Consider TTH, NDPH and/or MOH

TTH, NDPH and/or MOH

Headaches that always occur on both sides of the head during a single attack vary enormously in nature and tend to be the least well defined primary headache types. However, as a guideline, the following types are normally considered:

TENSION-TYPE HEADACHE

Tension-type headache (TTH) is normally experienced on both sides of the head at the same time, it is pressing or tightening in quality (not pulsating) and is of mild or moderate intensity. TTH mostly lasts from between 30 minutes to 7 days but it can be continuous.

It is not aggravated by routine physical activity such as walking or climbing the stairs, and there is no sickness or over sensitivity or light or sound.

Treatment

Most sufferers of tension type headache (TTH), when the pain is mild to moderate, can successfully self-manage the headaches with over the counter painkillers, Acetaminophen (paracetamol) and aspirin are most commonly used for the acute treatment of individual headaches. Other acute drugs include ibuprofen, ketoprofen, naproxen sodium and diclofenac. Combination analgesics can also be helpful. Preventative medication is often recommended in chronic TTH including various anti-depressants and muscle relaxants.

NEW DAILY PERSISTENT HEADACHE

New daily persistent headache (NDPH) is a headache that is daily and unremitting from the moment of onset, typically amongst people who do not normally get headaches. NDPH may take two forms; a self-limiting type which resolves without treatment within months, or a refractory form which is very difficult to treat.

Like TTH, NDPH is normally experienced on both sides of the head at the same time, is pressing or tightening in quality (not pulsating) and is of mild or moderate intensity. However, although NDPH resembles the onset of a headache identical to that of TTH, NDPH commonly has symptoms of migraine, such as over sensitivity to light and sound, and mild sickness.

Treatment

Generally, there is no specific treatment strategy for new daily persistent headache (NDPH). The self-limiting form of new daily persistent headache appears to improve over time without any medication, but the refractory form may continue for years or decades. Medications that may help include muscle relaxants, tricyclic and selective serotonin reuptake inhibitors and valproic acid.

MEDICATION OVERUSE HEADACHE

Frequent intake of painkillers for headaches and other pain conditions often leads to chronic headache, known as medication overuse headache (MOH). Medications which can cause this include ergotamine, triptans, opioids and a combination of other analgesics.

MOH often occurs daily and varies in severity, type and location of pain. Associated symptoms include loss of strength, sickness, irritability, anxiety, restlessness and depression. Severe MOH can lead to memory problems and a difficulty in communicating.

Treatment

Drug withdrawal of the offending medication is required for medication overuse headache (MOH). This is conducted under supervision either as an outpatient, or for more severe cases, as an inpatient in hospital.

If these brief descriptions do not match your headache type, go to Section 2 – Q.2

If your headaches only ever wake you during sleep, consider Hypnic Headache.