Just as you take a sip from your third cup of coffee, the pain hits like tiny needles being plunged into the base of your neck, slowly working their way up.
Tension headaches are the most common type of headaches. Unfortunately for sufferers, anything that causes stress, makes the headaches worse. This is according to Dr Elliot Shevel from The Headache Clinic.
Shevel is a maxillo-facial and oral surgeon, best known for his position on the cause of pain in migraines.
“People with a lot of tension in the jaw and neck muscles are more susceptible to headaches,” says the 75-year-old headache specialist.
“So the stress makes the muscle tension worse. And in turn, the pain causes more stress - it's a vicious cycle.”
In some cases, there is a gradual build-up in pain, resulting in a migraine. “The only difference between headaches and migraines is the pain,” notes Shevel.
Beryl Botha occasionally suffers from migraines. She says it's been occurring over a number of years. “They were diagnosed as stress-related,” says the online editor.
She says it starts with a build-up of pressure at the top of the head, while her eyes become over-sensitive to light. After that, it's a full-blown migraine attack. She could also be suffering from something called photo-phobia, a very common symptom during migraines.
“It is clear that the brighter the light, the more discomfort is felt,” noted Dr Kathleen B Digre, from The American Migraine Foundation.
For example, “blue light causes more trouble than other colours of light”.
Digre wrote that the amount of light that a person lives in will affect this symptom. “If one lives in darkness all of the time, then light will be sensed as being even brighter.”
Botha falls into the one in seven category. According to The Migraine Trust, an estimated global prevalence of 14.7% of the population suffer from the debilitating attacks, and it is the third most common disease in the world. It's even more prevalent than diabetes, epilepsy and asthma combined.
What he and his team at The Headache Clinic do is treat the problem holistically.
“We treat people to reduce the muscle tension,” he says before adding that this is the main culprit of any headache.
He then goes on to explain that they use a plate, called a posterior modifying appliance, which is placed on the patient's palette in the mouth. “It relaxes the jaw and neck muscles,” he adds. “Some of our patients wear it for a short while, others longer. But, it is so comfortable, you won't notice it's there.”
In Botha's case, who treats her migraines with medication, he says sometimes it works because of the different causes of the headaches. But in other cases, too many painkillers may make the pain more intense. “You have to be careful because medication overuse can sometimes have the opposite effect - the meds itself can even be causing the headache,” Shevel reiterates.
It's for this very reason The Headache Clinic uses little medication if possible because of the side effects. “There could be a million different triggers, so we try to decipher the exact cause of the headache,” he says.
And then there's the issue of caffeine intake. Over the years there has been conflicting studies relating to caffeine and headaches. The American Migraine Foundation states that caffeine is often a significant and overlooked contributor to the problem of frequent and chronic daily headache or migraines.
But then again, certain pain medications have it as the main active ingredient. The foundation goes on to further note that caffeine may aid in the body's absorption of these medicines, but can the ingredient itself relieve headaches?
Shevel has a two-pronged answer to this. “In some people, caffeine makes headaches worse; in others better.” It's just best to avoid caffeine altogether until further studies prove otherwise.
His advice for headache sufferers is to avoid the triggers. As far as work-related stress goes, you can't quit your job, but you can reduce the risk factors.