Headaches: An Introduction

Headaches are not a disease or condition but rather a symptom of pain in the region of the head or neck. They may be a major presenting symptom in conditions such as migraines or be one of many symptoms in a condition such as sinusitis.1

The pain of a headache can range from minor to debilitating and may be caused by age, gender, health or overall lifestyle factors such as stress, fatigue and hunger.2, 3 There are numerous types of headaches and these are classified into primary headaches and secondary headaches according to the International Headache Society. Primary headaches are due to the headache condition itself whereas secondary headaches occur because of another condition.1

This article is an introduction into the topic of headaches focusing on the major primary headaches that people will most likely experience.


Tension-Type Headaches

A tension-type headache (TTH) usually lasts from 30 minutes to several days. If it occurs once or less per month it is categorised as infrequent episodic TTH; if it is experienced 1 – 14 days of the month on average for three months it is categorised as frequent episodic TTH and if it occurs more than 15 days per month in three months it is categorised as chronic TTH.4, 5,6


Mild-to-moderate, dull, non-throbbing pain, usually on both sides of the head or across the forehead. 
Sensation described as a painful tightness or pressure around the head.
Interrupts concentration.7


  • Emotional tension, stress, anxiety and fatigue.
  • Physical tension in the muscles of the scalp and neck. 
  • Bad posture.
  • Eye strain.
  • Hunger and dehydration.
  • Physical factors such as bright light, cold, heat and loud sounds. 7


The exact mechanism of tension-type headaches is unclear. It is theorised that peripheral pain mechanisms are involved in episodic tension-type headaches, whereas central pain mechanisms and generalised increased pain sensitivity are significant in chronic tension-type headaches. Genetic factors may contribute to developing tension-type headaches.

Moreover, the pericranial (vascular connective tissue enveloping the skull) pain sensitivity as well as triggering environmental factors such as emotional stress may lead to central nervous system excitation.8



Migraines are moderate-to-severe headaches usually on one side of the head. There are several types of migraines such as migraine with aura, migraine without aura and migraine aura without headache.8 A migraine usually lasts from 4 to 72 hours and the frequency varies in each individual.9


Migraines usually develop in stages, however, not everyone experiences all of them. The stages each have different symptoms. 10

1. Prodomal stage - One or two days before a migraine, warning signs occur including:

  • Constipation    
  • Mood fluctuations
  • Food cravings
  • Neck stiffness10

2. Aura -  Auras are usually visual disturbances but can be sensory, motor or verbal disturbances also. They can occur before or during a migraine attack. They usually last 20 - 60 minutes. They include:

  • Visual disturbances i.e. seeing various shapes or flashes of light
  • Vision loss
  • Pins and needles sensations in an arm or leg
  • Weakness or numbness in the face or one side of the body10

3. Headache stage

  • Throbbing pain on one side or both sides of the head
  • Sensitivity to light and sounds
  • Nausea and vomiting
  • Blurred vision
  • Light-headedness10

4. Resolution stage – this stage occurs after a migraine attack and for about 24 hours the following symptoms may occur:

  • Confusion
  • Moodiness
  • Dizziness and weakness
  • Sensitivity to light and sound10


  • Hormonal changes. 
  • Emotional stress, anxiety and tension.
  • Physical tension such as tiredness, poor posture, fatigue.
  • Diet such as irregular meals, dehydration and caffeine intake.
  • Environmental factors such as bright lights, loud noises and strong smells.
  • Medications. 11


The exact cause of migraines is not clear, however, research has focused on the anatomy of the nervous system and genetic causes, such as the trigeminovascular system (which consists of neurons in the trigeminal nerve that innervate cerebral blood vessels) and its relationship with pain pathways. 

In addition, about half of people with migraines have a first-degree relative with the condition. Moreover, there is a positive correlation between the intensity of the migraine and familial link indicating genetics having a significant role in migraines.12


Written By Rima Chatrath



  1. Rutter P. Community pharmacy. Third Edition. Edinburgh: Churchill Livingstone; 2013.

  2. Causes of Headaches in College Students | National Headache Foundation [Internet]. National Headache Foundation. 2009 [Accessed on: 5 March 2018]. Available from: https://www.headaches.org/2009/10/08/causes-of-headaches-in-college-students/

  3. Headaches [Internet]. nhs.uk. 2017 [Accessed on: 5 March 2018]. Available from: https://www.nhs.uk/conditions/headaches/

  4. The International Classification of Headache Disorders, 3rd edition [Internet]. Ichd-3.org. 2018 [cited 5 March 2018]. Available from: https://www.ichd-3.org/wp-content/uploads/2018/01/The-International-Classification-of-Headache-Disorders-3rd-Edition-2018.pdf

  5. Tension-type headaches [Internet]. nhs.uk. 2015 [Accessed on: 5 March 2018]. Available from: https://www.nhs.uk/conditions/tension-headaches/

  6. Tension headaches [Internet]. Migraine.com. 2010 [Accessed on: 5 March 2018]. Available from: https://migraine.com/headache-types/tension-headaches/

  7. Tension Headache [Internet]. Patient.info. 2017 [Accessed on: 5 March 2018]. Available from: https://patient.info/health/headache-leaflet/tension-headache

  8. Headache - tension-type - NICE CKS [Internet]. Cks.nice.org.uk. 2018 [Accessed on: 5 March 2018]. Available from: https://cks.nice.org.uk/headache-tension-type#!backgroundsub:1

  9. Migraine [Internet]. nhs.uk. 2016 [Accessed on:5 March 2018]. Available from: https://www.nhs.uk/conditions/migraine/

  10. Migraine - Symptoms and causes [Internet]. Mayo Clinic. 2017 [Accessed on: 5 March 2018]. Available from: https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201

  11. Causes [Internet]. nhs.uk. 2016 [Accessed on: 5 March 2018]. Available from: https://www.nhs.uk/conditions/migraine/causes/

  12. Migraine - NICE CKS [Internet]. Cks.nice.org.uk. 2018 [Accessed on: 5 March 2018]. Available from: https://cks.nice.org.uk/migraine#!backgroundsub:1

  13. Migraine - Diagnosis and treatment - Mayo Clinic [Internet]. Mayoclinic.org. 2017 [Accessed on: 5 March 2018]. Available from: https://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207

  14. Treatment [Internet]. nhs.uk. 2016 [Accessed on: 5 March 2018]. Available from: https://www.nhs.uk/conditions/migraine/treatment/