PROBABLY everyone has had a headache at some time in their life. One of my friends who is a doctor, once said to me that in his house, Panadols are part of the weekly shopping, they are eaten like sweets.
One of the most universal fascinations with the career of Medicine is that perceived mythical power of the doctor to ferret out disease. The ability to scan all and sundry and pronounce ailments and remedies at the drop off a hat.
One of the common questions I get asked soon after I am introduced as a doctor at social gatherings, are questions on headaches. In fact, one of the reasons I became a doctors was to get on top of a debilitating headache which I suffered, for many years as a boy growing up in Kitwe. The attacks would come frequently and unexpectedly like a pincer gripping the upper part of my head around the forehead, the temples and the occiput (the back of the head). It was a sharp goring pain which would wax and wane, as though to say, I am just reminding you who is boss.
These experiences earned me the unkind nickname of a weakling. In a time when your ability to fight earned you respect, status and friends. I often had to be taken home and sleep off the headache. My mum had various remedies of course, as did mums in those days.
Her favourite one, which I disliked the most, was “Ukufutatila”. This was the equivalent of what the old physicians called steaming.
She would get me under a blanket and steam the headache out over a pots of hard boiled root herbs. It was an experience not easily forgotten.
When I got to the medical school the Professor of Psychiatry (Mental Illness), gave us a lecture on headaches. He began with his famous statement;
“There are at least 16 causes of Headaches,” he would say with his failing British accent, tampered, by years of living in Africa.
Everyone loves secrets and they love secrets that they can use. Especially if they are about common diseases. So I thought it might be good to discuss the very common subject of headaches by answering 3 questions.

1. What causes Headaches?
2. How can I tell a headache is serious ?
3.What can I do about headaches?

1. What causes Headaches?
One subsidiary question, is how common are headaches? If you think about it yourself and count how often you have had a headache. You will probably agree that this problem is very common.
It is commonly agreed that as much as 47 per cent of people will have headaches at least once a year. Headaches appear to be more common among women than they are among men.
There are 4 most common  types of Headaches. In Africa I have included a fifth. These make up 99 per cent of all the common headaches.
They are called by the International Society for Headaches Primary Headaches.  Only one per cent of headaches are really serious and require specialist attention.
These are called secondary headaches. A headache may be loosely defined as any pain around the area of the head where no immediate cause can be determined.
The commonest cause of headaches is what is called a Tension headache. This comprises more than 80 per cent of all headaches people will complain of.
Though many people assume that the pain from their headache arises from the Brain, this is in fact rarely the case. The brain itself has no sensory nerves and no sensation, it has a pain center   in the Brain called the Thalamus, which perceives pain from other parts of the body except itself.
Therefore pain in the head comes mostly from structures surrounding the Brain which have pain receptors. The most common sources are the Muscles of the head, the blood vessels, the nerves of the face and the membranes that cover the brain.
In a tension headache the pain comes from the muscles which are arranged in a circular fashion around the head. There are over 20 muscles in the area of the head, neck and face. These muscles blend into the skin and are responsible for facial expressions, by moving the skin.
This feature is peculiar only to the head.  Tension Headache is felt like a tight band around the top the head and  has a gripping squeezing nature. In describing the headache many people will grip the front of the head with the thumb and index finger cupping the supraorbital line ( eye brow line) .
Some will put a face towel or wet cloth over their forehead or will be seen to message their temple (the area just in front of and above the ears).The main cause of this type of headache is stress. The muscles around the head contract producing something akin to a muscle cramp.
In over worked muscle during a sports match, when the speed of muscle contraction exceeds the rate of supply of oxygen, a demand supply gap results. When this happens the muscle goes into a state of constant spasms.
This is called a muscle cramp. So one may think of a tension headache as a cramp of the muscles of the head.
The second most common headache is a migraine headache.
Up to 12-15 per cent of people will have migraine headaches. Migraines are 3 times more common in women than in men. This is a severe intense pulsating(throbbing) headache. It maybe unilateral (involving one side) or bilateral. The headache may or may not be associated with an aura( other sensations).These include a smell, visual signs or flashes, unusual tastes or sounds a few minutes before the headache hits.
These are called premonitions. Like a small tremor before an earth quake hits. So a migraine sufferer will often know they are about to get a headache. Some sports activities, computer games, foods may initiate these attacks. When the headache hits the person may have tearing of the eyes, weakness of the body, limbs or the hands. They often will avoid bright light and will feel better in a quiet dark room until the headache fades away gradually. Some migraine headaches will run in families, and it may be often said,
“Your grandfather suffered from this problem as well”.
The third type of Headache is called a cluster headache. This type of headache is  called  a cluster headache because it comes as a series of repeated headaches. They  occur in cycles which may be every 6 to 12 weeks. Typically they involve one side of the face and are associated with watering of the eye on the side of the headache, redness of the eye or stuffiness of the nose.
It can be one of the most severe headaches a person can suffer from. The pain may arise from blood vessels of the face and nerves of the face area. These Cluster headaches are most common in men. They affect 0.3 per cent of men and about 0.1 per cent of women.
The other type of primary headache, is what I would like to call an African headache. This is a headache which is due mainly to various diseases which are common in Africa, including Nutritional deficiencies (under nutrition, low iron levels), Sickle Cell disease(Abnormal Shaped Red Cells, this is common in Luapula Province), malaria, bilharzia, hookworms, round worm and other parasites.
These conspire to create an environment of persistent low levels of haemoglobin, or the blood carrying pigment in the blood. This leads to a low level of oxygen to the head and results in  long standing low grade chronic headache. There is a fifth group of primary headaches called drug induced headaches.
These are often side effects from certain types of drug which are used to treat different ailments. Common among these are contraceptive pills, heart and blood pressure medicines. These drugs induce headache by interfering with the blood pressure or the female chemical levels.

