All in the head: For some, headaches aren’t just an occasional annoyance but a debilitating condition

Different sorts of headaches need different treatment
Different sorts of headaches need different treatment
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I’VE got a headache – it’s the oldest excuse in the book, and one few of us take very seriously. Pop a pill, have a drink of water, it’ll be fine. Except for some it’s not fine at all. Ever since Christine McMonagle can remember she has suffered such excruciating headaches.

She has been unable to survive any of her own birthday parties without being forced to retreat to a dark room to lie down. She has ducked out of family weddings early and rarely sees the bells at new year.

For the 24-year-old from Edinburgh, the headaches come regularly, start gradually and last three days. That’s three days of feeling as though her brain is about to explode. So she, for one, welcomed a ground-breaking event in Hull last week that saw 200 health professionals gather to share information and develop better ways of managing one of the most common, but most poorly understood, medical symptoms in Britain.

“You know when you write stories at primary school?” she says. “My stories were all about having a sore head. It’s happened for ever, and I’ve been taking paracetamol ever since I was old enough.

“I used to vomit at the same time,” she adds, “but I do that less now. The pain is almost always on the left side of my head, right across my eyes, and I basically just have to sleep for two or three days.”

She works in marketing and says her employer and friends are very understanding. “I normally get the headaches at weekends anyway. That’s when I’m tired, I’m run down by the end of the week, or I’m excited about doing something. It’s incredibly common that I’ll be on a big night out and have to go home early. Most new years I don’t even make it to midnight. My birthday’s the same.

“I’ll be out of action right through Saturday and Sunday every three months or so. If I have to take a day off it is almost always a Monday, then by Tuesday I’m beginning to get better.”

As she has got older, she has learned to manage the symptoms more efficiently, but she still sees a neurologist every six months and takes four pills a day, including preventative medication and anti-epilepsy tablets. “I take injections when I actually get the migraines,” she says, “and in the past I’ve tried all sorts of things – stuff that melts on your tongue, powders you have to pour into drinks ...”

But a massive part of the problem is diagnosing the headache you have before you can even start treating it. “I tend to put headaches into two extremes,” says Dr Fayyaz Ahmed, a consultant neurologist and chair of the British Association for the Study of Headaches who spoke at the conference in Hull last week. “Either people take it too seriously unnecessarily or they take it too lightly, again unnecessarily. In between is a broad spectrum of about 89 per cent of headaches which can easily be banished by the patient themselves or their GP.

“People are worried about brain tumours and haemorrhage and meningitis,” he adds. “They panic and they get referred to a specialist, but only one in every 100 headaches may have a serious underlying cause.”

At the other extreme are those who keep popping the pills in the hope the pain will go away when, in fact, they’re making the situation much worse. “They say to themselves, ‘I just have a headache, I’ll go and get some painkillers.’ Even their GP might prescribe more painkillers,” says Dr Ahmed. “They keep taking them and then they run into a problem – which one per cent of the population have – of medication overuse headache. Because of the availability of, especially, codeine-based analgesic, people have a headache because of the painkillers.”

Educating GPs as well as the general public is the only way to increase awareness as different headaches require different treatment: perhaps a muscle relaxant or preventative medication, painkillers, neurostimulation ... even Botox has been mooted as being potentially beneficial.

But Dr Ahmed suggests looking out for “red flags” that could indicate something more serious is wrong. These include, “If you have a headache very suddenly, like someone hits you on the head with a cricket bat. If you have 
facial problems, or if it starts early in the morning then gets worse.

“It’s getting the diagnosis right,” he adds. “People tend to treat all headaches as just headaches, but if you have migraine and that type of migraine is diagnosed, you can get the correct treatment.”

McMonagle finds exercise helps her wind down – she’s taking part in the Edinburgh half-marathon later this year – but her hope is that one day researchers might find a cure to the debilitating headaches that have plagued her for so long.

“There are so many different types of symptoms so who knows, but it would be nice to think that one day they would go away.”

Twitter: @ruth_lesley;