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Central nervous system
Headaches are one of the most common pain complaints. Most people get headaches from time to time and they are usually just an inconvenience. However, some headaches are more frequent or severe, causing concern and disrupting family, social and working life. In rare cases, a headache may be a sign of a more serious condition.
The most common types of headaches are tension headache and vascular headache.

Tension headache is thought to be due to a tightening of the facial and neck muscles, possibly triggered by emotional stress, poor posture, eye strain, bright lights, dehydration, hunger, food intolerances, menstruation, coughs and colds, even to changes in the weather. Tension in the muscles is detected by pain receptors in nerves located in the scalp, causing the sensation of a headache. It is possible to develop headaches when using medication over long periods to relieve the headaches, this is called rebound. Sufferers find that they are experiencing more and more headaches, often daily, and that they require increasing amounts of medication to relieve them, creating a vicious cycle.

Vascular headaches are caused by a change in the blood vessels supplying the brain. Although the brain itself does not experience pain, there are receptors in the blood vessels which respond to the vascular changes, causing the sensation of pain. It is not known what causes these vascular changes but they can be triggered by chocolate, alcohol and strong smells. There are two types of vascular headache, migraine and cluster headache. Cluster headache will be explained in this section, for a more detailed explanation of migraine, please refer to Migraine in its own section.
A tension headache is a feeling of pressure or a tight band around the head. A constant throbbing pain is experienced on both sides of the head, extending across the forehead and sometimes creating a feeling of tension in the muscles of the neck. Pain builds up gradually, is generally mild to moderate in severity and usually lasts for a few hours.

A cluster headache is a rare form of headache where the pain occurs on one side of the head, is centred round one eye and is described as searing, excruciating, knife-like or boring into the eye. The eyelid will droop and the eye becomes red and watery. Individual attacks start quickly and last only a short time but they occur in 'clusters', ranging from once every other day, up to eight times a day. Clusters usually last for six to eight weeks with periods of remission which can last months or years.
Pain killers in the form of tablets or capsules containing paracetamol, aspirin or ibuprofen are available over the counter. They are most effective when taken at the first signs of a headache beginning.

For the short term treatment of acute, moderate pain which is not relieved by paracetamol, ibuprofen or aspirin alone, the pharmacist may recommend codeine or dihydrocodeine. However, it is important that these two medicines are taken for no more than 3 days as they may cause addiction and their over use may actually cause headaches. In fact, the over use of all analgesics should be avoided and it is important not to exceed the recommended dose. Aspirin or aspirin-based products should not be given to children under 16 years of age.

Cluster headaches do not tend to be eased by simple analgesics, but they can be treated with an injection of a drug called sumatriptan. If cluster headaches occur very frequently, drugs such as clonidine and methysergide can be used to prevent attacks. They all act by altering the vascular response, causing constriction in the blood vessels supplying the brain and therefore easing the pain. These drugs can not be bought over the counter, but may be obtained on a prescription.
When to see your pharmacist
All of the analgesics for the treatment of tension headache can be obtained from your local pharmacy without a prescription. If you are worried about your headaches, it is important that you talk to the pharmacist and describe your symptoms and when they occur. Your pharmacist will be able to tell if you have a tension headache, cluster headaches or a migraine and will be able to recommend an appropriate course of treatment or suggest that you see your doctor. Also tell your pharmacist if you are taking any other medicines as sometimes these may be the cause of your headache.
When to see your doctor
If you think you are suffering from frequent headaches, you should consult your doctor for an accurate diagnosis and to discuss appropriate treatment. If your headache occurs suddenly and severely (especially if you have recently experienced a knock to the head), if it is accompanied by a fever, convulsions, feelings of drowsiness, blurred vision or vomiting, if you notice a dramatic change from your normal headache pattern, or if your headache does not respond to over the counter analgesics you should seek medical advice urgently.
Living with headaches
Do not let tension headaches and cluster headaches control your life. There is much that you can do that can put you in control of your headaches, rather their controlling you. While you may not be able to prevent headaches completely you can reduce the number of times that they occur and you can reduce the severity of attacks if they do occur.

As many headaches occur as a result of tension or stress, learning to control stress or avoiding stressful situations can be a big help. Plan your day so you know what you want to do and when you want to do it. Do not try to do too much and do not worry if you do not manage to get everything finished. Organise your working environment. If something is in your way or if something is not working properly, move it or fix it. It's amazing how spending a short time resolving niggling problems will save so much time and make you feel so much better.

Take breaks and holidays doing something different where you can switch off from the pressure of your work. Take up a sport or do exercise such as yoga, a little at first, gradually building up your level of fitness. Try to establish a regular sleep pattern. Do not spend too much or too little time in bed. Instead establish a sleep pattern, going to bed early and getting up early, that provides about 8 hours sleep per day.

Drink plenty of water throughout the day, especially in warm weather of if you have been exercising, to avoid dehydration. Eat regularly, small amounts of food at regular meal intervals is far better than skipping breakfast, snacking during the day and eating large meals late at night.

Try to identify what is triggering the headaches by keeping a diary of things that you ate or the things that you did prior to the headache starting. Avoid these things in the future.

If you do get a headache this can often be eased by deep breathing exercises or a massage of the neck and shoulder muscles. Lowering body temperature by the application of a cold flannel to the forehead or by taking a cool shower will also help.

If you need to take pain killers, take them at the onset of a headache but do not get into the habit of taking pain killers regularly in the belief that they will prevent headaches, they are more likely to increase your headaches. Never exceed the recommended dosage or the recommended length of treatment of medicines.
Useful Tips
  • Have a rest or lie down somewhere quiet avoiding bright/strong light
  • Eating something sometimes helps
  • Try to avoid triggers such as stress or getting angry
  • Do not take analgesics regularly and never exceed the recommended dose
Further information
Organisation for the Understanding of Cluster Headache (UK)
OUCH offer support and guidance to sufferers of cluster headache and their families and work closely with the Institute of Neurology in London where their Patron, Professor Peter Goadsby, runs the Headache Group.

Headache UK
This umbrella organisation of the five leading charities in the UK devoted to headache and migraine aims to achieve recognition of chronic headaches as a major public health problem. The group promotes understanding of the significant impact headaches can have on the lives of people with these chronic conditions and tries to ensure speedy diagnosis and quality management for people who live with chronic headaches.

Migraine Action
A registered charity that provides support and information to sufferers, friends, families and carers
Helpline: 0116 275 8317 (Mon - Fri 09.00 - 17.00)