Why do I keep having headaches? The types, triggers and treatments
The latest NHS figures show that more of us are suffering from them than ever before. Here’s how to cope. By Peta Bee
Headaches, in all their throbbing, piercing and debilitating guises, are on the rise. According to a review of 350 scientific papers, more than half the world’s population is estimated to have experienced some form of “headache disorder” fairly recently, higher than in the last Global Burden of Disease study, in 2019.
These encompass everything from migraines, a severe pain on one side of the head, and cluster headaches, excruciating attacks around one eye, to exercise-induced and tension headaches.
About ten million adults in the UK suffer from migraines, which produce the most disabling headaches, while general headaches have always been among the most common neurological reasons for attending A&E, but both are increasing in prevalence. The latest NHS statistics reveal that hospital diagnoses of headaches in the UK spiralled by 39 per cent and migraines by 163 per cent between 2015 and 2022.
What is causing the increases, says Dr James Gratwicke, a consultant neurologist at Guy’s, St Thomas’ and the London Bridge hospitals, is likely to be lifestyle factors.
“There is always an underlying genetic susceptibility to migraine headaches, but then there are the triggers that cause the headaches to happen. We are seeing an escalation in migraines with higher levels of stress and poor sleep in society, with dehydration and fasting or skipping meals also common triggers for some people.”
The prevalence, he thinks, is probably higher than statistics show. “Not everyone reports migraines if they are mild and can be controlled with trigger management. Of those we know about, roughly one fifth of cases can be managed with lifestyle control, 30 per cent need acute treatment during a migraine attack and half of people with migraines get them for eight or more days a month and need a preventative approach.”
With symptoms ranging from annoying to disabling there is, Gratwicke says, “no such thing as a normal headache”, and the way one person deals with them will be different to treatment control for someone else. “Headaches are incredibly common and can be hugely disruptive,” he says. “It can be a process of elimination but there are always ways to help people and to improve their lives by reducing their frequency and severity.” Here’s how:
Stick to regular meal and sleep patterns
If you are prone to migraines and headaches, your brain probably prefers the balance that regular sleep and mealtimes provides. Skipping meals and occasional late nights can trigger them in susceptible people, and Gratwicke says he has seen an increase in patients for whom intermittent fasting diets are a migraine trigger.
“Routine and regular mealtimes are key for migraine prevention,” he says. A recent review of 71 studies published in the journal Neurology confirmed that our internal body clocks and circadian rhythms — the natural 24-hour sleep/wake cycle — may influence when and how often people experience headaches. Their findings showed that for 71 per cent of people who experience cluster headaches, which can persist for hours or days, there was a strong circadian pattern. Attacks peaked in the late evening to early morning, with people getting more cluster headaches in the spring and autumn.
About half of people susceptible to migraines were found to have more attacks from late morning to early evening, with fewer episodes at night. “We know that people with migraine are more sensitive to change,” says Ria Bhola, a headache-specialist nurse for the Migraine Trust. “A drop in blood sugar from skipping meals or an irregular meal pattern can act as a trigger, so maintaining regularity of meals is considered more important than the type of food when it comes to preventing attacks.”
Avoiding meals can also mean you drink less. “Dehydration is a very common but overlooked migraine trigger,” Gratwicke says. “Make sure you take on enough fluids every day.”
Why do I get a thumping head after a workout?
Headaches after a long, arduous workout are common and the International Headache Society lists “primary exercise headaches” on its list of triggers. Some researchers have suggested that prolonged, sustained exercise causes changes in blood flow to the brain that might be to blame, but other factors could be at play, says Juliet McGrattan, a former GP and author of Run Well.
“Dehydration and low blood sugar can bring on headaches, so making sure you eat and drink before workouts is important,” she says. “These headaches are usually associated with sustained exertion such as a long run or cycle, and might be exacerbated by poor posture and carrying tension in your shoulders and neck, so try to keep the upper body relaxed.”
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