Headache and migraine

Salma reads the nine o’clock news, and the camera forgives nothing. She keeps paracetamol in her handbag, her dressing-room drawer and the car. The headache arrives most afternoons, a tight band across her forehead, and during election coverage she took tablets every single day. She has stopped mentioning it. Everyone in television gets headaches.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding headache and migraine

Most headaches are primary headaches, such as tension-type headache and migraine, and are not signs of a dangerous disease. But they are real disorders, often linked with stress, poor sleep, anxiety and depression, which can each make the others worse. Taking painkillers on most days can itself cause a daily headache, called medication-overuse headache.

How common are headache and migraine?

Headache disorders affect about 40% of the world’s population, some 3.1 billion people in 2021, WHO estimates, and are more common in women.

Signs and symptoms of headache and migraine

• Headaches on many days a month, or getting more frequent
• Needing painkillers on most days
• Headaches tied to stress, poor sleep or low mood
• Seek urgent care for a sudden, severe “worst ever” headache, or one with fever, stiff neck, weakness, confusion or changes in vision

Treatment for headache and migraine

A doctor first rules out other causes and checks for warning signs. Then the work is to break the cycle: managing medication use, improving sleep, and treating any anxiety or depression that is feeding the pain. Psychological approaches, such as relaxation training and cognitive behavioural therapy, may reduce how often some headaches come, and preventive medicines help some people.

What getting better can look like

For someone like Salma, getting better might be a calendar of headache days that slowly empties, and a handbag with one strip of tablets instead of three.

Common questions about headache and migraine

Can taking painkillers every day make headaches worse?

Yes, it can. Taking painkillers on most days can itself cause a daily headache, known as medication-overuse headache. If you need tablets on most days, a doctor can look at the pattern and plan how to break the cycle, rather than you simply adding more tablets.

When is a headache an emergency?

Most headaches are not signs of a dangerous disease. Seek urgent medical care for a sudden, severe headache that feels like the worst ever, or a headache with fever, a stiff neck, weakness, confusion or changes in vision. In Bangladesh, call 999 in an emergency.

When to see a psychiatrist

If headaches have become part of most days, it is worth understanding why. Sudden or unusual headaches need medical attention straight away.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• World Health Organization, “Migraine and other headache disorders” fact sheet