By: Elizabeth Obigwe. Freelance Writer, with medical review and editorial support by the DLHA Team
Black man with headache holding the sides of his head. Image credit: Master 1305 on Freepik
There are 12 pairs of nerves that arise from your brain known as cranial nerves. One of these nerves is called the trigeminal nerve. The branches of the trigeminal nerve conduct pain and other sensations from the scalp, the blood vessels inside and outside of the skull, the lining around the brain (the meninges), and the face, ears, eyes, mouth, neck, and throat.
When there is a headache trigger such as stress, odours, inflammation, and certain illnesses, pain receptors on the nerve endings are activated and they relay the pain to the brain, causing your head to hurt. However, the brain itself does not feel pain as it does not have pain-sensitive nerves.
Headache is pain or discomfort in your head, face or neck. It is a common condition and can range from mild to severe and the pain may be dull, throbbing, burning, prickly or sharp. While most headaches are not serious, persistent or severe headaches may require medical attention to determine and address the underlying cause.
Headache is the most common form of pain among children and adults globally. Yet, there is little information on the burden of headaches in Africa. The few research evidence that exist are mostly on migraine, one of the many types of headache.
Even so, early studies had suggested that migraine was rare in Africa. However, this was later found to be untrue. The condition was underreported because it was underdiagnosed at the time due to a lack of awareness.
So far, no study has provided robust information on the burden of headaches in Africa. [1] However, there are statistics from different parts of the region that show the prevalence of headaches in certain areas.
For instance, studies have shown that the prevalence of headache generally and tension headache specifically are 12.1% and 7% respectively in a part of Tanzania. [2] In another rural part of the same country, a 23.1% prevalence of headache was recorded. [3] Whereas, a much lower prevalence of 4.7% for chronic headache and 1.7% for tension headache was found in a rural population-based study in Ethiopia. [4]
The Global Burden of Disease Study in 2013 showed that headache disorders collectively were the third highest cause globally of years lost due to disability (YLD). However, there are no clear statistics on the disability caused by headache in Africa.
The International Headache Society [5] classifies about 200 different headache disorders under 14 headings. These 14 headings are further grouped into three categories as shown below:
These are headaches that happen on their own and not as a result of any underlying health problem. They include;
These headaches happen due to other health problems or conditions. However, it is important to note that sometimes, headaches can occur simultaneously with another disorder by chance and without a causal relation. In such situations, they are not diagnosed as secondary headaches. The different types of secondary headaches include;
Of the various types of headaches, only a few are significant to primary care. Some of these are:
A migraine is the second most common type of headache known. It is often more intense and comes with additional symptoms beyond head pain.
Migraine is typically characterized by a throbbing or pulsing pain on one side of the head, though it can affect both sides. The pain is often accompanied by other symptoms such as nausea, vomiting, sensitivity to light and sound, and visual disturbances known as auras.
A tension-type headache is the most common type of headache that many people experience. It's usually characterized by a dull, aching pain on both sides of the head. Unlike migraines, tension-type headaches typically do not come with additional symptoms like nausea, vomiting, or sensitivity to both light and sound.
A cluster headache is one of the rare headaches globally and in Africa. It is intensely painful and typically occurs in cyclical patterns or clusters, hence the name. Also, cluster headaches are relatively short-lived compared to migraines. They typically last between 30 to 45 minutes (though some are shorter and some longer), and can occur multiple times a day during a cluster period.
Headache happens when your brain receives pain signals from the muscles, joints, connective tissue and blood vessels around your head, face and neck region. Although these signals are said to be a result of triggers, how they get turned on is still unclear.
Certain triggers or habits can increase your chances of getting a headache. Some common ones include:
The symptoms associated with headache depends on the type of headache. Typically, for the different types of headaches;
Other possible symptoms include:
To get the right diagnosis for your headache, you may need to undergo thorough medical evaluation, including further testing if need be. Your doctor will begin by asking you about a few things such as;
If your brain and nerve (neurological) examination is fine and your healthcare provider suspects a primary headache, there may be no need for further testing.
In case there is a need for further testing, you doctor may request any of the following tests:
1. Blood or urine test - to diagnose brain or spinal cord infections, blood vessel damage, and toxins that affect the nervous system.
2. Computed tomography (CT) or magnetic resonance imaging (MRI) - diagnostic imaging used to detect irregularities in internal organs including the brain and structure within the head.
