We’ve all been there. Just trying to get through the day when a headache sets in. It may be a constant dull ache that comes on slowly or it may be so sudden and so severe as to make you cringe at light or sound. Or maybe it’s something else entirely. Regardless of how they feel, all headaches are your body’s way of alerting you that something is wrong.
What is a headache?
While a headache feels like a pain inside your brain, it’s not. In fact, your brain has no pain receptors so it can’t even feel pain. Most headaches begin in pain-sensing nerves of the muscles and blood vessels that surround your head, neck, and face. They can be triggered by stress, muscle tension, allergens, sleep deprivation, dehydration, and countless other things. Different triggers create different types of pain and symptoms.
The key to treating a headache is understanding what type you have, what’s triggering it, and addressing that specific issue.
Types of headaches
The International Headache Society has classified over 200 different types of headaches in two specific categories:
1. Primary Headache:
"Primary headache" means that the headache is the main medical problem (this type makes up more than 90% of headaches).
2. Secondary Headache:
"Secondary headache" means that the headache is a symptom of another medical issue ranging from minor (think sinus infection) to serious (think stroke).
The majority of headaches fall into the primary category, the most common being migraines, tension headaches, cluster headaches, and sinus pain.
Do you have a primary headache or a secondary headache?
Determining what type of headache you have and how to treat it
Knowing what type of headache you have is critical to finding relief and potentially preventing them in the future. Diagnosing a headache involves a medical evaluation and may include diagnostic testing.
Common evaluation questions include:
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When do your headaches occur?
- What is the location of the headache?
- What do the headaches feel like?
- How long do the headaches last?
- Have there been changes in behavior or personality?
- Do changes in position or sitting up cause the headache?
- Do you have trouble sleeping?
- Do you have a history of stress?
- Is there a history of head injury?
If your doctor determines what you are experiencing is a secondary headache and not a primary headache, diagnostic tests may be done to find the cause. These include:
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Blood tests
- Sinus X-rays
- Magnetic resonance imaging (MRI)
- Computed tomography scan (also called a CT or CAT scan)
Diagnosis and Treatment for the Most Common Types of Headaches
As Dr. James Otis, a Baystate Health Neurologist and Associate Professor of Neurology at UMASS CHAN Medical School – Baystate notes, the majority of headaches experienced are diagnosed as primary headaches.
Here, he breaks down the four most common types, including symptoms, causes, and potential treatment options.
Migraines
A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. Migraine attacks can last hours or even days with pain can so severe that it interferes with daily activities.
Migraines are different from other types of headaches in that they have distinct phases.
Migraine Phases
While not all people experience each phase, the typical progression of migraine phases include:
- Premonitory or prodromal phase is the initial phase of a migraine and can lasts a few hours or days and usually precedes a headache by one to two days. Symptoms include irritability, food cravings, sensitivity to light or sound, fatigue, difficulty speaking or reading, and increased need to urinate.
- Aura phase occurs just before the onset of a headache and includes visual, sensory, or motor symptoms. Vision disturbances may include temporary loss of sight and hallucinations. Sensory symptoms often include tingling that begins in one limb or numbness that travels up your arm over a period of 10 to 20 minutes. For some people, the tingling or numbness can spread to one side of your face and tongue. The aura phase may also include changes in speech and general muscle weakness.
- Headache phase is the period during the actual headache. This phase lasts somewhere between 4 to 72 hours and is characterized by pain on one or both sides of the head. Sufferers may experience the pain as throbbing, drilling, or burning. Other common symptoms include nausea, vomiting, sensitivity to light and motion, depression, fatigue, insomnia, neck pain and stiffness, and anxiety.
- Resolution phase, often called the “migraine hangover,” is experienced by 80% of migraine sufferers but may not be experienced after every migraine. During this phase, the pain lessens but is often replaced with fatigue, dizziness, irritability, ongoing sensitivity to light, and trouble concentrating.
