Headaches can take a toll on our quality of life

Headache is very common. There are many types of headaches, with the most common being migraines, tension headaches and cluster headaches. Other types of headaches include cervicogenic headache (which is due to neck problems), occipital neuralgia, sinus headache, post-trauma headaches, and medication-overuse headache. We will cover the common headache types first, followed by the others below.

Here is how to differentiate between the common types of headache:

Characteristics of common headache syndromes

SymptomMigraine headacheTension headacheCluster headache
LocationOne-sided in 70% of people, on both sides in 30%. Usually over the forehead.Always on both sides of the headAlways on one side and in the area around the eye or temple
CharacteristicsSlowly builds up in intensity, pulsating/throbbing, moderate to severe in intensity, made worse by normal physical activityA sense of pressure and tightness that varies in intensity with time, usually light to moderate.Pain comes on suddenly and reaches a climax in intensity quickly in minutes, the sensation of a boring, excruciating, explosive and continuous pain that is extremely severe.
ActivityFinds relief in lying down in a dark and quiet roomVaries. may seek rest or activityUnable to rest
Duration3 hours to 3 daysVariable30 minutes to 3 hours
Other symptomsSensitivity to light and sound, nausea and vomiting; usually preceded by auras which represent changes in vision and hearing before the attackNoneA red-eye on the same side as the headache along with tearing, a blocked and runny nose, paleness of the face, intense sweatiness, drooping of the eyelids, and severe sensitivity to alcoholic beverages

Occipital Neuralgia

Occipital neuralgia is characterized by pain that arises at the back of the head near the occiput (that bony prominence that you can feel). The pain is like an electric shock, comes and goes, lasting moments, although there can be a lingering ache. The pain can also spread along the nerve towards the eye. The affected area can feel a bit numb, unpleasant, tender or exquisitely sensitive to touch. Other symptoms may include nausea and vomiting, difficulty with balance and slurred speech.

Treatment includes:
– Medications such as carbamazepine, gabapentin, pregabalin or tricyclic antidepressants
– Simple steroid injections
Pulse radiofrequency procedure
– Peripheral nerve stimulator
– Open surgery to “free” the entrapped nerve

Image result for occipital nerve


This condition is often very hard to differentiate from tension headache or migraine. If the patient has nasal discharge with or without fever and tenderness of the sinus in proximity to the headache, sinus headache should be considered as a diagnosis. There is usually no nausea or vomiting or any sensitivity to light and noise.

Treatment includes:
– antibiotics to treat any infection
– seeing an ENT specialist for consideration of drainage procedures

Post-trauma headache

Post-trauma headache, also known as post-concussion headache, can be due to motor vehicle accidents, falling down, and sports injuries. Symptoms may include headache, dizziness, mood and behavioural changes, forgetfulness and difficulty concentrating on a task, insomnia, and sensitivity to sound. An MRI may be needed to ensure that there is no bleeding in the brain or a serious injury that may need an urgent operation.

Symptoms usually improve after a week, although in some cases it may take up to 3 months. Treatment will need to address sleep, as well as cognitive and behavioural changes. Specifically for the headache, the treatment will involve:

– Medications such as amitrityline and nortriptyline, propanolol or indomethacin can be tried; intravenous metoclopramide or dihydroergotamine may be beneficial for certain patients.
– Some cases may respond to Pain Interventional Procedures such as an Occipital Nerve block or radiofrequency, or a sphenopalatine block.

Medication Overuse

People with chronic headaches usually rely on long-term usage of medications in order to cope with their symptoms. Unfortunately, these medications can become a cause of headaches as well. A vicious cycle forms in which a person takes medications to help with the headache, which causes a rebound headache when the medication wears off, leading the person to keep on using the medication in order to prevent a “withdrawal” symptom, which although less severe than an opioid withdrawal can still be very problematic.

The treatment involves:
– Avoiding this problem altogether by avoiding opioid medications and bulbalbital-containing medications
– Not using the following medications for more than 9 days a month: aspirin/paracetamol/caffeine combinations, triptans
– Not using the following medications for more than 15 days a month: NSAIDs such as aspirin, indomethacin or even newer COX-II inhibitors such as etoricoxib and celecoxib.
– Using a preventive medication for Chronic Headaches such as a tricyclic anti-depressant like amitriptyline or nortriptyline for long-term control of the headache.