What your headache is trying to tell you

Telegraph

5 days ago

How often do you feel the ominous sensation of a headache coming on? From a mild twinge after staring at a screen for too long, to a severe throb which makes work impossible, more than half the world's population has suffered from some form of 'headache disorder' recently, according to the most recent Global Burden of Disease (GBD) study.
But despite their prevalence, most of us never question what they might mean for our overall health. 'The vast majority are primary headaches, which means they don't have an external cause, such as viral meningitis or a head injury,' says Peter Goadsby, a professor of neurology at King's College London. 'The tendency to experience primary headache disorders is inherited, and then things in life will amplify it.'
Overall, there are more than 100 different clinical categories of headaches, ranging from those that can be tackled with paracetamol to frequent, seriously debilitating ones. Here is a guide to some of the most common headaches and their causes, as well as ways of preventing and treating them.
Around 10 million adults in Britain suffer from migraines, which costs the country approximately £2.3 billion every year in lost working days. They are characterised as a severe throbbing headache on one side of the head, which lasts between four and 72 hours and can be accompanied by blurred vision, nausea and acute sensitivity to sight and sound.
The most common trigger for migraines is variation, according to Prof Goadsby. 'Changing sleeping habits – getting too much or too little – skipping meals, suddenly starting to do overly extreme exercise, stress, drinking too much alcohol and a change in weather can all trigger a migraine,' he says.
It's rare to have one reliable trigger; for most people, it's caused by a number of factors coming together. And Prof Goadsby points out that some of what people assume are triggers – bright light, for example – are part of the initial stage of the migraine itself, before the headache hits.
Migraines are under-diagnosed and under-treated, says Dr Ben Turner, a consultant neurologist at London Bridge Hospital. 'There's a tendency to think a headache is only a migraine if there's visual disturbance, when this only happens to 20 per cent of people,' he says.
How to treat them
Migraines are ' highly treatable, so if your GP hasn't been able to help, seek a referral to a specialist and you're likely to find you've been suffering unnecessarily for years,' says Dr Turner. Triptans have long been used for migraine attacks, but recently a new class of drugs called gepants have become available, which are more effective, broadly tolerated and can be used to prevent as well as treat migraines.
The most excruciating form of headache, confined to one side of the head, cluster headaches last for an hour or two, often waking sufferers in the night. They are rare, and those affected – most commonly men – have rated the pain at 9.7 out of 10 – worse than childbirth at 7.2, a gunshot wound at 6 and a migraine at 5.4. They will usually become agitated and feel the need to move around, rocking and possibly hitting their head.
'It will happen every day, once or twice a day, for six to eight weeks at a time,' says Prof Goadsby.
The exact cause is unknown, but these headaches affect an area of the brain called the suprachiasmatic nucleus, a tiny region in the hypothalamus which acts as the body's central circadian pacemaker, regulating daily rhythms including the sleep-wake cycle. This may explain why cluster headaches tend to appear at the same time each day, and even occur at the same time each year. 'Peak times [for cluster headaches] tend to be spring and autumn, and in between, it's completely turned off,' says Prof Goadbsy.
How to treat them
Cluster headaches are sometimes misdiagnosed as dental pain or acute allergies because of symptoms including a watery eye and a stuffy nose on the painful side. They require specialist treatments to relieve the pain, such as oxygen therapy, sumatriptan injections or nasal spray.
The drug verapamil, taken as a tablet several times a day, is the main treatment for prevention, but it can cause heart problems in some people.
The most common type of headache, tension headaches cause a steady, mild to moderate ache that can feel like a tight band or pressure around the head, and can usually be alleviated with aspirin, paracetamol or ibuprofen. Unlike migraines, they do not cause nausea, vomiting or sensitivity to light and sound.
Often caused by poor posture and stiffness in the neck muscles, or eye strain, they can also be an indication of dehydration, lack of sleep, emotional stress, or too much caffeine.
How to treat them
Tension-type headaches – their official term – usually get better when someone moves around, particularly outdoors, so factoring in plenty of screen breaks is crucial. Gentle stretches, massages and heat on sore muscles can also be beneficial.
Prof Goadsby warns that if you're regularly getting headaches after staring at a screen for extended periods, there could be another underlying cause. 'A good starting point would be to get your eyes checked by an optician, but for most people in this situation, it's not a tension-type headache but migraine.'
A sinus headache is a symptom of a sinus infection (sinusitis), where the lining of the sinuses becomes inflamed and swollen, causing congestion and a dull pain behind the eyes, in the cheekbones, forehead or bridge of the nose. Research has shown that between 50 and 80 per cent of cases labelled as sinus headaches are actually misdiagnosed migraines. Dr Taylor says neurologists often see patients in this situation.