Migraine Causes
Causes of migraines vary and can be hard to pinpoint. It is recommended you visit with your primary care physician first who then may refer you to a neurologist to help determine the cause of your migraine, such as:
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Changes in serotonin levels
- Specific sounds, lights or odors
- A specific food
- Changes in the weather
- Sleep deprivation
- Smoking
- Hormones
- Family history of migraines
- Skipping meals or dehydration
One of the best ways to prevent migraines is to avoid known triggers. Keeping a headache diary can help identify the specific causes or your migraines.
In addition, there are numerous medications available to treat migraines. These include pain-relieving medications and preventative medications.
Your treatment choices depend upon the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have. Some of these medications are not safe to take during pregnancy. If you're pregnant or trying to get pregnant, don't use any of these medications without first talking with your doctor.
Tension Headaches
The most common type of headache, a tension headache typically starts later in the day and lasts at least half an hour. Often experienced with tightness in the neck, shoulders and jaw, common symptoms of tension headaches include:
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Pressure, tightness, or a band squeezing your head, and typically affects both sides
- A dull, non-throbbing pain located at the back of the neck, forehead, cheeks, behind both eyes, or, all over the head
- Sufferers often experience trouble sleeping and focusing, irritability, and muscle aches.
While the specific cause of tension-type headaches is not known, stress and poor sleep are the most commonly-reported trigger. It’s best to treat tension headaches soon after they begin when the symptoms are still mild. The goal is to ease your pain and prevent more of them from happening.
Common treatments include over-the-counter painkillers such as acetaminophen, aspirin, ibuprofen, and naproxen. It’s important to follow the dosing instructions for each medication careful to avoid “rebound headache.” Brought on by the overuse of medication, rebound headaches can trigger a vicious cycle of headaches brought on by the medication intended to treat them. Rebound headaches are difficult to treat and can severely impact one’s quality of life.
If over-the-counter pain relievers don't provide relief, your doctor may prescribe a stronger medication.
Cluster Headaches
A cluster headache is identified as a severe headache that comes on quickly. Cluster headaches occur in spurts or “clusters,” where you may have headaches regularly for a few weeks or months and then none for some time. Cluster headaches are usually located behind one eye or on one side of the head.
Other symptoms of a cluster headache are:
- A red, teary eye, a smaller pupil and/or a drooping eyelid on the side of your head that you are experiencing pain
- Puffiness around one or both eyes
- Runny or stuffy nose
- A flushed or warm face
- Restlessness
While the exact cause of this type of headache is unknown, cluster headache patterns suggest that abnormalities in the body's biological clock (hypothalamus) may play a role. Other possible triggers include the use of medications such as nitroglycerin, a drug used to treat heart disease. Once a cluster period begins, drinking alcohol may quickly trigger a splitting headache.
Cluster headache treatments involves a two-part approach: the first aims to stop or reduce the immediate pain and the second to prevent future attacks.
The first part of the treatment, ideally administered as soon as the headache hits, may include high-dose oxygen therapy (inhaling high-flow oxygen through a mask) via a face mask and injections of pain medicine.
The second part of treatment may include daily medications such as calcium channel blockers and corticosteroids, as well as nerve block injections, all of which are proven effective for warding off future attacks.
Sinus Headaches
Sinus infections cause swelling and pressure in your sinuses, which leads to sinus pain. Normally, these air-filled cavities located behind your nose and eyes allow air to circulate throughout the nasal passages and mucus to freely drain. However, when they become inflamed, mucus becomes trapped. As pressure builds, it causes pain that ranges from dull to severe. You can also feel like you have sinus pain when you actually have a migraine.
Often accompanied by cold-like symptoms, sinus discomfort may include:
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Increasing pain if you lean forward, move suddenly, or lie down
- Stuffy nose
- Fatigue
- Aching in your upper teeth
- Thick, yellow or green nasal discharge
- Pain that’s worse in the morning
- Pain that increases when exposed to sudden temperature changes
- Fever
- A sore throat and postnasal drip
Because sinus pain is often the result of an infection, it is best treated by your primary care physician. Treatment options frequently include antibiotics, antihistamines, decongestants, nasal steroid sprays, or pain relievers. If medications don’t improve your symptoms, surgery may be recommended.
