Headaches are a very common health problem affecting millions of people globally. They can range from mild discomfort to intense pain that can significantly affect daily life.
Understanding headaches
Headaches are one of the most common health problems worldwide. The World Health Organization (WHO) estimates that about 50% of adults get a headache each year, and about 30% of adults suffer from chronic or frequent headaches (1). According to the Global Burden of Disease Study (GBD), headaches are the second most common health problem globally. The most common types are tension-type headaches, migraines, and cluster headaches. Tension-type headaches are the most common, affecting up to 70% of people at some point in their lives (2). While headaches are common, they can be difficult to understand because they can have many different causes, ways of affecting the body, and symptoms.
In the UK, headaches are also a major health issue. Around 47% of adults in the UK report having a headache each year. A study by the National Institute for Health and Care Excellence (NICE) found that 1 in 10 adults have frequent headaches, and 1 in 50 suffer from daily headaches (3). The most common types of headaches in the UK are tension-type headaches and migraines. Around eight million people in the UK have migraines (4).
How do headaches work?
The pathophysiology of headaches involves the activation of various pain pathways in the brain and other parts of the nervous system. The way headaches develop can depend on the type, and they can involve a mix of neurovascular, musculoskeletal, and biochemical processes.
Tension-type headaches
Tension-type headaches are often linked to muscle contraction and stress. The pain in this type of headache is thought to arise from increased sensitivity in the central nervous system, especially in the trigeminal nerve, which transmits pain signals from the face and head. Tension or stress can lead to the tightening of muscles in the neck, shoulders, and scalp, which can then trigger headache pain. This increased pain sensitivity is known as central sensitisation, where the brain becomes more responsive to pain stimuli (5).
Migraines
Migraine is a more complex condition involving several different mechanisms. One key feature of migraine pathophysiology is cortical spreading depression, a wave of electrical activity that moves across the brain’s cortex, which leads to changes in blood flow and the activation of pain pathways. Additionally, during a migraine, the trigeminal nerve becomes activated, releasing substances like calcitonin gene-related peptide. This peptide causes blood vessels to dilate and become swollen, contributing to the throbbing pain often felt during a migraine attack (6). Environmental triggers, such as bright lights, certain foods, hormonal changes, and stress, can make the brain more sensitive, increasing the likelihood of a migraine.
Cluster headaches
Cluster headaches are characterised by severe, unilateral pain around the eye or temple. They are thought to result from dysfunction in the hypothalamus, the part of the brain responsible for regulating biological rhythms. This dysfunction can cause the activation of pain pathways that result in intense pain. Unlike other headaches, cluster headaches tend to occur in cycles, with periods of frequent attacks followed by remission periods. Factors such as alcohol, strong smells, or sleep disruptions can trigger cluster headaches in susceptible individuals (7).
Understanding the root causes
Headaches can result from a variety of intrinsic and extrinsic factors, making diagnosis and treatment complex (8).
Primary causes
Tension-type headaches
Stress, poor posture, anxiety, and muscular tension in the neck and shoulders are the most common triggers (8).
Migraines
Genetic predisposition plays a significant role, with family history being a major risk factor (9). Environmental triggers include hormonal changes, stress, certain foods (e.g., dark chocolate, cheese), alcohol, and bright lights (10).
Cluster headaches
The exact cause is unclear, but it is thought to be related to hypothalamic dysfunction, often triggered by alcohol consumption, strong smells, or changes in sleep patterns (11).
Stress as an important trigger
Stress is one of the most common triggers for headaches, particularly tension-type headaches and migraines (12). The relationship between stress and headaches is complex and involves both physiological and psychological mechanisms. When a person experiences stress, the body’s fight-or-flight response is activated, leading to an increase in stress hormones like cortisol and adrenaline. These hormones can cause muscles to tighten, especially in the neck, shoulders, and scalp, which often leads to tension-type headaches (13).
Additionally, stress can cause changes in the brain’s chemistry, including the release of neuropeptides such as calcitonin gene-related peptide, which plays a role in the dilation of blood vessels, a process associated with migraines (14). Chronic stress can also lead to heightened sensory sensitivity, meaning the brain becomes more sensitive to pain, making an individual more prone to experiencing headaches when under stress. Stress may also affect sleep patterns, leading to poor-quality rest, which is another significant trigger for both tension headaches and migraines (15).
Secondary causes
Secondary headaches are those caused by other underlying conditions. These may include:
Sinusitis
Inflammation or infection of the sinus cavities can lead to sinus headaches (8).
Medication overuse
Chronic use of painkillers can lead to medication-overuse headaches, which occur due to withdrawal from analgesics (16).
Cervical spine issues
Conditions such as cervical spondylosis and neck trauma can cause referred pain that presents as a headache (17).
Infections
Meningitis and encephalitis are serious infections that can lead to severe headaches. These are a medical emergency, so if these are suspected it is important to seek urgent medical care (18).
Signs and symptoms
Symptoms of tension-type headaches
Tension-type headaches often present as a dull, aching pain that feels like a tight band around the head. The pain typically affects both sides of the head and is associated with muscle tightness in the neck, shoulders, or scalp. People with tension headaches may also experience sensitivity to light and sound, although these symptoms are generally less severe than with migraines. Tension-type headaches are usually not accompanied by nausea or vomiting (12, 17).
Signs and symptoms of migraines
Migraine symptoms are more intense and can include (9,10):
- Throbbing or pulsating pain, usually on one side of the head
- Sensitivity to light, sound, or smells (photophobia, phonophobia, osmophobia)
- Nausea and vomiting
- Aura, which may include visual disturbances (flashing lights, blind spots), tingling or numbness in the limbs, and difficulty speaking (though not everyone with migraines experiences aura)
The pain from a migraine often worsens with physical activity, and individuals may seek a dark, quiet room to rest during an attack.
