14 October 2004

The causes of headache

Muscle contraction can lead to tension headaches, while migraine and cluster headaches are caused by vascular factors. Infection can also be a cause of headache.

Muscle contraction, vascular factors and infection are a few of many factors that can cause headaches.
  • The most common cause of headache is scalp and neck "muscle contraction" or tension headache. This affects 20% of the population. Tension headaches are usually in relation to stress or anxiety.
  • Vascular headaches, namely migraine and cluster headaches, make up the other large group of headaches – affecting 5 – 10% of the population.

    Both tension and vascular headaches can occur in an individual at the same time. In practice, the distinction between these two entities is often less clear-cut, and there may be an element of both muscle tension and a vascular component at the same time.

  • Headaches due to infection of surrounding structures: sinus infection, tonsillitis, toothache, meningitis.
  • Headache due to inflammation of surrounding tissues: cervical spine arthritis, constant coughing, straining of the eyes, acute glaucoma, trigeminal neuralgia and temporal arteritis
  • Certain conditions will cause a stretching or pulling of pain-sensitive parts and inner structures of the head. These include concussion and other head trauma, strokes, brain tumours and spinal taps (lumbar puncture).
A number of metabolic, toxic or environmental causes are:
  • The use of certain medications (side-effects)
  • Eating or drinking iced foods and fluids
  • The use or withdrawal of alcohol ("hangover"), caffeine, or other analgesic drugs (analgesic headaches)
  • Breathing in smoke or fumes from chemicals
  • Repeated exposure to nitrate compounds (found in heart medicine and dynamite; also used in a meat preservative, sodium nitrate – such as in hot-dogs and bacon)
  • Exposure to materials containing chemical solvents (for example benzene, turpentine, spray adhesives, rubber cement and certain inks)
  • Eating foods (such as Chinese food) prepared with monosodium glutamate, a flavour enhancer
  • Exposure to poisons such as insecticides, lead and carbon tetrachloride
  • Use of drugs such as amphetamines
  • High altitudes (above 4 500m)
  • High blood sugar (hyperglycemia)
  • Low blood sugar (hypoglycemia)
  • Low calcium levels in the blood (hypocalcaemia)
  • Kidney failure (uraemia)
If a headache is caused by a serious illness, other symptoms are often present, such as vomiting, dizziness or changes in vision.

Reviewed by Dr Andrew Rose-Innes, MD, Department of Neurology, Yale University School of Medicine, New Haven.

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Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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