【Major Points】
  1. Migraine and tension headache are the most common and chronic recurrent events.
  2. It is important to learn about headache prevention, relief techniques and take medications to manage chronic headaches effectively.  
  3. You should seek medical attention immediately if your headache gets worse and other events such as fever or incoherent speech.
What is headache?
Headache can be caused by different reasons, which can be divided into primary and secondary headaches.
  1. Primary headache (which is not caused by another disease): refers to migraine, tension headache, trigeminal neuralgia, etc. of which migraine and tension headache are the most common.
  2. Secondary headache (which is caused by another disease): it can be caused by a variety of reasons, such as fever, head trauma, cerebral hemorrhage, viral infection (e.g. COVID-19, influenza virus), sinusitis, and drug side effects.
What are the common symptoms?
  1. Primary headache: often chronic and recurring.
    1. Migraine:
      • Unilateral and throbbing pain (a pulsing sensation of the head) that can last for 4 to 12 hours, the pain may worsen when exercising, under dazzling lights or noise, etc. Sometimes symptoms like photophobia, nausea, or vomiting may occur.
      • One in every three migraine patients would experience an aura before the attack, e.g. feeling depressed, loss of appetite, or excessive yawning..., etc.
    2. Tension headache:
      • Feeling like wearing a tight hat or headband caused by tight muscles, usually near the temple on both sides of the head.
      • It may be worsened when nervous or irritated, it is less likely to combine with vomiting or exacerbated by exercising.
  2. Secondary headache:
    1. It cannot be improved spontaneously, need to treat the underlying cause of the pain.
    2. You should seek medical attention immediately if your headache is associated with the following symptoms:
      • Headache that keeps getting worse or aggravates suddenly (worst headache ever).
      • Fever combined with a stiff neck and pain.
      • Sudden change in the state of consciousness, e.g. seizing (involuntary movement of limbs), fainting, slurred speech, drowsiness,or incoherent speech etc.
      • Unsteady gait, weakness or numbness in limbs, even loss of sensation.
      • Visual impairment, e.g. sudden loss of vision or visual blockage, blurred vision, two images of the same object (aka double vision), etc.
Care principles:
An individual's physical and psychological status, lifestyle, fatigue, level of stress, or changes in sleep patterns (e.g. excessive sleepiness or sleep deprivation, changes in daily routine) may worsen the headache. Here's how to prevent headaches, methods to relieve the symptoms, and principles of care when seeking medical attention:
  1. How to prevent headache?
    1. Avoid substances or foods that may trigger headaches (e.g. alcohol, more or less caffeine, chocolate, cheese, etc.).
    2. Headache triggers are varied with the individual, keep a headache log to record substances/causes that trigger or improve the pain. It will be helpful to tackle the problem of headaches.
    3. Doing mild exercise regularly can prevent or ease the episode of chronic headaches, e.g. aerobic exercise or yoga, etc.
    4. Maintain regular sleeping patterns and quality.
  2. How to relieve the pain?
    1. Get a good rest: find a quiet and dark place to lie down and rest, especially during an episode of migraine.
    2. Head massage: may gently massage the scalp when it is not wounded.
    3. Warm/Cold compress:
      • Apply a cold compress to your forehead, and cease the application if the pain gets worse.
      • Tension headache could be relieved by a warm compress.
    4. Practice relaxation techniques: use mindfulness meditation, static stretching, etc.
    5. Get adequate hydration: dehydration can easily induce or worsen the headache.
  3. Medical approach:Make an appointment with a neurologist in the clinic when having recurrent chronic pain. Please provide information about the pain to your physician:
    1. When does it start? How bad is the pain (severity of the headache)? How long does it last? How often does it happen?
    2. Is the headache unilateral or bilateral?
    3. Does the pain combine with any other symptoms?
    4. What will worsen the headache? What can be done to relieve it?
    5. Do you have a family history of migraine (Anyone else in the family suffered from migraines too)?
    6. Are there any reasons that can cause a headache?
  4. Take your medicine as prescribed:
    1. The selection of medical treatment for prevention and cure is based on the symptoms of headache, complications, drug side effects, the cost, and the patient's preferences.
    2. Do not self-medicate painkillers.
    3. Take medications as prescribed and do not stop abruptly.
  1. Peng, T. R., Wu, T. W. (2020). Recent Advances in Migraine Treatment,Journal of Internal Medicine of Taiwan,31(5), 325-332.https://doi.org/10.6314/JIMT.202010_31(5).06
  2. Ailani, J., Burch, R. C., Robbins, M. S., & Board of Directors of the American Headache Society. (2021). The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain, 61(7), 1021-1039. https://doi.org/10.1111/head.14153
  3. Sullivan, D. P., Martin, P. R., & Boschen, M. J. (2019). Psychological sleep interventions for migraine and tension-typeheadache: a systematic Review and Meta-Analysis. Scientific Reports, 9(1), 1-8. https://doi.org/10.1038/s41598-019-42785-8
  4. Giamberardino, M. A., Affaitati, G., Costantini, R., Guglielmetti, M., & Martelletti, P. (2020). Acute headache management in emergency department. A narrative review. Internal and Emergency Medicine, 15(1), 109-117. https://doi.org/10.1007/s11739-019-02266-2
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