A headache is a very common condition that causes pain and discomfort in the head, scalp, or neck. It is estimated that seven in 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 to perform other daily activities. In fact, approximately 45 million Americans frequently have headaches that can be disabling. Luckily, most headaches can be managed with medication and lifestyle changes.
There are three types of headaches: tension headaches, cluster headaches, and migraines.
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 excruciatingly severe, burning pain on one side of the head or behind the eye and usually cause the eyes to tear up and 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 20-40. According to Dr. Stephen D. Silberstein, M.D., director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, alcohol intake may trigger a cluster headache during a cluster period.
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. They are very intense, throbbing headaches that affect one side of the head. Migraines 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 one out of every four 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. Hemiplegic migraines are dangerous but very rare, affecting only 0.03 percent of Americans.
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
- drinking alcohol
- caffeine withdrawal
Most headaches aren’t symptoms of a life-threatening illness. However, you should contact your doctor if a headache occurs after head trauma. You should also call your doctor immediately if a headache is accompanied by the following symptoms:
- facial numbness
- slurred speech
- weakness in an arm or a leg
Pressure around the eyes with a yellowish-green nasal discharge and sore throat also should be evaluated by your doctor.
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 certain 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, an imaging test that 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, which is a relaxation technique that helps with pain management
- stress management classes, which can teach you how to cope with stress and how to relieve tension
- cognitive behavioral therapy, which is a type of talk therapy that shows you how to recognize situations that make you feel stressed and anxious
- acupuncture, which is an alternative therapy that may reduce stress and tension by applying fine needles to specific areas of your body
- mild to moderate exercise, which can help increase the production of certain brain chemicals that make you feel happier and more relaxed
- cold or hot therapy, which involves applying a heating pad or ice pack to your head for five to 10 minutes multiple times a day
- taking a hot bath or shower, which 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)
You and your doctor can discuss which specific treatment would be best for relieving your headaches.