Tension-type headache is very common and accounts for 90% of all headache. Tension-type headache is less disabling than migraine and generally patients are able to continue to function. Precipitating factors include; stress, sleep deprivation, poor posture and missing meals. Although some patients require preventative medication, positive adjustment to lifestyle, including; remaining well hydrated; avoiding stress; and maintaining a good posture, can be helpful.
Migraine is the second most common type of headache and can make life miserable, especially when chronic. In a recent study, the World Health Organization ranked migraine as the 7th most common cause of disability. Despite being common migraine remains underdiagnosed and therefore untreated in nearly 50% of patients. Pain is moderate to severe and often associated with nausea or vomiting and their is frequently intolerance to bright light, loud noises and strong smells. Exercise often exacebates the pain and typically there is loss of function. Approximately a third of patients also experience aura, which is usually visual, lasting for approximately 20-30 minutes and preceding pain. Simple adjustments to lifestyle may improve things, although patients with frequent attacks often require specific preventative medication or procedures. The regular use of painkillers unfortunately often makes things worse and should be avoided. Although there is no cure for migraine there are a number of treatment options now available, which have been shown to reduce the frequency and severity of attacks.
Cluster headache is considered the most painful headache disorder. Pain in characteristically unilateral (side-locked) and located around the orbit and temporal area. Often there are associated symptoms including; eye puffiness; reddening of the eye; constriction of the pupil; tearing or nasal stuffiness. Typically patients with cluster headache wake in the early hours and need to pace around as the pain is so severe. Attacks may occur daily for several weeks or months before disappearing only to return at a later date. Alcohol is a potent trigger and should be avoided. Treatment focuses on the management of acute attacks and preventative medication to reduce attacks.
Minor head injury may result in concussion, which is considered a mild form of traumatic brain injury. Patients present with a variety of symptoms including: headache, dizziness, memory disturbance, poor concentration, nausea, fatigue and mood disturbance. Headache may be daily and very similar to migraine or tension-type headache.
Headaches associated with exertion and sexual activity
Headache associated with sexual activity may present as a dull headache that increases in intensity with sexual excitement or very acutely as thunderclap headache. Although various preventatives are available thunderclap headache should always be taken very seriously and requires urgent medical attention.
Cervicogenic headache is characteristically unilateral and often originates in the cervical spine or soft tissue around the neck. Often there is a history of injury or age-related degenerative change in the neck. Various treatment options are available including specific painkillers, physiotherapy or nerve blocks.
Occipital neuralgia is characterized by electric shock like pain along the distribution of the occipital nerve. The scalp is typically tender and often patients can't lay on that side in bed.