It’s been a busy day, you’re juggling a million things and your head is banging. But the show must go on. You pop a painkiller and carry on regardless. But what causes headaches initially?
Headaches are one of the most common neurological diseases globally, with an estimated 50 percent of the adult population suffering at least one headache in the past year.
Headaches are categorised as tension, cluster or migraine, and migraines significantly affect more women than men.
While Australian data is currently limited, stats from a 2018 Deloitte white paper found that 4.9 million people in Australia suffer from migraines. Seventy one percent of these migraine sufferers are women and 86 percent are of working age.
Yet, headaches remain one of the most underestimated, underrecognized and under-treated disorders throughout the world. But have we contributed to this? Are we so desensitised to pain that we’re dismissive of our suffering?
“When it comes to pain, many women have grown up with the attitude to ‘just deal with it’,” says Associate Professor Lauren Sanders, a neurologist and the Australian and New Zealand Headache Society co-secretary.
“Our experiences of pain have been downplayed, and often this has been perpetuated by society. It’s common for women with headache and migraine to also have menstrual problems, and it’s disheartening how many women haven’t even considered that it could be better.”
Professor Sanders notes it’s common for women to refer to their headaches as “normal”; however, this can backfire and exacerbate the underlying condition. “Headaches may be the result of a night out or a stressful day, but they indicate that your body’s out of balance and needs attention,” she says.
For people with a primary headache disorder such as migraine, physiological, mental or emotional stress will increase the chance of the body responding with a headache.
“The three non-medication things to consider are hydration, quality sleep and stress management,” she says. “It’s rare that the solution to a headache is medication alone, particularly after the intensity of living through a pandemic. Many people lost their connection to health ‘maintenance’ activities, and we’ve certainly seen a significant spike in stress levels. Our bodies aren’t designed to be ‘on’ 24/7.”
GPs are a great starting point for understanding your headache, as they’ll explore any “red flags” and typically check your blood pressure and run blood tests. Based on the frequency, severity and characteristics of the headache they’ll determine if any brain imaging is needed, though that’s usually not the case.
“There are a number of new headache treatments available now so there’s even more reason to see a GP if you’re suffering,” says Professor Sanders.
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What causes headaches?
Food allergies
There’s growing evidence to indicate that some headaches can be a symptom of food allergies or sensitivities. This is because the body confuses food as a danger so releases antibodies into the bloodstream causing a change in blood vessel behaviour.
“If you’re suffering regularly, try keeping a food and headache diary,” advises Kate Save, an accredited practising dietician and CEO of Be Fit Food. “Without changing your diet, take note of the ingredients of each meal, the time of consumption, and the time any headaches start to occur. This allows you to identify any links between what you’re eating and your headaches.”
Typically, if a headache is food-related it occurs between 20 minutes and two hours after eating.“Eliminating certain foods can help you to identify any likely triggers,” says Kate.
“If you continue to get headaches, then you can ascertain it wasn’t the ingredient, and vice versa. It’s also important to consider the amount of food you’re eating [too much or too little] and remember, dehydration is generally the most common cause of a headache.”
Kate adds that, while more studies need to be done, processed foods such as refined sugar, salt and preservatives can trigger negative reactions.
“My best advice for anyone suffering regular headaches is to consciously eat a diet rich in colourful vegetables, fruits, grains, legumes and healthy fats, avoid highly processed foods and stay hydrated.”
Tension and posture
Tension-type headaches and cervicogenic headaches are common. Tension, particularly in the upper body can cause headaches by increasing pain sensitivity and tightness in the muscles and joints.
Cervicogenic headaches are caused by issues in the neck, due to a direct connection between the nerves in the upper neck and the head. “Our modern lifestyle predisposes us to these problems,” says Helen Fleming, an Australian Physiotherapy Association musculoskeletal physiotherapist.
“Increased loading such as carrying children and lifting all the shopping at once places strain on our neck and shoulders.”
Sustained sitting at the computer and looking at our phones or tablets also contributes, she says. This has been more pronounced during COVID, with people working from home with poor ergonomic set-ups.
“If the neck is the primary source of the headaches, through posture or injury, physiotherapy can be effective in providing long term relief,” says Helen.
Physiotherapy treatment includes manual therapy to address tight muscles and joints, and exercises to improve posture, muscle strength and flexibility. For headaches associated with prolonged or awkward postures, Helen recommends regular breaks and changes of posture.
“For every half an hour of sitting, spend 5-10 minutes away from your workstation to ease neck and spine strain. Decrease tension when sitting by gently stretching the head, neck, and arms.
“With everyday activities such as carrying shopping, aim to have equal weight through each arm and make more trips with less weight. When carrying or holding children, swap sides frequently to avoid prolonged strain on the neck and shoulders.”
Mental health
When we perceive something as a threat, our body prepares itself for fight or flight, causing our muscles to tense, which can trigger stress headaches. The more threatened we feel, the greater the muscle tension and the more intense the headache can become.
Similarly, focusing on the headaches can manifest in health anxiety – a fear that the sensations mean something catastrophic. It can become a vicious cycle.
“Relaxation strategies are core to helping with anxiety and stress headaches,” says Dr Jodie Lowinger, a psychologist and author of The Mind Strength Method: Four Steps to Curb Anxiety, Conquer Worry and Build Resilience.
“Circuit breakers such as calm breathing can help to bring your stress levels back down to baseline, and practising daily self-care and wellbeing is also important.”
She suggests movement in the outdoors, connecting with community, getting enough sleep, and practising gratitude and acts of kindness to ourselves and others. To prevent our body from tipping into fight or flight mode, Dr Lowinger recommends embracing mindfulness strategies such as meditation.
“Move from worry into problem solving. Think about the things you can control to help you step out of agitation,” she says. “By purposefully focusing on the present, you automatically distract your attention away from anxious thoughts and concerns about the future.”
Hormones
Hormones can play havoc with our bodies so it’s no surprise that they can cause headaches too. During our menstrual cycle and pregnancy our levels of oestrogen and progesterone fluctuate, which impacts headache frequency and severity.
“Many women develop a headache just prior to or when their period begins,” says Dr Peter England, an obstetrician and gynaecologist.
“This can be attributed to a drop in hormone levels and is known as a premenstrual migraine.”
Symptoms can include nausea, visual disturbance, and discomfort with bright light. Headaches are also common during pregnancy.
“Women generally get headaches in early pregnancy due to the marked changes in hormones, but these typically settle by 20 weeks,” says Dr England. “Other headache triggers include dehydration from morning sickness and high blood pressure [known as pre-eclampsia].”
He notes that headaches aren’t an especially common symptom of menopause, although sleep disturbance often is, which can cause headaches.
“Lifestyle management helps a lot with headaches. Drinking plenty of water in pregnancy and in the late phase of the menstrual cycle helps, as does adequate rest and sleep,” says Dr England.
“Simple pain relief medication like paracetamol and ibuprofen are also effective in women who are not pregnant.”
Types of headaches
Tension – the most common and short-lived of all headaches, caused by poor posture, stress, muscle pain and stiffness. Symptoms include mild to moderate pain, a feeling of pressure around the head, and tenderness in the scalp, neck, and shoulders.
Cluster – the least common headache. These regularly recur over a certain period lasting anywhere from 15 minutes to three hours. Symptoms include intense pain localised to one eye and one side of the head, eye swelling, tearing and redness and blocked sinuses.
Migraines – the most severe form of headache, lasting anywhere from a few hours to a few days. Symptoms include severe pain affecting one side of the head, sensitivity to light and noise, nausea and vomiting.
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