Frequent Headaches

Headache is a symptom, not a diagnosis, and the useful first question is which type. Tension-type headache is the most common — a bilateral, pressing, band-like pain of mild to moderate intensity without nausea. Migraine is less common but far more disabling: typically unilateral, throbbing, moderate to severe, worsened by movement, and accompanied by nausea, light sensitivity or sound sensitivity. Around a third of people with migraine experience aura, a transient visual or sensory disturbance preceding the attack. Migraine affects roughly 12% of adults and is around three times more common in women than men, peaking between ages 25 and 55. The World Health Organization ranks it among the leading causes of years lived with disability worldwide. The single most important pattern to recognise is medication-overuse headache. Taking acute painkillers — including over-the-counter combinations, triptans and codeine-containing products — on more than 10 to 15 days a month can convert episodic headache into a daily one. It is common, frequently missed, and only improves when the overused medication is withdrawn. Preventive treatment is generally offered at four or more headache days a month, or fewer if attacks are severely disabling. Alongside prescription options, several nutritional agents carry guideline support: magnesium at 400-600 mg daily, riboflavin at 400 mg, and coenzyme Q10 at 300 mg have all been rated probably or possibly effective for migraine prevention.

• •Throbbing or pulsating one-sided pain (migraine)
• •Band-like pressure across the head (tension-type)
• •Nausea or vomiting
• •Sensitivity to light and sound
• •Visual aura — zigzag lines, blind spots
• •Pain worsened by routine physical activity
• •Neck stiffness or tenderness
• •Fatigue or irritability in the day before an attack

• •Migraine (a primary neurological disorder)
• •Tension-type headache
• •Medication-overuse headache
• •Poor or irregular sleep
• •Skipped meals and dehydration
• •Hormonal fluctuation, particularly perimenstrual oestrogen drop
• •Alcohol, especially red wine
• •Stress and the post-stress let-down period
• •Neck and jaw dysfunction
• •Bright or flickering light

Migraine is now understood as a disorder of neuronal excitability rather than a purely vascular event. Cortical spreading depression — a slow wave of depolarisation across the cortex — underlies aura, while activation of the trigeminovascular system and release of calcitonin gene-related peptide drives the pain. Genetic predisposition is substantial. Tension-type headache involves peripheral myofascial sensitisation early on and central sensitisation as it becomes chronic.