An overview

Headaches are an extremely common complaint. They vary in pain intensity, pattern and location from individual to individual. Although irritating the majority of headaches do not require medical intervention.

Medical assessment should be sought if headaches occur that:

  • Are new and unaccustomed.
  • Have changed in their pattern or intensity.
  • Increase in their frequency.
  • Are associated with drowsiness, numbness, stiff neck, weight loss or fever.

Clinical approach and assessment


On assessment, the practitioner may try and narrow down what type of headache is being experienced. This is done by taking a clinical history of symptoms namely the location, severity and frequency of the headache. Other factors that may be included in the assessment are:

  • Whether any medication is being taken at present.
  • What aggravates or eases the symptoms.
  • Whether the headaches are associated with any other symptoms such as nausea or vomiting.

There are a number of different classifications of headache. Below is an overview of the most common types and those associated with sporting activities.

Vascular Headaches

These headaches are extremely common, affecting approximately 20% of the population at some stage of their life These headaches are thought to be associated with an increase in blood flow to the head causing a throbbing sensation. Two main types exist:


a) Migraine

Signs and Symptoms of migraine:

This headache is characterized by an intense, throbbing, or pounding pain that is felt periodically in the forehead, temple, ear, jaw, or around the eye. In some cases, prior to the pain, patients may see flashing lights, stars, or other white objects. This is known as an aura and usually lasts about 15-20 minutes. Visual disturbance, problems with speech, vomiting and nausea may also be present during or after the attack.

A number of factors commonly predispose to migraines such as:

  • Changes in altitude
  • Metabolic changes
  • Variation of medication
  • Changes in blood pressure
  • Hormonal changes
  • Changes in sleeping patterns
  • Variations in diet


Treatment of migraines

  • Drug prescription from a medical practitioner is thought to be the most effective treatment.
  • During a migraine headache, application of a cold pack to the head may provide relief.
  • Pressing on a prominent artery found either in front of the ear or on the painful side of the head may temporarily relieve symptoms.
  • Other methods of treatment are sleep, alteration of diet, biofeedback training and reduction of stress.
  • Simple pain killers, such as aspirin, taken regularly should be avoided in the event of a migraine as this may intensify symptoms in the future.

b) Cluster Headache

These headaches are so called as they commonly occur in ‘clusters’ over a period of weeks or months, at approximately the same time of day.

Signs and Symptoms of a cluster headache:

  • The pain associated is very intense, characterized by a burning or boring sensation that often immobilizes the person.
  • Cluster headaches are about 5 times more common in men.
  • Attacks may last form 30-45 minutes
  • Treatment for a cluster headache:
  • Specific anti-migraine drugs can help with the symptoms of a cluster headache.
  • Rapid inhalation of pure oxygen through a mask for 5 to 15 minutes is also known to help although the mechanism for this is unclear.

c) Cervical Headache

The other main type of headache is a cervical headache. These headaches are caused as a result of dysfunction in the muscles, joints, nerves or fascia in and around the neck region. Pain radiates towards the skull giving the sensation of a steady dull, ache.


Causes of cervical headache

  • Nerve compression in the between the neck bones
  • Abnormal tenderness in the neck tissues-associated with trigger points in certain muscles. See figure below.
  • Limited neck range of movement i.e. ‘stiff neck’
  • Treatment of cervical headache
  • Massage to release tension in the muscles
  • Acupuncture
  • Posture retraining

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