There are steps sufferers can take to find relief while waiting for medication to take effect. These include:
- Drinking more fluids
- Using a humidifier or vaporizer to moisten the air
- Using a saltwater nasal spray
- Applying a warm, wet towel to your face
Other Causes of Headaches
Other causes of a general dull-feeling headache, not attributed the above tension headache can include:
- Sleep deprivation
- Allergies
- Straining your eyes
- Depression and/or anxiety
- Caffeine withdrawal
- Injury or trauma
- Strenuous exercise
- Hangover
- Hunger or dehydration
- Brain freeze from eating or drinking cold food
- Rebound: a headache that appears after stopping an anti-headache medication
- Jaw problems
- Fever, flu or common cold
- Menstruation
At-home and alternative therapies for headaches
In addition to the treatment options noted above, some headache sufferers find relief from simple home treatments and more involved alternative therapies. Common home treatments include:
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Using an ice pack on your forehead, scalp, or neck
- Taking OTC meds like acetaminophen, ibuprofen, or naproxen
- Ingesting caffeine
- Spending time in a dark, quiet room
Several alternative or complementary therapies found to provide relief or even prevent attacks in some individuals include:
- Osteopathy: involves the manipulation and soft tissue techniques on the head, neck, and upper back
- Biofeedback and relaxation: helps you control how muscle groups react to stress and may help prevent or relieve tension headaches
- Acupuncture: the practice of placing thin needles at specific points on the body, acupuncture has been shown to relieve tension and migraine headaches for some people
- Mind-body medicine: includes deep breathing, visualization, meditation, and yoga can help relieve pain by helping you deal with stress. These therapies are particularly helpful for tension headaches. In addition, hypnosis may lower your perception of pain and reduce suffering.
- Cognitive behavioral therapy: combines meditation and relaxation with education in motivation, behavior, and how to handle emotions. With the help of a psychotherapist, this approach may help you avoid tension-type and migraine headaches
- Botulinum toxin: best known as Botox, this treatment has been medically proven to prevent chronic migraine headaches in adults
When to Seek Emergency Help for a Headache
If you have a headache that could be described by the “worst headache of your life” or a “thunderclap” feeling, you could be experiencing a stroke, brain aneurysm, or brain hemorrhage and you should call 911 immediately.
Other reasons that may indicate the need for emergency treatment include:
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A headache that lasts more than 72 hours with less than a solid four-hour pain-free period while awake
- A headache that persists, continues to get worse, or won’t stop
- The characteristics of your headaches change
- The symptoms of your migraine attacks change
- If you are taking pain relievers more than two days a week
- Coughing, sneezing, bending over, exercise or sexual activity cause headaches
If you are experiencing a headache after injuring your head, especially if you lost consciousness when injured, you could have a concussion causing blood to form on the brain. This is called hematoma and needs emergency help. Other signs of hematoma include:
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One eye pupil is larger than the other
- Inability to wake up or stay awake
- The headache continues to get worse
- Slurred speech
- Weakness or numbness in the body
- Loss of balance or clumsiness
- Loss of movement (paralysis) on the opposite side of the body from the head injury
- Repeated vomiting, convulsions or seizure
- Unusual behavior, increased confusion, restlessness, or agitation
- Drowsiness and progressive loss of consciousness
It’s important to note that while you may develop signs and symptoms of a hematoma immediately after suffering an injury to your head, they may take weeks or longer to appear. For this reason, if you experience a head injury, ask someone to keep an eye on you. Memory loss caused by the blow to your head can cause you to forget about the injury. Someone other than you may be more likely to recognize the warning signs and get you medical attention you need.
Learn More About Headaches and Health Problems That Cause Headaches
If you are concerned about any headache pain you are experiencing, contact Baystate Health Neurology. We can help you determine what’s causing your suffering and recommend the best approach to achieving short- and long-term relief.