“[A] migraine isn’t a knee injury… it’s something you can’t physically see,” Serena Williams, the 23-time Grand Slam singles winner, once told People magazine. Many athletes play through an injury and a pregnancy, just like Williams did. But she also smashes the green ball across the tennis court when she has migraine headaches.
We all know what headaches are and might have experienced them. However, the invisible nature of these annoying pains contributes to their high prevalence and masks how debilitating they can be. A 2022 study in the Journal of Headache and Pain Reports finds that 52 per cent of the global population suffers from different types of headaches.
Just like a kaleidoscope displays various changing colours and patterns, headaches come in myriad forms, intensities, and locations. They vary based on which part of the head hurts, how long the pain persists and the accompanying sensations that come with the pain.
Cause or no cause
Headaches occur when the pain-sensitive nerve endings respond to headache triggers and transmit the signals through the trigeminal nerve to the thalamus. The thalamus then relays the pain sensation to the body.
Headaches are often compounded by an external cause, says Dr Gurneet Singh Sawhney, senior neuro and spine surgery consultant at Fortis Hospital Mulund, Mumbai. Based on the presence of this external cause, he says that headaches can be categorised as primary or secondary headaches.
“In primary headaches, we don’t know the cause, or the cause is hidden, and the brain scans appear normal,” says Dr Sawhney. These types of headaches are considered distinct, and studies suggest they arise from a combination of genetic and environmental factors.
Primary headaches can occur in a wide range of symptoms.
1. Migraine, the one-sided menace:
According to the Global Disease Burden Reports 2019, migraine is the second cause of disability worldwide as it significantly affects the quality of life of a person. Dr Sawhney describes these throbbing one-sided headaches as similar to being struck on the head with a hammer. He says they are more common in women, and that an attack can last up to 72 hours. “People with migraine often don’t like sound and light; they have photo phonophobia,” he observes.
The causes of migraines, too, vary among individuals. “However, most of the time, migraines are induced by stress and diet,” says Dr Ramesh Ranganathan, a Bengaluru-based neuro and spine surgeon. He says identifying the triggers for migraines is crucial for implementing preventative strategies.
Treating migraine involves a multifactorial approach, according to Dr Ranganathan. This includes counselling the person on tackling their stresses and guiding them through breathing, yoga practices and medications to ease the onset of headaches.
Read more: Four holistic ways to manage migraine
2. Taut and tense, the tension-type headache
Tension-type headaches present as mild, non-throbbing pain circling around the head like a tight band. “This is the most common type of headache, which occurs because the muscles of the scalp and the neck are tight,” Dr Sawhney states. He explains that the muscles turn tight due to excessive straining, stress, muscle tension, poor posture and anxiety, all of which can contribute to these dull headaches. The treatment usually depends on identifying the cause of the stress.
3. A cycle of pain, the cluster headache
Cluster headaches are rare but excruciatingly painful and more common among men. They often go unnoticed or are misdiagnosed. The pain is localised to one eye, accompanied by redness, tearing and a stuffy nose. The characteristic feature of these headaches is they occur cyclically or in clusters. The cycles could last anywhere between a few weeks and a few months, followed by periods of relief. Cluster headaches are remarkably “punctual”, occurring at the same time each day during an attack.
Dr Sawhney says that though some medications help, giving a high flow of oxygen to the person can provide instant pain relief.
Read more: Why some headaches recur with CLOCKwork precision
4. The cure is the cause, the overuse headache
Overuse headaches, often resulting from excessive medication or analgesic use, can lead to a troubling cycle. “These people feel like the medication is helping them with the headaches, but it is the other way around, and they are actually addicted to the painkiller,” Dr Sawhney explains.
Research indicates that people with pre-existing primary headaches like migraines and tension-type headaches are more susceptible to these headaches. Dr Sawhney recommends completely withdrawing the dependent medication, transitioning to a milder alternative, and taking appropriate rehabilitation measures.
Secondary headaches
As per Dr Sawhney, secondary headaches occur due to some structural problem in the head, which often show up in the scan as a tumour or bleeding. Dr Ranganathan agrees, adding that secondary headaches could uncover some kind of anomaly like strokes, head injury, increased pressure in the skull and infections like meningitis which could be causing the pain. The experts concur that the treatment for these headaches varies and depends on detecting the underlying cause.
It is vital to be vigilant of the red flags that may indicate a secondary headache. These warning signs include headaches that significantly disrupt daily life, accompanied by symptoms of disorientation, weakness, and extreme sickness. “If these signs are present, seeking medical help is crucial. A doctor can analyse the structural changes to the brain that could be causing the headache,” Dr Ranganathan advises.
