Dr Elliot Shevel, South Africa’s pioneer in the field of migraine surgery, and the medical director of The Headache Clinic in Johannesburg, shares important information about various types of headaches.


Migraines affect 959 million people a year, according to the 2015 Global Burden of Disease Study. A migraine is a very intense type of primary headache. The International Headache Society (IHS) divides migraines into two types: those with auras, where migraine is preceded by the sufferer seeing spots, lights or blurry lines, or experiencing speech difficulties, and those sufferers without auras.

Migraines can last anywhere from hours to days, and can occur many days a week or once a year. The medical profession does not know what causes migraines, although a genetic link has been established. The Headache Clinic in Johannesburg has identified the two main anatomical structures that generate the pain of migraine: these are muscle tension of the jaw and neck muscles, and painfully dilated arteries in the scalp.

Some sufferers are able to identify triggers that contribute to a migraine attack. However triggers should not be confused with causes – they merely precipitate attacks in susceptible individuals. Stress is the most common trigger, but there are many others such as missing meals, hormonal changes, weather changes, smells, alcohol or drugs, irregular sleep patterns, physical activity, food triggers, or even sex.

It is important to understand that the pain of migraine never comes from the brain or from any structure inside the head. Most of the pain comes from the muscles of the jaws or neck, or from the small arteries (blood vessels) in the scalp, just under the skin. The treatment of muscle pain is radically different from the treatment of arterial pain. Diagnosis requires highly specialised training.

 Tension-Type Headache (TTH)

Tension headaches usually present with a tightness or pressure around the head, which may affect the neck. The pain is normally a moderate, steady ache. It is a primary headache. These headaches may last a few hours to a few days, and can be episodic or chronic. Episodic tension headaches are more common and occur less than 15 days a month, while chronic tension headaches occur more than 15 days a month.

Increased tension in the jaw and/or neck muscles can cause these headaches. The treatment of muscle tension headaches is varied, including very comfortable intra-oral appliances that relax the jaw and neck muscles, physiotherapy, trigger point therapy, and Botox in some cases to relax the affected muscles. Unfortunately, muscle relaxant medications are not very effective in jaw and neck muscle tension. Relaxation techniques can also help, where stress is an aggravating factor.

 Cluster Headache

Cluster headaches are the most painful type of headache, and are five to six times more common in men. They present as an intense stabbing or burning sensation and are often accompanied by pacing up and down. Cluster headaches are so painful that they are also known as suicide headaches, because people do commit suicide to escape the pain. They are usually focused around one eye, and can cause redness in the eye, tears, a drooping or swollen eyelid, and a blocked or running nose on the affected side of the face.

These headaches tend to be shorter than migraine, but can sometimes last for up to three hours. Because they come on so abruptly, and can be short-lived, they are hard to treat. However there are some fast-acting medications available, including self-administered injections of a drug called Imigran. Imigran nasal spray is also often effective.

Sinus Headache

Sinus headache is rare, and if you have been diagnosed with sinus headache and do not have infected mucus or post-nasal-drip, the diagnosis is most probably wrong. Doctors often mistakenly make the diagnosis of “sinus headaches” when there is dull pain felt in the front of your face, in the area around your eyes or nose. The confusion is caused by the fact that migraine and tension headache can and do cause pain in the same areas. Genuine sinus headaches are secondary headaches, and are accompanied by fever, a bad smell, and usually only affect one sinus at a time.

The first line treatment for a genuine sinus infection is with antibiotics. However it is important to ensure you have a correct diagnosis, otherwise the treatment will be ineffective.

Medication-Overuse Headache (MOH)

MOHs develop over time and are identified by whether the sufferer requires increasingly more painkillers, taken more frequently, to stop the pain. It can be accompanied by nausea, restlessness, difficulty concentrating, memory problems or irritability.

These headaches are the result of excessive use of certain painkillers for the treatment of headaches, which leads to your body building up tolerance towards them, so more and more pain killers are needed. They are secondary headaches.

MOHs are normally experienced 15 or more days a month, for at least three months. They occur most days, often waking the sufferer up. The best approach is to treat the original cause of the pain, so that the use of pain relief medication no longer becomes necessary and can be eliminated without triggering withdrawal.

 Hemiplegic Migraine

Hemiplegic migraine affects only a tiny percentage of sufferers and is one of the worst migraine variants. The aura phase, or the warning phase that comes before the excruciating pain, is so extreme that patients suffer full or partial paralysis of one side of their body resulting in inability to walk, speak or see.

Hemiplegic migraine sufferers’ prognosis is horrific. They are not allowed to take vasoconstrictor migraine medication for fear of developing a permanent stroke. They have to suffer this terrible affliction without even the temporary help that migraine sufferers can get from medication.

As with other primary headaches, the cause is unknown.

Hemiplegic migraine is mainly caused by arterial pain, and the only way to eliminate the condition is to close the arteries causing the problem. Fortunately, says Dr Shevel, there is an abundant blood supply via a forest of arteries to the scalp, and the human body can function perfectly normally without a few of these small arteries.

 To find out more, contact The Headache Clinic on www.theheadacheclinic.net or call 011 484 0933.



DISCLAIMER: The information on this website is for educational purposes only, and is not intended as medical advice, diagnosis or treatment. If you are experiencing symptoms or need health advice, please consult a healthcare professional.