What’s causing your headache?


by Charlotte Haigh-MacNeil |

Meet our experts: Dr Fayyaz Ahmed is a consultant neurologist at Hull Royal Infirmary and spokesperson for The Migraine Trust (www.migrainetrust.org)); Dr Nick Silver is a consultant neurologist at The Walton Centre in Liverpool

If you regularly experience headaches, you’re not alone. More than ten million of us suffer from them. For most of us they’re not serious and taking a painkiller and having an early night is enough to clear them. But more severe or persistent headaches can be highly debilitating. Our guide will help you work out what might be causing yours – and how you can help yourself.

You’re not drinking enough

According to American research, if you drink less than 1.5 litres of fluid a day, you could suffer from mild dehydration – and that may lead to headaches. The general advice is to aim for 1.5 litres (3pt) of fluid daily, including tea, coffee, juice and other drinks. But to headache-proof yourself, it may be better to aim for 1.5 litres of plain water.

Scientists at the University of Maastricht, Netherlands, found that when women drank this amount each day, they experienced less frequent and less intense headaches.

Solve it: Set an alarm to remind you to drink a glass of water on the hour, or download the free Waterlogged app, which logs your water intake and prompts you to drink.

You’re taking too many painkillers

If you take painkillers for your headaches more than twice a week, your body can get used to them and this can actually trigger headaches as the effects wear off. “Between five and ten per cent of people have headaches for this reason,” says neurologist Dr Fayyaz Ahmed, consultant neurologist at Hull Royal Infirmary.

Solve it: Stop taking the headache tablets. “You’ll feel worse for about a week to ten days, but much better once the painkillers are out of your system,” says Fayyaz. After that, you should try to limit painkillers to once or twice a week and don’t take them on consecutive days. The exception to this is if you’ve been taking codeine-based painkillers regularly for a year or more. It can be dangerous to suddenly stop taking these, so have a word with your doctor about reducing them gradually.

You’re having too much caffeine

If you are experiencing frequent headaches, crave caffeine and feel perked up when you drink it, you may be over-doing it. Other signs to watch out for include insomnia and restless legs.

“Caffeine is known to have pain-relieving qualities, hence the old wives’ tale about having a strong black coffee to relieve migraine,” says Dr Nick Silver. “This is also the reason caffeine is added to many over-the-counter painkillers. It helps for a while but, just as with painkillers, once it wears off it can trigger rebound headaches.”

Solve it: You need to detox from caffeine, and stay off it. Be aware you’re likely to get headaches and may even feel sick for the first week, but after that you should start to feel much better – and have more energy, too. “Avoid tea, coffee, green tea and chocolate,” says Nick.

“White chocolate is fine as it doesn’t contain caffeine, and you can have some decaffeinated tea and coffee, although these still contain very small amounts of caffeine, so try to limit them.” Switch to herbal teas instead.

Struggling to cut out caffeine entirely? It may only be worthwhile for you if you suffer from really severe headaches or migraines. “But try to drink it in moderation,” says Fayyaz. Limit yourself to two or three cups of tea or coffee daily.

You have seesawing blood sugar

If you often skip meals, or you eat a lot of meals high in refined carbs such as white bread, pasta and white rice, then low blood sugar could be the common cause of your headaches and migraines, although doctors don’t fully understand the connection.

Solve it: “You need to eat regularly so you have a constant flow of energy,” says Fayyaz. Eat little and often rather than having two or three big meals. You should also avoid high-carb meals as this can lead to a big surge in energy, followed by a slump that may trigger headaches.

Avoid too many refined carbs and instead, aim for combinations of protein with unrefined carbs – such as an apple with a handful of nuts, an oatcake with cottage cheese, or chicken and veg with brown rice.

Your helter-skelter hormones

Fluctuating hormones, especially when you are going through the menopause, are a major cause of headaches and this is the chief reason women are twice as likely as men to suffer from migraine. Changing levels of oestrogen and progesterone throughout the menstrual cycle can be triggers and, just before the start of the menopause, erratic levels can mean headaches get worse for a while. On the plus side, once you’ve been through the menopause, they’re likely to get better.

Solve it: See your doctor if you have migraines and they’re getting worse. “Most women will suffer much less after the menopause but a small number are still affected and HRT can help,” says Fayyaz.

Red flags

Rarely, headaches can be a sign of a more sinister condition. Always see your doctor if:

You’ve suddenly started getting headaches when you haven’t suffered before

Your headaches suddenly get worse

Headaches feel worse when you lie down and better when you stand

You also have regular nausea and vomiting at night

Migraine: Busting the myths

Is your headache really a migraine? Understanding your pain could help you get the right treatment.

Myth: Migraine is uncommon

Fact: At least 15 per cent of the population is known to be affected, but migraine is vastly under-diagnosed. “Migraine is the commonest cause of headache in the over-55s,” says Nick. Many people dismiss migraines as simple headaches and don’t seek help, while GPs may misdiagnose them as tension headaches. In fact, says Nick, “Tension-type headaches are probably rare and may just be migraines with fewer features.”

Myth: You have visual disturbances with migraine

Fact: Only 15 per cent of sufferers have what’s known as an ‘aura’ – which can be bright spots or wavy lines in front of the eyes.

Myth: Migraines are very severe headaches

Fact: Not necessarily – while some people with migraine are in bed for days when they have episodes, others have milder headaches. Surprisingly, some experts see migraine as a ‘whole body’ condition that doesn’t even always involve headaches.

“Sufferers may experience little in the way of actual headache in some cases, but, for example, they may feel tired, apathetic and dizzy, yawn, crave sweet food, experience nausea and loss of appetite, pass a lot of urine, have diarrhoea, restless legs, neckache and stiffness,” says Nick.

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