'Unless there's significant nasal congestion and discharge, it isn't sinusitis,' he says. 'We see GPs prescribing antibiotics to clear an infection, but if the problem is really migraine, they won't have any effect.'
How to treat them
Usually the infection clears in seven to 10 days, and using over-the-counter painkillers such as Sudafed can help manage the pain.
The vast majority of us will experience a dehydration headache at some point if we've been too busy to ensure we drink enough water. But why does dehydration manifest as a headache? The hypothalamus in the brain acts as a control centre, regulating bodily functions such as body temperature, hunger and thirst. If we become dehydrated, 'this area of the brain will be overstimulated,' says Prof Goadsby. 'In those who are susceptible, it can trigger migraine.'
How to treat them
Drinking 2-2½ litres of fluid a day (around six to eight glasses) is essential to keep headaches at bay.
Drinking too much caffeine can cause headaches for some people, but conversely, if you are a regular tea or coffee drinker, suddenly reducing your intake can also trigger them.
Caffeine's stimulating effects are exerted primarily by blocking adenosine receptors in the brain. Adenosine is a neurotransmitter that promotes sleepiness and relaxation by slowing down nerve cell activity. 'When you withdraw caffeine, you get a headache from the sudden increase in adenosine activity,' says Prof Goadsby.
How to treat them
Over-the-counter pain relief should help, but don't use it too often. 'If you're taking painkillers more than three days a week, it will give you a headache,' says Dr Taylor. Research shows that medication overuse can turn episodic headaches into chronic headache disorders, increasing their frequency and intensity.
Ophthalmodynia periodica, or ice-pick headache, is characterised by sudden, sharp stabbing pains behind the eyes which last for a few seconds at a time and can spread to the rest of your head.
'It comes from nowhere, and you can't stop it,' says Prof Goadsby. The exact causes are unknown, though a 2017 study found that these types of headaches are more common in women, and tend to affect people who usually suffer from migraines or cluster headaches. 'Around a third of migraine sufferers experience this kind of headache,' Prof Goadbsy adds.
How to treat them
'You just need to pause, let it play out and it will pass,' says Prof Goadsby. If they are happening frequently (over several consecutive days) and having a debilitating impact, seeing a doctor to rule out an underlying cause is a must.
Can headaches be hormonal?
Migraines disproportionately affect women – 20.7 per cent globally compared with 9.7 per cent of men, according to one 2022 review of research. For women aged 18 to 49, migraine is the leading cause of disability throughout the world. This is believed to be a result of hormonal fluctuations, particularly oestrogen, with migraines often most commonly occurring during a woman's reproductive and childbearing years.
Researchers estimate around 50 to 60 per cent of women with migraines experience menstrual migraines, occurring in the days leading up to menstruation, when oestrogen drops. 'It peaks at around the age of 40 for women, and if you begin to experience migraines around this time, it's often the first sign of the hormonal fluctuations which come with perimenopause,' says Prof Goadsby. 'After menopause, women have a four-out-of-five chance of migraines going away completely.'
If headaches are debilitating during perimenopause, hormone replacement therapy (HRT) can lessen their frequency and severity in some women. In others, it can worsen them, so speak to your GP about options.
How can you prevent headaches?
Many types of headaches can be prevented or at least reduced in frequency or severity. Proven prevention strategies include:
Drinking enough water
Keeping a consistent sleep and eating schedule
Exercising regularly
Managing stress
Eating a healthy diet
Supplementing with magnesium and vitamin B2
Lifestyle changes, including maintaining a consistent sleep and eating schedule, drinking enough water and taking regular moderate exercise, are the simplest and most effective place to start.
Relaxing after stress is a known trigger, which explains why some people wake up after a lie-in on a Saturday with a pounding headache. This is because, as your levels of stress hormones drop, there is a rapid release of neurotransmitters which send out impulses to blood vessels to constrict then dilate, which causes a headache. Prof Goadsby says: 'It may sound slightly hair shirt, but it's better to resist the temptation to lie in and get up at the same time every day.'
Managing stress throughout the week is vital, too. Techniques such as deep breathing, meditation or even a 10-minute walk around the block during a lunch break can help prevent stress levels climbing too high.
Eating a healthy diet is also likely to help. Keeping blood sugar levels steady by avoiding too many refined white carbohydrates and replacing them with fruits, vegetables, nuts, beans and wholegrains is sensible. It's often believed chocolate is a trigger, but according to Prof Goadsby: 'Research indicates that during the 'premonitory' early phase of a migraine, people may crave certain foods. So rather than triggering the migraine, reaching for a chocolate bar could be a warning that a migraine is starting.'
A 2025 review of research concluded that taking magnesium is effective in reducing migraine attack frequency and severity. Taking 400mg per day of riboflavin, or vitamin B2 supplements, for at least three months has also been shown to have a similarly positive effect.