Overview of headaches
A headache is a very common condition that causes pain and discomfort in the head, scalp, or neck. It’s estimated that 7/10 people have at least one headache each year.
Headaches can sometimes be mild, but in many cases, they can cause severe pain that makes it difficult to concentrate at work and perform other daily activities. In fact, approximately 45 million Americans frequently have severe headaches that can be disabling. Luckily, most headaches can be managed with medication and lifestyle changes.
Main causes of Headache(Primary)
Primary causes of headaches are causes that aren’t related to separate medical conditions. These headaches are the result of an underlying process in the brain. Examples of common primary headaches include migraine, cluster, and tension headaches.
Secondary causes of headache
Secondary headaches are those that are due to an underlying medical condition. Examples of secondary headache causes include:
Brain tumor or brain aneurysm
The presence of a brain tumor or brain aneurysm (brain bleed) can lead to headache. This is because there is only so much room in the skull. When the skull starts to build up with blood or extra tissue, the compression on the brain can cause a headache.
Cervicogenic headaches occur when discs start to degenerate and press on the spinal column. The result can be significant neck pain as well as headaches.
Medication overuse headaches
If a person takes a significant amount of pain medications daily and starts to taper them or discontinue them altogether, a headache can result. Examples of these medications include hydrocodone.
Meningitis is an infection of the meninges, which are the membranes that line the skull and enclose the spinal cord and brain.
Sometimes a person will experience headaches after trauma to the head, sustained during an event like a fall, car accident, or skiing accident.
Inflammation in the normally air-filled sinus cavities in the face can cause pressure and pain that leads to a sinus headache.
A spinal headache can occur due to a slow leak of cerebrospinal fluid, usually after a person has an epidural, spinal tap, or spinal block for anesthesia.
Several different headache types exist. Examples of these headache types include:
Tension headaches are the most common type of headache and occur most frequently in women over age 20. These headaches are often described as feeling like a tight band around the head. They are caused by a tightening of the muscles in the neck and scalp. Poor posture and stress are contributing factors.
Tension headaches usually last for several minutes, but in some cases, they can last for several days. They also tend to be recurrent.
Cluster headaches are non-throbbing headaches that cause excruciating, burning pain on one side of the head or behind the eye. They usually cause the eyes to tear up and produce nasal congestion or rhinorrhea (runny nose). These headaches can last for extended periods of time, known as the cluster period. The cluster period can be as long as six weeks.
Cluster headaches may occur every day and more than once a day. The cause is unknown; however, this type headache is rare and generally affects men age 20 to 40.
Migraine headaches are severe headaches that can cause throbbing, pounding pain, usually on one side of the head. Several different types of migraine headache exist. This includes chronic migraines, which are migraines that occur 15 or more days a month.
Hemiplegic migraines are those with symptoms resembling that of a stroke. A person can even experience migraines without head pain, which means they have migraine symptoms such as nausea, visual disturbances, and dizziness, but without head pain.
Rebound headaches are those that occur after a person stops taking medications they used regularly to treat headaches. A person is more likely to experience rebound headaches if they take medications such as acetaminophen, triptans (Zomig, Imitrex), ergotamine (Ergomar), and painkillers (like Tylenol with codeine).
Thunderclap headaches are abrupt, severe headaches that often come on very quickly. They will usually appear without warning and last up to five minutes. These headache types can signal an underlying problem with blood vessels in the brain and often require prompt medical attention. A significant number of headache types exist.
Headache vs. migraine
Migraines are the most severe and complex type of headache. Researchers believe they may be caused by changes in the activity of nerve pathways and brain chemicals. Genetic factors and environmental factors are also thought to affect a person’s susceptibility to developing migraines.
Migraines are very intense, throbbing headaches that affect one side of the head. They can also increase sensitivity to light and noise. They may last anywhere from several hours to several days.
Incidence and types of migraines
According to the Migraine Research Foundation, nearly 1 out of every 4 households in the United States includes someone with a migraine. Migraines are one of the top 20 most disabling illnesses in the world.
Among adolescents, migraines are more common in boys than in girls. Among adults, however, migraines occur more frequently in women than in men. They are also more likely to affect those who have family members that often experience migraines.
There are two basic types of migraine headaches: migraine with aura and migraine without aura. Auras are visual disturbances that consist of bright spots, flashing lights, or moving lines. In some cases, auras cause a temporary loss of vision. These visual disturbances occur about 30 minutes before the migraine begins and can last for 15 minutes.
Migraine with aura tends to be less severe and disabling than migraine without aura. However, most people experience migraine without aura.
