken only if the pain is of moderate severity, according to Assoc Prof Tjia. 

“Most of the painkillers can cause gastric upset and the possibility of drug allergies in susceptible patients. The long-term use of NSAIDs can also damage organs like the kidneys.”

Here’s a look at what the common types of headaches are, and how to get relief pronto.

• MIGRAINE

Migraines tend to be three times more likely to occur in women than men, according to Medical News Today. The intense throbbing pain on just one side of the head can be accompanied by nausea and vomiting. You may also see zig-zag lines, and flickering lights or spots. Some patients may experience partial vision loss, a sensation of pins and needles, muscle numbness and difficulty speaking, too.

Duration: Each episode can last up to three days.

Triggers: Stress, anxiety, sleep disruption, hormonal changes, skipping meals, lights and loud noises, dehydration, and certain foods and medicines.

Treatment: Your doctor may prescribe medicine specific for migraine as well as to quell the nausea and vomiting. If it is not severe, you can take an over-the-counter (OTC) painkiller and go to sleep in a dark and quiet room, according to the Mayo Clinic. Drink water to keep yourself hydrated.

Your doctor may put you on migraine-preventing medication if you have four or more debilitating attacks a month, each attack lasts more than 12 hours, and painkillers don't help. 

• TENSION HEADACHE

It feels like a dull, constant pain on both sides of the head. You may also experience pressure behind your eyes as well as tenderness of the face, head, neck and shoulders, according to Healthline.

Duration: It can last for 30 minutes to several hours.

Triggers: Stress, anxiety and depression are common triggers. Other causes include dehydration, loud noise, lack of exercise, poor sleep quality, bad posture, skipping meals and eye strain.

Treatment: OTC painkillers should help to ease the headache. But if it persists for more than 15 days in a month, and spans over three months, you should see a doctor, according to Medical News Today.

Lifestyle changes that can help prevent tension headaches include managing your stress, getting enough sleep, regular exercise and stretching, improve your sitting and standing postures, and getting your eyes tested.

• CLUSTER HEADACHE

These severe and recurrent headaches are six times more likely to develop in men than women, according to Healthline. Symptoms include watery eyes, swollen eyelids, a blocked or runny nose, sensitivity to light and sound, and agitation.

Duration: Attacks tend to take place in clusters (hence the name) at the same time every day for weeks or months, and often can strike a few hours after falling asleep, according to Medical News Today. Each spell can happen suddenly and lasts between 15 minutes and three hours.

Triggers: These headaches tend to happen to smokers.

Treatment: They include an injection, nasal spray and/or inhaling 100-per cent oxygen through a mask for relief. Sometimes, the doctor may prescribe corticosteroids for fast relief, according to Healthline. Quitting smoking would also help.

• EXERTIONAL HEADACHE

This headache feels like a throbbing pain throughout the head, and are more common in those with a family history of migraine, according to Medical News Today.

Duration: It is short lived but can sometimes last up to two days.

Triggers: As the name suggests, this headache is caused when you perform strenuous physical activities, such as running, jumping, weight lifting and even coughing, sneezing and having sex.

Treatment: An OTC painkiller should take care of it. Taking an NSAID before exertion can help prevent the headaches. Warm-up stretches before exercising can help, too.

• MEDICATION-OVERUSE HEADACHE (MOH)

The irony of taking painkillers for headache relief is that they can become the cause of your headache. An MOH or rebound headache is an example. It has symptoms that are similar to those of tension headaches or migraines.

Duration: It can be a frequent or even a daily occurrence.

Triggers: This headache usually results from taking painkillers (such as opioids, acetaminophen, triptans and NSAIDs) for more than 15 days in a month, according to Medical News Today. To avoid MOH, don’t take painkillers for headaches for more than two days in a week.

Treatment: Stop taking the painkillers. But be warned that the headache symptoms are likely to worsen before they improve and stop typically within 10 days, according to Medical News Today. 

However, the withdrawal symptoms, including nausea and vomiting, increased heart rate, sleep disturbance, anxiety, restlessness and nervousness may take a week or three to subside. Before you go cold turkey on the painkillers, consult a doctor who can devise a plan to help ease the withdrawal process.

The headache you get after two months of not touching any pain-killing medicine would be the non-MOH kind. According to Medical News Today, it would be safe to take painkillers at this stage. 

To prevent another MOH, avoid using codeine. If you're still wary, Assoc Prof Tjia suggests this non-medicated method: Place a cold towel or ice pack on the affected part of the head, and rest in a dark, quiet room.

• SINUS HEADACHE

The dull, throbbing ache can be felt around or behind the eyes, across the cheeks and bridge of the nose, along the forehead, or along the top teeth, according to eMedicineHealth.com. Moving and straining can worsen the headache. Sinus headaches are always accompanied by coloured nasal mucus, nasal congestion, plugged ears, swelling of the face and fever.

Duration: It usually resolves in a week when the underlying cause of sinusitis clears up. Otherwise, see a doctor.

Triggers: The pain is caused by sinusitis, which is the swelling of the sinuses. It is often the result of an infection or allergy.

Treatment: To ease the headache, a corticosteroid nasal spray may be prescribed to help reduce the sinuses’ swelling. A doctor can assess if the sinusitis is caused by a bacterial infection that needs antibiotics, or an allergy that can be cleared up with antihistamines, according to Medical News Today. Surgical drainage by an ear, nose and throat specialist may be needed to treat some cases.

• CAFFEINE-RELATED HEADACHE

This headache is brought on by heavy coffee consumption the likes of more than five cups or 500mg of caffeine a day, according to the Cleveland Clinic. Even 200mg of caffeine daily for over two weeks is enough to cause migraine-like headaches when you stop drinking coffee abruptly, according to Medical News Today. Other symptoms may include tiredness, difficulty in concentrating and irritability.

Duration: For as long as you don’t consume caffeine. The symptoms generally ease on their own within an hour of caffeine intake. If you’re trying to quit coffee, they will take about seven days to go away, according to Medical News Today.

Triggers: Caffeine.

Treatment: Different people react differently to caffeine but generally, reducing caffeine intake could decrease the chances of getting headaches. According to the Cleveland Clinic, you should limit your caffeine consumption to the equivalent of two cups of coffee a day. Also limit the use of painkillers - either OTC or prescribed - to two days a week.