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With or without auras.

Some people who get migraine attacks also get what is called an aura before an attack. The aura happens because some of your nerves don’t work in the way that they usually do. The aura is a warning of an attack, and it can be frightening. About 1 in every 6 people who have migraines (15 percent) get auras. If you get an aura you may suddenly:

* See flashing lights or have blind spots (areas that you can’t see)
* Have ringing in your ears
* Develop numbness in parts of your body, such as your hand, or have pins and needles
* Have trouble speaking. For example, you may not be able to find the right words.

All of these symptoms are what make migraines different from other headaches, including tension-type headaches (the most common type of headache). But every person is different, and your migraine symptoms may not be the same as other people’s.

When should I see a doctor straight away?

If you have any of the symptoms in this list, see your doctor urgently.

* You have a very painful headache for the first time that came on suddenly (within one or two minutes), especially if you feel it is the worst headache of your life. If you have a headache that feels like someone has kicked you in the back of your head, it may be a sign that a blood vessel in your brain has leaked. If this has happened you need urgent treatment. Dial 999 or visit the Accident and Emergency (A&E) department of your local hospital.
* Your symptoms suddenly change. For example, you’ve had migraine attacks for a while, but there is a change in how often you have them and the headaches get stronger. Or perhaps your arm feels numb for the first time. Some people who have migraines with auras start getting attacks without auras. None of these things necessarily mean anything is seriously wrong. But your doctor will want to find out about any changes to the usual pattern of your symptoms.
* You have your first severe headache and you are over the age of 50. It is not that common to start having migraine attacks at this age, so your doctor will want to be certain that nothing else is causing your symptoms.
* You have a severe headache with fever, sickness and possibly a rash. These symptoms could mean you have a serious illness called meningitis and you should get treatment straight away.

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You have migraine if you get a headache that lasts from four to 72 hours and you also have two of the symptoms listed below.

* The pain is on one side of your head (this is called unilateral pain). This pain is often at the front of your head.
* The pain is a throbbing pain.
* The pain gets worse when you move.
* The pain is moderate or severe.

If you have a migraine attack you will also have one or more of the symptoms in this list:

* You may feel nauseated (as if your stomach is upset or you are going to vomit) or you may vomit
* You may feel extra-sensitive to light (this is called photophobia)
* You may be extra-sensitive to sounds (this is called phonophobia).

Migraine attacks often start when you wake up in the morning. If they start during the day, these attacks tend to take several hours to build up to their worst.

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Many people take painkillers, such as paracetamol or ibuprofen, to help with the occasional tension headache. That’s fine, but people with chronic tension headache get headaches 15 days a month or more. You shouldn’t take painkillers this often. Taking painkillers more than two or three times a week can actually cause more headaches.

In one study, 75 in 100 people had fewer headaches when they cut down on painkillers. If you take painkillers regularly, talk to your doctor. They will be able to help you find another treatment.

The antidepressant drugs amitriptyline and mirtazapine (Zispin SolTab) can help with chronic tension headache. Taking one of these drugs regularly can mean you get fewer headaches. The headaches you do have should get better faster. Your doctor will start you on a low dose and increase it gradually. You’ll probably take an antidepressant for about six months. After this time, your doctor may want to see how you get on without the drug. If your headaches come back, you’ll be able to start treatment again.

Antidepressants can cause side effects. In one study:

* About 6 in 10 people who took amitriptyline felt sleepy
* About 5 in 10 people got a dry mouth
* About 2 in 10 people put on weight

Another study found that mirtazapine was less likely to cause these side effects than amitriptyline.

Research has found that taking antidepressants can make some people, especially those under 18, more likely to think about suicide or self-harm. This is more likely in the early stages of your treatment, or if the dose of your antidepressant is changed. If you’re taking an antidepressant and are worried about any thoughts or feelings you have, see your doctor straight away.

Tranquillisers are drugs that help you feel calm. There’s been some research on a drug called diazepam for chronic tension headache. But researchers found diazepam caused only a small improvement, and it has serious side effects. You can get addicted, and it can make you drowsy, confused and forgetful.