3. Electroencephalogram (EEG) - to monitor brain wave patterns and help in the diagnosis of conditions such as brain tumours, seizures, head injuries, and inflammation that may cause headaches.
Generally, headaches are managed depending on the type and individual presentation. Your doctor will determine the best treatment approach upon examination.
Primary headaches may be managed by avoiding triggers and using over-the-counter painkillers or NSAIDs like paracetamol or ibuprofen. While secondary headaches may require more specific treatments that target the underlying cause.
Other treatment methods may include use of natural or herbal remedies, talk therapy and lifestyle changes.
In Africa, aside from orthodox medicine, most people rely on medicinal plants to fight headaches. For instance, 96 plants were identified as local remedies for headaches among three tribes (Zulu, Xhosa and Sotho) in South Africa. [6]
A 2021 study revealed that the countries in Africa with the highest number of plant species for treating headaches are (in descending order); South Africa, Nigeria, Ethiopia and Uganda. [6]
Most of the plants identified across the 27 African countries in the study belonged to Asteraceae (10%), Fabaceae (10%) Lamiaceae (9%) and Mimosaceae (5%) plant families.
The study also showed that the parts of the plants that Africans use the most are the leaves (49%), roots (20%) and bark (12%). Similarly, the most common methods of preparation of these medicinal plants are decoction and infusion.
These methods involve the extraction of bio-active compounds of the plant parts using water. Decoction is employed for the hard parts like the root and bark while infusion is used for the leaves and flowers. The methods are generally inexpensive.
After extracting the herb, most people prefer to take it orally (52% according to the study). This preference is because they consider the oral route to be effective, non-invasive and a suitable method of administration.
Most of the time, you may be able to manage your headache either by simple lifestyle changes (such as sleeping better and reducing stress) or by using over-the-counter pills. In other cases, your doctor can give you medications to treat more severe headaches.
However, some situations are more critical and may be a cause for worry. See your doctor immediately if you notice any of the following;
Environmental factors such as stress, noise, strong smell or odour, etc. are among the most common triggers of primary headaches. To prevent it, you simply need to avoid the things or habits that cause you to have headaches. These triggers can vary from person to person,
For secondary headaches, treating the underlying illness and making healthy lifestyle choices can help to prevent headaches.
Almost everybody will suffer a headache at some point or another in their lifetime. In fact, in 2016, the WHO reported about 50% prevalence of headache disorders globally in the last year. [7]
In Africa, headache is also believed to be a common disorder of the nervous system, although there are no adequate statistics on the condition. But, a study has shown that the clinical features of headaches in Africans (e.g., migraine) are similar to those of Caucasians. [1]
Aside from orthodox medicine, many Africans use medicinal plants to treat their headaches. However, these herbal medicines can interact in yet unknown ways with the properties of prescription medicines. Therefore, you should exercise caution when using natural herbs and remedies to treat your headache.
Always consult with your healthcare provider if you have concerns about a headache that would not go away after 24 – 48 hours of supportive treatment.
1. Haimanot RT. Burden of headache in Africa. The Journal of Headache and Pain. 2003;4(S1). doi:10.1007/s101940300009
2. Dent W, Spiss H, Helbok R, Matuja W, Scheunemann S, Schmutzhard E. Prevalence of migraine in a rural area in South Tanzania: A door-to-door survey. Cephalalgia. 2004;24(11):960–6. doi:10.1111/j.1468-2982.2004.00775.x
3. Winkler A, Stelzhammer B, Kerschbaumsteiner K, Meindl M, Dent W, Kaaya J, et al. The prevalence of headache with emphasis on tension-type headache in rural Tanzania: A community-based study. Cephalalgia. 2009;29(12):1317–25. doi:10.1111/j.1468-2982.2009.01885.x
4. Haimanot RT, Seraw B, Forsgren L, Ekbom K, Ekstedt J. Migraine, chronic tension-type headache, and cluster headache in an Ethiopian rural community. Cephalalgia. 1995;15(6):482–8. doi:10.1046/j.1468-2982.1995.1506482.x
5. The International Classification of Headache Disorders - ICHD-3 [Internet n.d.]. [cited 2023 Nov 22]. Available from: https://ichd-3.org/
Migraine: An overview for Africans
Published: December 4, 2023
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