Headaches: All You Need to Know, Doctor-Reviewed

What causes headaches?

The most common causes include: 

• Infections e.g. a cold, the flu, meningitis and sinusitis. 
• Head injury, brain tumor, bleeding in the brain. 
• Side effects of medicines. 
• Dehydration. 
• Dental problems. 
• Vision problems, e.g. glaucoma. 
• High blood pressure. 
• Stress. 
• Excessive alcohol consumption. 
• Smelling strong odours. 
• Taking too many painkillers. 
• Poor posture. 
• Skipping meals. 
• Looking at a screen for too long. 
• Sex. 
• Women during menstruation or menopause. 
• Certain foods, e.g. those containing MSG and nitrates, chocolate and red wine. 
• It can also be symptoms of chemical and hormonal imbalances in the body.

When to see a doctor

Visit your doctor if: 

• Your headache comes and goes very often. 
• Headaches are unusually severe. 
• Symptoms do not improve after OTC treatment or get worse. 
• Your headaches wake you up or disrupts your daily activities. 
• There are new headaches, especially when you are over 40 or pregnant. 
• You have headaches after a head injury or exercise. 

You should also see your doctor if headaches happen with any of the following symptoms: 

• Fever, neck stiffness, confusion, or decreased alertness or memory. 
• Visual problems, e.g. blurry or double vision. 
• Weakness, numbness in limbs or a tingling sensations. 
• Troubles with speaking or understanding others, slurred speech. 
• Seizures. 
• Painful jaw while eating. 
• Nausea or vomiting.

How to treat a headache?

It is important to see a doctor if the headache is persistent to have a history and examination. 

Tests may be carried out to asses for any underling medical condition first. You can buy over-the-counter medications to bring some relief from headaches, for example paracetamol, ibuprofen, naproxen and aspirin (never give it to children younger than 16 due to the risk of Reye’s syndrome). Always read the instructions on the packages before taking OTC drugs. Consult your doctor or pharmacist if you have any problems. 

Sometimes pain seems not to stop even after taking medicines, however, do not overuse painkillers as it can cause rebound headaches. 

Other medications are also used in treating severe migraines, such as sumatriptan. Opioids like morphine are not warranted. Studies show that supplements, for example magnesium, vitamin B2 and CoQ10, may help migraine management. 

If your headache is caused by sinusitis, antihistamines (e.g. loratadine and cetirizine) and decongestants (e.g. phenylephrine and pseudoephedrine) may relieve the headaches. 

Some people may find alternative treatments, for instance acupuncture, herbal or health products including supplements, or meditation, useful in pain relief, although these are not yet supported by research evidence. 

Your doctor may suggest keeping a headache diary for your child or teen to help find the best course of treatment. It should record information like the date, time and duration of all headaches experienced, symptoms other than headaches, possible triggers and medications taken.

What you can do to feel better

You can ease headache with the following simple ways: 

• Drink plenty of water, particularly in the summer. 
• Avoid drinks that contain alcohol or caffeine. 
• Rest in a quiet, cool and dark room. 
• Massage your head and neck. 
• Put a heat pad, towel soaked in hot water or ice packs on your forehead. 
• Try to relax and calm yourself as stress can worsen headaches. 
• Breathe slowly and deeply. 
• Do not skip meals or eat too little. It is important to keep blood sugar stable. 
• Do not strain your eyes.

How to prevent a headache?

There are a number of things you can do to keep headaches at bay.

• Get enough sleep. A lack of sleep can trigger headaches. But sleeping more than what you’re used to may also worsen headaches. 
• Find ways to cope with stress, e.g. listening to music, meditating. 
• Exercise regularly. It can reduce stress too. 
• Avoid triggers. Some foods can cause headaches, e.g. greasy food, aged cheese, food additives like MSG or ice cream. 
• Avoid consuming too much caffeine or alcohol. 
• Take preventive medications for migraines, including antihypertensives (e.g. propranolol, lisinopril), anticonvulsants (e.g. valproic acid) and antidepressants (e.g. amitriptyline).

Dr. Lily Wong 黃淑婷醫生 is a family practitioner at The London Medical Clinic. She is both a registered general practitioner and a pharmacist in the UK and HK. Having lived and worked as a general practitioner for many years in busy practices in London, she relocated to Hong Kong with her family a few years ago. Dr. Wong has also been appointed Honorary Assistant Professor in the Department of Family Medicine at Hong Kong University, for her teaching of medical students.