2. How can I tell that the headache is serious?

Whereas headaches are very common and you need not rush to the hospital or clinic each time you have a headache. Some headaches may be due to diseases in the rest of the body.
When someone has this type of headache, they need to go to the hospital and be seen. These type of headaches are often called secondary headaches. This means as distinct from the primary headaches that we discussed earlier these are often caused by a specific disease process.
It may not be easy to understand the difference between these two. However, most people will understand that some headaches are serious and require medical attention while others are not so serious and can be treated at home.
The question that one might then ask, is; how can I tell that my headache, is a serious one or not?
A very simple answer to this question , is, any headache that is different from the normal headache you are used to is potentially a serious headache. Some common examples would be a headache with body hotness.
The normal headache will not be accompanied by body hotness or fever. So if you have a headache with fever this is a serious headache. Some common causes of headache with fever are diseases like malaria and Meningitis (disease of the coverings of the brain).
Some symptoms with which will make the  headaches serious include  vomiting, fits, weakness of the body, confusion or loss of consciousness. All these symptoms suggest a serious underlying disease of the brain.
When there is an infection or growth(such as a cancer) in the Brain, the coverings or membranes of the brain are stretched and this  causes the headache.
The brain disease itself will give symptoms of weakness of a limb or body part, vomiting and fits, depending on which part of the brain is affected. Bleeding in the brain and stroke (blockage of blood vessels in the Brain), will also give sudden severe headaches which may also be followed by sudden loss of consciousness.
Visual, hearing, strange smells, alteration of taste or speech disturbances associated with headaches also suggest some disease of the brain. In addition to these, headaches that have unusual patterns must be considered to be serious. For example a headache that worsens with change in posture or position. This suggests a disease around the balancing system of the hearing apparatus or the hind brain called the cerebellum, which controls balance.
You should be weary of headaches which occur after the age of 50years or which have changed from your usual pattern of headaches. Headaches which are getting progressively worse should be considered serious. Headaches in children below 10years old, should be considered potentially serious for two reasons.
The first is that primary headaches tend to occur most commonly after puberty and are very rare in children below 10 years of age. The second is that brain tumours especially of the hind Brain are especially common in children below 10year.So be especially sensitive of children who complain of headaches.

3. What can I about  my headaches?

The first thing to do is to decide is this a normal headache (primary headache) or is it a serious headache(secondary headache). Normal headaches are ones that you will have had before and will last for a fairly brief period. Most of the headaches you are likely to get are of this type.
The most common primary headache will be a tension headache. This is best treated by some rest and relaxation. Several topical gels are available including vics, diclofenac gel and others  that will ease the muscle cramps and may be rubbed onto the area of the temple and just below the hair line.
A massage of the head may be helpful. Some mild pain killers like panadols will usually be effective.

Spend some time trying to identify the headache triggers. Some common triggers are work and social stresses. Some headaches may be trigger by  foods, drinks, alcohol or smoking.
If your headache is regular keep a daily headache diary and you may be able to see what precipitates or triggers the headache. Red wine and cheese are common triggers of headaches.
These  contain chemicals called serotonins and Tryamines that may precipitate headaches. Some women will have headaches during or before menstrual flow.
Some drugs for high blood pressure and heart disease may cause headaches. Sports like swimming and running may cause headaches as well. Computer games and TV  may precipitate headaches.
Be systematic in your approach to your headache. Start with the most simple of treatments. Find a quiet room, apply a moist face towel to your forehead.
If you anticipate a heavy day take a panadol or two before hand. Many people will get headaches in pressurised environments such as aeroplanes. You may take some anti-emetics (anti-vomting and anti-dizziness drugs), before the flight.
Migranes and Cluster headaches have specific drugs treatments, which can be recommended by your doctor for use. Relaxation, exercise, cutting down on smoking and alcohol are known to reduce the frequency of headaches. Spending some time in less polluted environments like the country side  is likely to improve your headache.
A few people will getting headaches following or before sexual activity.
Try and take some pain killers shortly before and you may find this helps. Many people suffer from headaches after an accident or an injury. This tends to improve with time, and generally relieves with moderate pain killers like diclofenac and brufen.