Making sense of headaches

by | April 12, 2016

While most will ease after some time, other conditions may require medical attention.


headacheIs it a sign of something serious if you wake up with dizziness and a throbbing pain in your head? Almost everyone would have experienced headaches at some point in their life, but most headaches are not triggered by threatening conditions, says Dr Jonathan Ong, an associate consultant with the Division of Neurology, National University Hospital (NUH).

“These are known as primary headache disorders,” he explains. “Common primary headaches include tension-type headaches and migraine. Other less common primary headaches include cluster headaches.”

Here are types of headaches you should know:

1) Tension headache – People who suffer from this often experience a squeezing or pressure sensation on
 the head. The headache can last from a few hours to several days. Occasionally, it may become more persistent and last for months. “Despite the discomfort, most people can carry on with their daily routine without any issues,” says Dr Ong.


  • Tightness in the muscles at the back of the neck and over the scalp. Factors such as poor posture, and mental and physical stress may worsen
 tension headaches.
  • Consuming too much caffeine or alcohol.

2) Migraine – This type of headache is usually characterised by a one-sided, throbbing pain. It can last a few hours or up to three days. Sometimes, a chronic form of migraine may develop. Common causes include physical and mental stress, hunger, eating certain foods, irregular sleep patterns and dehydration. Movement or physical exertion could also aggravate the pain.

“Often, one would need to stay in bed to try and sleep off the migraine,” says Dr Ong.


  • A heightened sensitivity to bright lights, sounds and odours during episodes of migraine.
  • Nausea and vomiting.
  • Seeing flashing lights or zig-zag lines. About one-third of migraine sufferers experience this “aura” before a migraine kicks in.

3) Cluster headache – One of the most excruciating types of primary headaches, it occurs in periodic patterns or clusters, with men being more susceptible to it. Cluster headaches tend to strike around the same time like clockwork.

“A single attack may last from 15 to 180 minutes. Bouts of frequent attacks, known as cluster periods, may last from weeks to months, followed by remission periods when the attacks stop completely,” says Dr Ong. There is no known cause for cluster headaches, but once it strikes, consuming alcohol can quickly trigger a splitting headache.


  • An intense pain in or around one eye on one side of the head.
  • Excessive tearing, redness of the eye, congested or runny nose, drooping eyelid, sweating or pale skin on the side affected by the headache.

4) Hormonal headaches – Headaches in women, particularly migraines, are tied to shifts in the levels of the female hormone oestrogen throughout the reproductive cycle.

Migraine headaches are most likely to occur in the two days leading up to a period, or the first three days during a period. “This is due to the natural drop in oestrogen levels at these times. The attacks are typically more severe than migraines at other times of the month,” Dr Ong explains.

Women approaching menopause may also experience worsening headaches because of disruption to the normal hormone cycle. Headaches could also intensify during the first few weeks of pregnancy, but they usually ease or stop completely during the last six months.

5) Secondary headaches – Unlike primary headaches, secondary headaches are linked to an underlying illness or injury, and these conditions should be evaluated by a doctor (see sidebox below on “When do I see a doctor?”). One such headache 
is the sinus headache. Caused by inflamed sinuses, sinus headaches usually occur after a cold or an upper respiratory viral infection.

“You get a constant, throbbing pain in the face, a pressure and ‘full’ sensation in the cheek or forehead, or an achy feeling in the upper teeth coupled with a congested nose,” says Dr Ong.

“Whatever your headache, there are quick, effective ways to ease the pain, or consult your doctor.”


SIDEBOX: 6 ways to fight that pain in the head

  • Drink plenty of water.
  • Reduce stress.
  • Do 30 minutes of exercise at least three times a week.
  • Maintain regular sleep patterns.
  • Eat your meals at regular times and stick to a healthy diet.
  • Keep to the treatment plan prescribed by your doctor to avoid overuse of pain-relieving medications.


SIDEBOX: When do I see a doctor?

  • If you are experiencing headaches for the first time, especially after age 50.
  • If the intensity, quality or location of the headache has changed.
  • If you get visual blurring, persistent nausea
 and vomiting. These symptoms may indicate an increased level of brain pressure.
  • When you get headaches upon waking which worsen with changes 
in posture or position, coughing or sneezing, or are accompanied by limb weakness or numbness, or changes in speech.
  • When headaches strike while you have other underlying medical conditions (e.g. immuno-compromised states, cancer, etc).
  • If a fever and neck stiffness accompany the headache.

“These symptoms require early medical evaluation for more serious causes such as brain tumour, inflammation and infection,” says Dr Ong. If these indications arise, usually a detailed neurological assessment followed by a brain scan will be conducted. If a
 brain tumour is suspected, a neurosurgeon may be involved.

“Generally, benign brain tumours have a better diagnosis and are more responsive to various treatments,” adds Dr Ong.


(** This article has been reproduced with permission. It was first published in “Lifeline”, a publication of the National University Hospital.)

(** PHOTO CREDIT: Bob Smith,






  1. Agnes

    I have migraine, sensitive to light. Normally after sleeping can ease pain but now have to take more panadol. I also have hormonal headache. Normally headache1or 2 days before mentrual period but now no mentrual. Headache on off coming. It make me feel frustrated especially busy of work. Can TCM ease pain? Please give advise. Thanks and regards.

    • agelessadmin

      Thanks, Agnes for your comment. Let me check with NUH on this.

      • agelessadmin

        Hi, Agnes, here’s the query answered by the doctor: “Dear Agnes, thank you for your question. Our advice would be to visit your doctor, especially if you are suffering from regular and difficult to control headaches during and in between your menstrual cycles. Your doctor will perform a thorough assessment and discuss with you a strategy to manage these headaches.

        Although TCM has many proven benefits for several medical conditions, unfortunately at present there is no robust evidence for its effectiveness in migraine management.

        In the meantime, do maintain a healthy lifestyle. A healthy diet, regular exercise and adequate sleep can go a long way.” – Dr Jonathan Ong, associate consultant, Division of Neurology, National University Hospital, Singapore.

        • agelessadmin

          Agnes, here’s a comment from a TCM physician: “Reader described having a migraine which involved sensitivity to the light. This indicates poor blood circulation to the head and face regions and is caused by undue pressure exerted on the cervical vertebra. Generally, this condition does not require oral medication. Tui Na is very effective in addressing the pain frequency, intensity and duration of migraine headaches.

          Regarding the second issue about hormonal and menstrual headaches, headaches, dizziness and related symptoms occurring immediately prior to and during menstruation are often related to blood stasis, blood deficiency and obstruction along the liver meridian. Actual treatment to cure or alleviate these symptoms depends on the person’s presentation, patterns of symptoms and assessment by the TCM physician.” – Li Bin, TCM physician, Yi Qi Yang Sheng Guan TCM, Singapore


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