Understanding the problem
Understanding the problem
When to refer
As headaches are so common, many people will downplay their symptoms, so it’s important to be able to identify when a customer should be referred. Signs that something is not quite right include a headache that:
- Is worsening and accompanied by a fever
- Has a sudden onset and becomes severe very quickly
- Is triggered by pressure changes such as sneezing, moving from standing to sitting, or exercising
- Has changed significantly since it began or has been present for a long time
- Follows an accident or knock to the head
- Does not respond to OTC analgesics within a day
- Is in someone with a compromised immune system, such as a patient undergoing cancer treatment
- Follows exposure to, or withdrawal from, a substance
- Is accompanied by vomiting without an obvious cause, a painful red eye, personality changes, lockjaw, impaired consciousness or other signs of neurological or cognitive problems, such as memory loss or numbness, slurred speech or confusion.
Tension-type headaches and migraine are the two most common forms of primary headache. Medication overuse headache, a secondary headache, is the third most common type of headache.
Tension-type headache is the most common type of headache. The pain, often described as pressure or tightness, is usually felt on both sides of the head. It is estimated that frequent tension headaches affect a third of adults. The term chronic tension-type headache is used if the headache occurs on 15 or more days a month and lasts for more than three months at a time. Chronic tension-type headache can have a significant impact on a person’s quality of life.
Migraine is also common, affecting women more than men. A throbbing pain is usually felt on one side of the head, other symptoms include nausea, vomiting and an aversion to light and noise. A migraine can last from several hours to three days and be occasional or recur several times a year. Migraines can be debilitating, and people may need to leave work or school to manage their symptoms and recover.
Migraine is often associated with symptoms that precede the headache, such as seeing spots or flashing lights, feeling confused, dizzy or lightheaded and experiencing numbness, tingling or difficulty speaking or listening. This is known as migraine with aura.
Medication overuse headache can occur when a person overuses painkillers so that they are taking them regularly for at least three months at a high or frequent dose. This results in a ‘rebound headache’, which can make a person feel like they constantly have a headache. Paracetamol, NSAIDs such as ibuprofen and opioids such as codeine are common culprits. Other drugs used to treat headache and migraine, such as triptan sumatriptan, can cause medication overuse headache too.
Other types of headache can be triggered by something specific, such as hormonal changes, dehydration, eyesight problems, blocked sinuses or cold and flu viruses. There is another, less common, type of headache called a cluster headache. This causes sudden, severe pain on one side of the head, often accompanied by a painful, watering eye and a watering or blocked nostril on the same side.