Other treatments

Cognitive behaviour therapy is a talking treatment. It can be used to help people cope with stress. If your tension headaches are triggered by stress, therapy could help you feel better. There hasn’t been much research, but one study found that about a third of people who had therapy got fewer or less severe headaches over six months.

Relaxation training and biofeedback are used to teach you how to relax the muscles of your head and neck. The idea is that learning to relax relieves the tension that might be triggering your headaches. In biofeedback, you wear an electrical device that tells you how tense your muscles are. When you relax, you get a signal, such as a beep. Eventually, you learn to relax by yourself.

You won’t have to take any drugs, but relaxation and biofeedback take up a lot of time. And there hasn’t been much research to say whether they work.

Acupuncture is an ancient Chinese treatment. In this treatment, a trained acupuncturist puts thin, sterile needles into your skin. Some people try acupuncture because they don’t want to take medicines. But the research on this treatment isn’t good enough to say whether it works.

What will happen to me?

Tension headaches are usually fairly mild. But if they happen a lot, they may interfere with your work or your social life. Getting treatment can help. Tension headaches tend to happen less often as people get older.

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Tension headaches happen when you’re feeling stressed, tired or angry. Some doctors think the pain is caused by tension in the muscles of your neck or your head. But other doctors don’t think these headaches are caused by muscle tension at all. So they prefer to call them tension-type headaches.

If you have chronic tension headache, you get these headaches a lot. Doctors say you have chronic tension headache if you get tension headaches more than 15 days a month for at least three months. For some people, the pain never goes away completely.

Tension headaches are different from migraines. Migraine headaches can make you sensitive to light or noise, and make you feel sick or dizzy.

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Most people get headaches from time to time. But if you have chronic tension headache, you have a headache most days.

Chronic is a word doctors use to describe any medical condition that people live with for a long time. It doesn’t mean that a condition is severe. In fact, tension headaches are usually fairly mild. They’re a problem only because they happen so often.

We’ve looked at the best and most up-to-date research to produce this information. You can use it to talk to your doctor or pharmacist and decide which treatments are right for you.

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Headache medicine is commonly prescribed to treat the pain frequently attributed to tension and stress headaches. These headaches can become a daily nuisance for patients, striking seemingly at random and seriously impairing quality of life. In some cases, headaches become a very real impediment to daily functioning. It is important to treat these headaches promptly, in order to bring quality of life back up to normal levels.

Over the counter medications such as ibuprofen, aleve, and acetaminaphen can do a great deal to alleviate headache pain. In some situations, more powerful headache medicine may be required in order to resolve the problem. Non-steroidal anti-inflammatory drugs can usually do a great deal to reduce pain and symptoms, but sometimes more powerful medicines may be required. Triptans are a more powerful family of headache medicine, and are usually prescribed to sufferers of migraine headaches. Hormonal headaches can potentially be a cause of severe headache pain. This kind of headache is due to shifting levels of hormone production, and are difficult to prevent. Regular NSAID over the counter medication can also treat this variety of headache fairly effectively.

Sinus problems can also be a significant source of headache pain. Under these circumstances, sinus pressure that builds up behind the nasal cavity causes an uncomfortable sensation. In severe cases, the excess mucus that has built up behind the nasal cavity can become infected. When this happens, the pain can be quite severe. A persistent pain behind the eyes is a good sign of such an infection, as is any swelling or blood discharge from the nose. Decongestants, nasal sprays, and antibiotics can all act as effective treatments of are all good treatments for sinus infections, and may be necessary headache medicine.

In addition to headache medicine, prevention is an important part of treating frequent headaches. Primary headaches are by far the most typical kind of headache, and occur due to added tension or stress, either physical or emotional. Stress management can be an effective way to treat headaches, thereby preventing them from occuring. Stress and tension headaches frequently develop as a band like feeling above the eyes. This can act as a definite signal to take preventative measures. Regular anti-inflammatories are typically a decent treatment when headaches begin to develop. Further treatment can include biofeedback, or massage therapy.

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