What a headache!

  • Health
  • Sunday, 09 May 2004


Continuing from the last article on the dangers of self-medication, let’s look at one of the most common symptoms that we self medicate for – headache. Chances are that the headache is harmless, but beware that some headaches are just not the same as others, and can be quite dangerous. 

Some of the more common types of headaches include:  

Tension type headache 

Tension type headache is the commonest form of headache, with up to two-thirds of people experiencing it at some stage in their lives. 

Tension headaches are usually felt on both sides of the head. The pain is dull and persistent, varying in intensity. It is often described as a feeling of pressure, heaviness or tightness in a band around the head. 

Episodic tension type headaches can last from 30 minutes up to a week. They usually occur infrequently, but can progress to what is known as a chronic condition, where headaches occur all the time, with sufferers enduring headaches of varying intensity all day, every day, and can be woken by them at night. 

Generally, tension type headaches are diagnosed as being chronic when they are present for more than 15 days per month. In this case, a sufferer will notice the headache at the start of the day, and it will remain as a dull ache throughout the course of the day. 

Tension type headaches may be triggered by emotional or physical stress (for example, an argument, fatigue, prolonged reading, dehydration or sitting for a long time with bad posture), or by environmental factors such as loud music. 


Combat stress by keeping fit, getting regular sleep and exercise and eating a balanced diet. Some people find that learning specific relaxation techniques or posture improvement techniques such as yoga or meditation are effective because they teach you to relax, particularly during times of stress. 


Episodic tension type headaches are best treated with mild, over-the-counter analgesics such as aspirin and paracetamol. If the headache continues, you should take a shower or bath, apply a warm compress to your forehead and get some sleep. 

If your headaches occur daily and are diagnosed as being chronic tension type headache, your doctor may prescribe tricyclic antidepressants which have been shown to be useful in this condition, and which may also be useful for any associated depression. 

Some migraine sufferers (about 10%) also suffer from tension headaches. It is important to keep an accurate record of the exact symptoms and triggers for all your headaches so that your doctor can see if you fall into this category and treat you accordingly. See your doctor if your headache lasts more than 24 hours or occurs more than three times a week; you are woken by headaches, or they are worse in the mornings; your headache starts when you exercise, strain or cough; and your headache gets progressively worse over several days.  

Sinus Headache 

A sinus headache usually occurs as a gnawing pain over or under both eyes. It usually accompanies blocked sinuses caused by cold, flu or allergies and can be associated with a rise in temperature. The affected area may be painful when touched. The headache gets worse as the day goes on and increases in intensity if you bend forward. Sinus headaches can occur at any time. 

Sinuses are air-filled spaces in the facial bones around the nose, which are part of the respiratory system. Sinus headaches are one symptom of sinusitis, where your sinuses become infected and inflamed. 


If possible, stay indoors in a room with an even temperature, as a dry overheated environment could make your high temperature and nasal congestion symptoms worse. Steam inhalation may be useful to try and clear the sinuses. 


Take aspirin or paracetamol to relieve the headache. If symptoms persist, you need to see your doctor to be prescribed a broad spectrum antibiotic to combat the sinus infection and possibly a nasal decongestant to unclog your nose. If your sinusitis does not clear up, you may need to undergo a minor operation to remove any obstruction from your sinuses. 

See your doctor if symptoms last for more than a couple of days. 


Migraines affect one in eight adults in the developed world. People of any age can suffer, although adults aged 25-34 are most commonly affected, and women two or three times as frequently as men. 

The main migraine symptom is a moderate to severe throbbing pain, usually on just one side of the head. This is often accompanied by nausea (feeling sick), cold hands, vomiting and sensitivity to light and sound. 

A migraine where people suffer an “aura” or warning 10 to 30 minutes before the migraine begins only occurs in one in five cases. The aura may take many forms: lines or spots before the eyes, total darkness, tingling or numbness in the limbs and speech impairment. This can be a frightening experience. 

Eighty percent of migraines have no aura, although a few days beforehand you may feel irritable, lethargic and experience food cravings. A migraine attack occurs on average once a month and usually lasts between 4 and 72 hours. 

There is a wide range of possible triggers associated with migraine. They include: bright or flashing lights; irregular sleeping or eating patterns; loud noises and strong smells; sudden weather or altitude changes; and emotional factors such as stress, fatigue or excitement. Women may find fluctuating hormone levels (due to ovulation, menstruation, or birth control pills) are a contributing factor. 

Your diet can also make you vulnerable to migraines – red wine, cheese, chocolate, nuts, soy sauce, citrus fruit, alcohol, excess caffeine (e.g. cola, tea, coffee) and some food additives (monosodium, glutamate, sodium nitrate) are all possible triggers. 


One way to manage migraine headaches is to learn to recognise if there are “triggers”, so they can be avoided. Keeping a diary will help by highlighting suspect events, moods or foods. Given that stress is one of the most common triggers for migraines, relaxation such as yoga or meditation may be helpful. 

However, only a minority of people with migraine can clearly identify what triggers their attacks and even if triggers can be identified, they cannot always be avoided.  


Until recently, doctors were relatively limited in managing migraine. However, modern medicines are now available that can help minimise the disruption migraine makes to your everyday life. 

Mild migraine pain can be treated with analgesics (for example, aspirin, paracetamol), antihistamines and anti-emetics (to combat nausea). 

If you suffer two or more migraines a month, your doctor may prescribe preventative medication, which is used when migraines are severe or frequent enough to disrupt your life. This continuous, daily medication should help you to reduce the number of migraines and may eliminate them altogether.  

For moderate or severe attacks which are not too frequent, you may prefer effective, on the spot acute treatment rather than daily preventatives. In this case, medications such as sumatriptan or ergotamine can effectively reduce the severity and the duration of migraine pain and its associated symptoms. 

See your doctor if you think you might be suffering form migraine or if you are not satisfied with your current migraine treatment. If you have been suffering from migraine for years, there may now be more effective treatments available. 

  • Diong Swee Hoon is a qualified pharmacist. For more information, e-mail starhealth@thestar.com.my . The Star disclaims all liability for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. 

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