Headaches: When do you require immediate medical attention?
Written by: Hayley Kwon
Headaches are one of the main causes of absences from work and they frequently prevent people from enjoying their social life.
However, not everyone suffers from the same type of headache.
The International Classification of Headache Disorders (ICHD) defines more than 150 types of headache. The most common are tension headaches, migraines and cervicogenic headaches.
How many people suffer from headaches?
According to the World Health Organisation, 50–75% of adults aged 18–65 years had at least one headache during the last 12 months worldwide. Of these individuals, more than a third reported having a migraine. The Global Burden of Disease Study reported that headaches were the third highest cause of years lost due to disability (YLD). Migraine on its own was found to be the sixth highest. (1)
Different types of headaches
Tension headaches are the most common type of headache. They can be episodic, occurring for less than 15 days per month with attacks usually lasting only a few hours but can continue for several days. Alternatively, they can be chronic, occurring for more than 15 days in a month or even continually. Chronic headaches cause more disruption to daily activities than episodic headaches. (1)
The most noticeable symptoms of this type of headache include (2,3):
Constant, tight, heavy or pressing sensation on or around the head (the pain is
often described as a ‘tight band around the head’)
Tenderness of the neck and shoulder muscles
Pain felt on both sides of the head
Pain of mild or moderate intensity that does not inhibit daily activities
Lasting from 30 min to 7 days
Treatment is often by taking over-the-counter medication and decreasing stress.
A migraine is a neurological disorder and they can be very distressing. They are most commonly experienced by women aged between 35 and 45. The frequency and severity of migraines may be affected by female hormones. They can first occur around the menarche. The prevalence increases during the reproductive years and then decreases during the menopause. (4)
Symptoms of migraines include (5):
Intense throbbing pain on just one side of the head
Moderate to severe pain, often aggravated by movement
Photophobia (sensitivity to light)
Phonophobia (sensitivity to noise)
Lasting between 4 and 72 hours
Some people can experience an aura (visual disturbances such as flashing lights or blind spots lasting 20–45 minutes), and these are classified as migraines with aura.
There are various treatment options for migraine. Some headaches can be managed by taking aspirin, paracetamol or triptans. Unfortunately, these medications do not work well enough for some people. Other treatments that can be beneficial are acupuncture, chiropractic treatment, massage and yoga.
Recent studies have suggested that chiropractic care, including spinal manipulation, can
improve the symptoms of a migraine. (6)
Cervicogenic headaches are secondary headaches, which means that they are caused by an underlying condition. Migraines and tension headaches are classified as primary headaches, since they have no clear cause. (7)
They are commonly due to referred pain from neck structures, including the spine and the muscles of the neck. A cervicogenic headache is often difficult to distinguish from a migraine or tension headache. However, people who suffer from a cervicogenic headache often report altered neck posture or limited range of motion of the neck, and the headache can be triggered or reproduced by active and passive neck positioning. Muscular trigger points are commonly found around the base of the skull, the neck and the shoulders. (8)
The characteristics of this type of headache include:
Pain at the base of skull and around the eyes, usually starting in the neck
Pain exacerbated by neck movement or certain postures
Associated with neck pain and tenderness
Lasting from an hour to weeks
Physical therapy is the most effective treatment for this type of headache. The therapy mostly involves treating the structural problem in the neck that is referred to the head and causes the headache. Many studies have shown that chiropractic treatment, including manual adjustments, is helpful in alleviating a cervicogenic headache. (6)
If you have a headache but are unsure what type it is, we recommend that you consult a medical professional, who can make a diagnosis based on criteria published by the International Headache Society. Once you know what type of headache you have, you can be treated using the most effective treatment for that type.
Headaches that require immediate medical attention
A headache can also be a sign of a serious condition.
If you are experiencing any of the following symptoms, seek emergency care:
The worst headache ever
A sudden, new, severe headache
A headache associated with neurological symptoms such as weakness, dizziness, sudden loss of balance or falling, numbness or tingling, mental confusion
A headache with fever, shortness of breath, a stiff neck or rash
A headache after a head injury or accident
Bryans, R., Descarreaux, M., Duranleau, M., Marcoux, H., Potter, B., Ruegg, R., ... & White, E. (2011). Evidence-based guidelines for the chiropractic treatment of adults with headache. Journal of manipulative and physiological therapeutics, 34(5), 274-289.
Schankin, C. J., & Straube, A. (2012). Secondary headaches: secondary or still primary?. The journal of headache and pain, 13(4), 263.
Biondi, D. M. (2005). Cervicogenic headache: a review of diagnostic and treatment strategies. The Journal of the American Osteopathic Association, 105(4_suppl), 16S-22S.