Prevalence

Headache is among the most common adverse health conditions, affecting four fifths of women and two thirds of men each year. Over 90 per cent of people in the UK will experience a headache at some point during their life time, with tension-type headaches (TTH) accounting for half of all headaches experienced.1

Migraine affects 10 per cent of children, while around 18% of younger women and 8% of men have at least one attack each year, but prevalence starts to decline from the mid 40s. An estimated 190,000 migraine attacks occur daily among the UK’s 6 million adult migraineurs, and many people have more than one attack a month. Over half say that the migraines interfere with daily activities, potentially causing an average loss of nearly six working days per affected person annually.1,2

Headache classification

Since 1988, the International Headache Society has promoted a globally-recognised classification system for headaches. The most recent significant revision of the guidelines was published in draft format in 2013. When finalised, this International Classification of Headache Disorders 3rd Edition (beta version) will synchronise with the World Health Organization International Classification of Diseases 11th Revision, due in 2018.3

ICHD-3(beta) has three core categories, indicating a range of headache disorder types and many subcategories:

·      primary headaches such as TTH, trigeminal autonomic cephalgias (such as cluster headaches), migraine, and other primary headache disorders, for example brought on by exercise, cold-stimulus, or coughing

·      secondary headaches arising from or being associated with trauma, vascular disorders, other diseases, infection, drug use and withdrawal, musculoskeletal and psychiatric disorders, bodily imbalances, and even space travel

·      painful cranial neuropathies, other facial pains and other headaches.

Tension type headaches (TTH)

Around half of UK adults experience TTH once or twice a month, although a third may experience them every other day.4 TTHs are regarded as chronic when they occur on 15 or more days a month for at least three months in a row, a problem for 2-3 per cent of people.

TTHs are usually:3

·      bilateral, rather than occurring on one side of the head,

·      of mild to moderate intensity

·      experienced as a pressing or tightening sensation

·      last from minutes to days.

Nausea and vomiting are not normal, but there may be some light or sound sensitivity (photo/phonophobia).

Cluster headaches

Cluster headaches have been described as being “pain so severe you just want to die.” It is usually on one side of the head around the eye socket or in the temple but can spread or swap sides. They affect around 0.4 per cent of the population, usually developing in the 20s-30s age group, and are up to seven times more likely in men than women.5

Attacks last from a few minutes to several hours and may occur up to eight times a day, often in episodic bouts of weeks or months. Pain-free remission periods can be weeks or years, but people with chronic cluster headache may not even have four weeks’ pain-free remission in a year.