Hemiplegic migraines are another type of migraine. These migraines are accompanied by stroke-like symptoms, such as slurred speech and numbness or weakness on one side of the body.
Migraines have three phases: prodrome, peak headache, and postdrome.
Prodrome is the period leading up to the migraine. This is the time when auras can occur. The prodrome phase may affect concentration, mood, and appetite. This phase may also cause frequent yawning.
Peak headache is the period when migraine symptoms become the most severe. This phase may last for several minutes.
Postdrome is the 24-hour period after the migraine. During this time, drowsiness can occur and mood can fluctuate between feelings of sadness and feelings of joy.
The exact cause of migraines isn’t known. However, there are numerous factors that are known to trigger the onset of migraine episodes. These include:
- fluctuating hormone levels, especially among boys going through puberty, and women
- stress or anxiety
- fermented and pickled foods
- cured meats and aged cheeses
- certain fruits, including bananas, avocados, and citrus
- skipped meals
- too little or too much sleep
- bright or strong lights
- fluctuations in atmospheric pressure due to changing weather
- alcohol consumption
- caffeine withdrawal
Headache symptoms by type
Tension headaches tend to cause the following symptoms:
- neck stiffness
- pain that is dull and aching
- scalp tenderness
- shoulder stiffness
- tightness or pressure across the forehead that may extend to the sides or back of the head
Sometimes tension headaches can feel like migraines. However, they don’t usually cause the same visual disturbances that migraine headaches do.
Cluster headaches are often short in duration and often cause pain behind the eyes. The pain is usually on one side, and it may be described as throbbing or constant in nature. Cluster headaches will typically occur about one to two hours after a person goes to bed. While they may have some symptoms similar to migraines, they usually don’t cause nausea.
Migraine headaches often feature symptoms such as:
- a pulsating feeling in the head
- pain on one side of the head
- sensitivity to sound and light
- severe, throbbing pain
Migraine headaches often cause pain that’s so severe a person can’t concentrate or perform their daily activities.
Rebound headaches tend to occur daily, and they’re usually worse in the morning. They often improve with medication but return when the medication wears off. Other symptoms associated with rebound headaches include:
- trouble remembering important details
The nature of the headache often depends on what type medication a person was taking.
A thunderclap headache causes head pain that is short in duration, yet intense in nature.
A headache can sometimes be a symptom of a disease or other medical condition. A doctor may be able to determine the underlying cause of a headache by taking a medical history and performing a physical examination. This exam should include a complete neurological evaluation.
Taking a comprehensive history is also important, as the sudden absence of medication and certain foods can cause recurrent headaches. For example, heavy coffee drinkers who suddenly stop drinking coffee can experience headaches.
A doctor may also order diagnostic tests if they suspect that a certain medical condition is causing the headaches. These tests might include:
- complete blood count (CBC), a blood test that can show signs of an infection
- skull X-rays, an imaging test that provides detailed pictures of the bones of the skull
- sinus X-rays, an imaging test that may be performed if sinusitis is suspected
- head CT or MRI scan, which might be done in cases where stroke, trauma, or blood clots on the brain are suspected
Treatment for headaches varies according to the cause. If headaches are being caused by an illness, then it’s likely that the headaches will go away once the underlying condition is treated. However, most headaches aren’t symptoms of serious medical conditions and can be successfully treated with over-the-counter medications, such as aspirin, acetaminophen (Tylenol), or ibuprofen (Advil).
If medications aren’t working, there are several other remedies that can help treat headaches:
- Biofeedback is a relaxation technique that helps with pain management.
- Stress management classes can teach you how to cope with stress and how to relieve tension.
- Cognitive behavioral therapy is a type of talk therapy that shows you how to recognize situations that make you feel stressed and anxious.
- Acupuncture is an alternative therapy that may reduce stress and tension by applying fine needles to specific areas of your body.
- Mild to moderate exercise can help increase the production of certain brain chemicals that make you feel happier and more relaxed.
- Cold or hot therapy involves applying a heating pad or ice pack to your head for 5 to 10 minutes multiple times a day.
- Taking a hot bath or shower can help relax tense muscles.
Preventive treatment is used when headaches occur three or more times per month. Sumatriptan is a drug that’s commonly prescribed for the control of migraine headaches. Other medications that can be used to treat or prevent chronic migraine or cluster headaches are:
- beta blockers (propranolol, atenolol)
- verapamil (calcium channel blocker)
- methysergide maleate (helps to reduce blood vessel constriction)
- amitriptyline (antidepressant)
- valproic acid (anti-seizure medication)