Headaches are often downplayed by the medical profession and society in general. I?m not sure whether this trivialisation of the symptoms reflects each person?s own experience of headaches ? that, by and large, they tend to be transient and rarely debilitating, or whether it reflects the fact that conventional remedies are essentially not much use in treating very serious headaches.

Not infrequently the headache is a part of some other generalised illness like flu, tonsillitis or hepatitis. In these cases, dealing with the generalised illness sorts out the headache.

The problem arises when a headache is feature in its own right. Acute migraine, tension-type headache, cluster headache and chronic daily headache can be difficult to separate from one another. To make matters worse, these so-called ?primary? headaches are often difficult to distinguish from secondary headaches. Secondary headaches account for a small proportion of headaches but are important because they are caused by some other cause either relatively benign (such as sinusitis) or more severe (such as a tumour in the head or something equally nasty). It must be stressed that headaches due to these causes are rare ? not every headache is a brain tumour. Also, over 50% of brain tumours do not cause a headache.

The diagnosis, treatment and issues raised by headaches are numerous and I will not attempt to discuss them all here. If you consider that the International Headache Society (HIS) has described 129 different types of headache (many of them admittedly rare and of interest only to those who suffer from them and researchers) you will appreciate that a comprehensive discussion of headaches is beyond the scope of this article. A few of the common and central issues will suffice.

An issue where I face incredulity on an almost daily basis is from people who suffer from a chronic daily headache. Two factors are so commonly (in my experience) associated with this form of headache that I routinely exclude these phenomena before dealing with the headache in another way.

The first is a phenomenon called rebound headache. Some commonly available (and over-the-counter) medications, if used too frequently, cause a headache whenever their use is discontinued. The headache then induces the use of the culprit medication again and an ever-worsening spiral is set up. The most common culprit in South Africa is Codeine Phosphate, which is available in many over-the-counter preparations.

The conversion of migraine or tension-type headache into a rebound headache is usually a gradual process. A predictable and irresistible pattern of painkiller use is often seen. Patients seem able to continue with normal daily activities, although normal headache prevention medications seem to have little effect. One approach to treatment is to replace the usual painkiller with no therapy or with an anti-inflammatory which is often less powerful in its pain relief than the initial painkiller. This is where most patients get incredulous: ?Doc, you want to help my headache by stopping my treatment altogether, or put me on a weaker pain pill?? The answer is, if this is a rebound headache, yes ? you?ll be glad you did.

The second is the frequency with which mild to moderate depression is tied up with headaches of all descriptions. Many patients are unaware or unwilling to consider that they may be depressed and hound the doctor to find an organic cause for their headaches. Many unnecessary and costly brain scans are performed on people who have a mild depression and would benefit from therapy and or a mild anti-depressant.

No one should suffer from a headache on a daily basis. No one should be taking strong painkillers on a daily basis. Just about all of the 129 different kinds of headache can be dramatically alleviated or cured. So if you feel that your headache is just too frequent for you to bear, consult your GP ? help is available.