Symptoms of cluster headaches
- Severe, sharp pain typically around one eye or temple, often described as the worst pain imaginable (11).
- Autonomic symptoms like eye watering (lacrimation), nasal congestion, or a drooping eyelid on the side of the headache (11).
- The pain tends to occur in short bursts (15 minutes to three hours) and can happen multiple times a day over a period of weeks or months (11).
- Cluster headaches are often unilateral, meaning the pain is felt on only one side of the head (11).
Herbal medicine solutions
Key herbal actions for the prevention and treatment of headaches include anti-inflammatory, analgesic, nervine tonic, circulatory stimulant, and muscle-relaxant properties (19).
- Circulatory stimulants: Herbs that improve blood flow and oxygenation to the brain can help with the prevention of headaches, and examples include ginkgo, garlic, gotu kola, and hawthorn (20,21). Ginkgo can be a good preventative for various reasons. It can improve blood flow to the brain, also called cortical perfusion, and it has anti-platelet effects, making it useful in migraine prevention (19, 22).
- Nervine tonics: These herbs help reduce stress, anxiety and support the nervous system, for example ashwagandha, American skullcap, st john’s wort and valerian (19, 23, 24). Corydalis can be helpful as it also helps with pain (19).
- Menstrual migraine suport: Herbs with estrogenic effects, such as wild yam, shatavari, and tribulus, can be beneficial for migraines that come during menstruation (25, 26). For premenstrual headaches, vitex (chaste tree berry) may help regulate hormonal fluctuations and prevent this type of headaches (27).
- Spasmolytics that promote circulation: Herbs that relax muscles and encourage blood flow are particularly helpful, both for prevention and during episodes. These include hawthorn, chamomile, and cramp bark (19, 28).
- Anti-inflammatories: Reducing overall inflammation can lower the likelihood of headaches and minimising the inflammatory cascade can help with pain relief. Anti-inflammatory herbs that are useful include turmeric, ginger and feverfew (19, 29, 30, 31).
Feverfew (Tanacetum parthenium)
Feverfew is one of the most commonly used herbs for migraine prevention. It contains parthenolide, an active phytochemical that has anti-inflammatory and analgesic effects. Studies have shown that feverfew can reduce the frequency and severity of migraines (32).
Butterbur (Petasites hybridus)
Butterbur is another well-known herb used for the prevention of migraines, particularly in Europe. It has been shown in clinical studies to reduce the frequency of migraines by inhibiting the inflammatory pathways involved in migraine attacks (33). It is thought to work by inhibiting the production of leukotrienes, which contribute to the inflammatory response.
Peppermint (Mentha piperita)
Peppermint oil is widely used for tension-type headaches and can be applied topically to the temples or massaged into the neck and shoulders. Menthol in peppermint has analgesic and muscle-relaxant effects, which can relieve pain and reduce muscle tension associated with tension headaches (34).
Ginger (Zingiber officinale)
Ginger is a powerful anti-inflammatory medicinal that can help alleviate headaches by reducing inflammation. It is particularly effective in reducing nausea associated with migraines and has been found to be as effective as certain pharmaceutical treatments in reducing the severity of headache attacks (30).
Lavender (Lavandula angustifolia)
Lavender oil has relaxing and anti-anxiety properties and has been shown to be effective in reducing the frequency and intensity of migraines when inhaled or used in aromatherapy (35). It can also help reduce stress, a common trigger for tension-type headaches.
Holistic solutions
Proper hydration is very important, as even mild dehydration can contribute to headaches. Studies suggest that increasing water intake can help reduce headache severity and frequency in those who are prone to them (36). Nutritional support is another key factor; magnesium deficiency has been linked to migraines, and supplementation may help prevent their occurrence. Similarly, riboflavin (vitamin B2) has shown promise in reducing the frequency and intensity of migraines (37).
Physical therapies like acupuncture and massage can alleviate tension-type headaches by promoting relaxation and improving circulation. Research indicates that acupuncture can significantly reduce the frequency of migraines and tension headaches, making it a viable non-pharmacological treatment option (38). Stress management techniques such as mindfulness meditation and yoga have also been found to be effective in regulating stress-related headaches. Practicing yoga has been shown to decrease the frequency, duration, and intensity of headaches while also improving overall well-being (39).
Aromatherapy, particularly with essential oils like peppermint and lavender, can provide relative immediate relief. Peppermint oil has a cooling effect that helps relax muscles and improve blood flow, and lavender oil has been found to reduce migraine pain and promote relaxation (40). Dietary modifications, including reducing the intake of processed foods, artificial additives, and excessive caffeine, can prevent headaches triggered by food sensitivities. Studies suggest that certain foods, such as aged cheeses, alcohol, and artificial sweeteners, may act as triggers for migraines in sensitive individuals (41).
References
- World Health Organization (WHO). Headache disorders. Published 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/headache-disorders. Accessed February 1, 2025.
- Stovner LJ, et al. The global burden of headache: A documentation of headache prevalence and disability worldwide. Headache. 2018;58(6):1605-1613.
- National Institute for Health and Care Excellence (NICE). Headaches: Diagnosis and management. Published 2019. Available at: https://www.nice.org.uk/guidance/cg150. Accessed February 1, 2025.
- The Migraine Trust. What is the impact of migraine in the UK? Published 2020. Available at: https://migrainetrust.org/wp-content/uploads/2021/08/State-of-the-Migraine-Nation-impact-rapid-review.pdf. Accessed February 1, 2025.
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