Chronic headache? See your doctor

Anyone who has a headache at least 15 days a month is suffering from chronic headache. The two most common types are migraines and tension headaches. In this column I won’t be going into other types, such as those caused by cerebral haemorrhage, aneurysm, trauma or sinus problems.

        Migraines can begin in childhood, adolescence or early adulthood. Women are three times as prone, although in childhood, headaches tend to affect boys more than girls. By puberty, however, more girls are affected.

        Migraines cause severe pain, often on just one side of the head. Contrary to other types, they’re often accompanied by additional symptoms, such as visual disturbances (like flashing lights, which in turn can trigger the migraine attack), sensitivity to light and noise, intense fatigue, nausea and vomiting.

        Such disabling symptoms can have a serious impact on your life, and yet migraines are often undiagnosed and thus untreated.

        The causes are still poorly understood, but both genetics and environmental factors seem to play roles. Acute dilatation of blood vessels in the brain was once considered the main cause, but a neurological origin is more accepted nowadays, with some of the latest studies showing changes in brain activity at the cellular level.

        Migraines can rarely be effectively treated with overthecounter medications – they require prescriptions. Although there’s no definitive cure, carefully prescribed drugs can reduce the frequency and severity.

        Complementary alternative treatments can help, such as yoga, massage and acupuncture. Certain foods appear to trigger headache and need to be avoided. Regular sleep, mild aerobic exercise and control of stress are also beneficial. Women will find it useful to avoid or reduce medication that contains oestrogen, such as birthcontrol pills and hormone replacement, and seek out alternatives.

        Tension headaches, by far the most common type, affect the overall head but the pain is often most intense at the back of the neck and around the temples.

        Unlike migraine, there are no other neurological or digestive symptoms, and sufferers usually just put up with the pain, even when it lasts several days.

        The precise cause is also unknown, but triggering factors include alcohol, smoking, caffeine, stress, physical exhaustion and nasal congestion.

        Treating a minor and occasional headache is easy, but inappropriate selfmedication for chronic headache can result in more frequent and severe pain, because the drugs will progressively induce pain rather than relieve it.

        This is referred to as “medication overuse headache” or “rebound headache”. You end up in a vicious cycle, where more painkillers are used, only to cause more frequent headaches.

        So clearly, chronic headache requires consultation with a doctor – and sometimes a neurologist.

        At the same time, coping with the pain is easier when you have the support of friends, family and peers. Otherwise, ensure a healthy lifestyle at normal weight, avoid smoking and alcohol, and exercise regularly to reduce the occurrence and severity.

Dr Gerard Lalande is managing director of CEOHealth, which provides medical referrals for expatriates and customised executive medical checkups in Thailand. He can be contacted at[email protected].