An Overview of Headaches

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Whether you suffer from a headache disorder or have a loved one who does, you know that a headache or migraine can be a painful, exhausting experience. The good news is that these issues are treatable, usually through a combination of medications and behavioral therapies, like trigger avoidance or lifestyle changes.

By gaining knowledge about your specific headache or migraine type, you are taking a vital first step and being proactive in your health care. Be assured that you can live well with headaches or migraines.

Symptoms

The vast majority of headaches are primary headaches, meaning they develop on their own. The three most common types of primary headaches are:

  • Tension-type headaches
  • Migraines
  • Cluster headaches

Tension-Type Headaches

Tension-type headaches are the most common type. In fact, experts estimate that nearly 80 percent of people will experience a tension-type headache at some point in their life.

The experience of a tension-type headache resembles its name. It feels like a tight grip or band around your whole head. The pain is notable, but usually not enough to derail someone's day.

Tension-type headaches may cause sensitivity to sound or light, but not both, and do not lead to nausea or vomiting.

Migraines

Migraine is another primary headache disorder that is much more debilitating than a tension-type headache. A person with a migraine is usually unable to work or engage in a social activity because of their symptoms.

A migraine attack consists of four phases (although not everyone experiences all of them). These four phases include:

  • Prodrome: Symptoms are subtle and include yawning, fatigue, and food cravings, and start one to two days before the migraine.
  • Aura: About 20 to 30 percent of people with migraines experience auras, which may include a number of reversible neurological symptoms like vision changes (most common), sensory disturbances (like numbness and tingling), and language problems (like difficulty finding words). Each symptom lasts from 20 to 60 minutes.
  • Headache: The pain of a migraine headache is throbbing (like a drum beating on your brain) and tends to affect one side of the head. The pain lasts for four to 72 hours. During this phase, you may also have nausea and/or vomiting, as well as a sensitivity to sound and light.
  • Postdrome: Symptoms include irritability, fatigue, anxiety, depression, or scalp tenderness, and can last for hours or even days.

Cluster Headaches

Cluster headaches are much less common than tension-type headaches and migraines. They are extremely painful, debilitating headaches that can be so severe they are often referred to as "suicide headaches."

Cluster headaches cause a stabbing, piercing pain around one eye or temple, and they tend to occur at night. In fact, cluster headaches run like clockwork, often occurring at the same time each night. For this reason, they are also sometimes called "alarm clock headaches."

Other Headache Disorders

Besides these, there are other rare types of primary headache disorders including:

  • Primary stabbing headache: Also called ice pick headache, there is a sharp jabbing sensation, with pain lasting three seconds or less. Often this is felt in the eye or temple area. The pains happen several times a day, without a pattern.
  • Primary exercise headache: This headache occurs only after physical activity. It is a pulsating headache that lasts less than 48 hours and is felt on both sides of the head.
  • Primary cough headache: You feel this headache suddenly after coughing, on both sides of the head and usually towards the back of the head. It is usually short in duration from seconds to minutes.
  • Primary thunderclap headache: This headache is sudden and severe, reaching peak intensity in less than a minute and lasting for five minutes or more. It is described as "the worst headache of your life." This is often a symptom associated with a ruptured blood vessel in the brain, but it rarely happens without another condition.
  • Primary headache associated with sexual activity: You may have a headache develop during sex or come on suddenly around the time of orgasm.

    Causes

    Headaches are one of the most common medical complaints. In fact, the World Health Organization reports that half to three-quarters of adults between the ages of 18 and 65 have had a headache in the last year. They can affect anyone regardless of age, race, or gender.

    In general, a headache can be caused by stress, or may be the result of a particular medical condition like high blood pressure, diabetes, depression, or anxiety. Here is an overview of the types of headaches and the causes behind them.

    Tension Headaches

    While experts don't know exactly what causes tension-type headaches, they believe that these headaches stem from a person's nerves and not from muscle tightening in the head, neck, or scalp. For that reason, they are no longer called muscle contraction headaches.

    Tension-type headaches have also been referred to as stress headaches because stress is a common trigger. That being said, tension headaches are very real, and not psychological ("in your head"), as may be suggested by the name.

    Migraines

    Migraine is a neurological disorder and much more than just a headache. Researchers don't quite know what structures and processes are involved, but suspect the brainstem, trigeminal nerve, and the brain chemical serotonin. A combination of genetics and environmental factors probably increase your risk of migraine. Migraines tend to run in families. Three times more women than men have migraines and they seem to develop at the time a girl begins to menstruate, and change in pattern with hormonal fluctuations, then decrease after menopause.

    People with migraine can often identify triggers that can lead to a migraine attack. The leading triggers are stress, hormone changes in women, alcohol, caffeine, skipping meals, weather changes, sleep disturbances, sensory stimuli (bright light, strong odors, loud sounds), physical exertion, and certain foods.

    Secondary Headaches

    Secondary headaches are headaches that occur as a result of some other condition. For example, people with giant cell arteritis—a blood vessel problem—can develop a headache, one that is centralized in the temple or scalp.

    With secondary headaches, there are usually other clues that point to a diagnosis other than simply a headache or migraine. With giant cell arteritis, for example, a person also may report weeks to months of fatigue, body aches, and jaw pain after eating food.

    Other examples of secondary headaches include menstrual migraines, which occur around the time a woman is menstruating (when her estrogen levels fall), and caffeine withdrawal headaches, which occur when a person skips or delays their usual daily caffeine intake.

    Diagnosis

    Headache disorders are diagnosed primarily by physical examination, neurological examination, and health history. A neurologist or headache specialist will first rule out more serious causes for your headache, especially since certain life-threatening medical conditions (like a brain bleed or clot) can mimic these primary headache disorders.

    You may have blood and urine tests done to assess your general health and screen for health conditions that might produce headaches as a secondary symptom. If an infection is suspected, you might have a spinal tap. If you have had symptoms of a seizure, your doctor may do an electroencephalogram (EEG). It is less common for imaging to be done, but it might be performed if your doctor thinks there could be a structural cause.

    You can expect a series of questions about your symptoms, including the location of the pain, onset, duration, description of the sensation, severity, whether the pain radiates, what makes the pain better or worse, and what other symptoms are associated with the headache.

    After ruling out other causes, your doctor then applies criteria created by the International Classification of Headache Disorders to make a diagnosis.

    Treatment

    When it comes to treating headaches, the options vary based on the diagnosis. For instance, most people with tension-type headaches do not seek treatment from a doctor because over-the-counter medications are generally sufficient.

    Meanwhile, migraines are more disabling and often require a prescription medication, like a triptan. People with chronic tension-type headaches and migraines also usually require a preventive medication to thwart head pain before it begins.

    While both over-the-counter and prescription medications can be effective, taking them too frequently can actually lead to a medication overuse headache.

    What's more, it can be challenging, even for a doctor, to tease apart whether your headache is from medication overuse or is part of your original headache disorder.

    That's why it's important to take headache and migraine medication under the guidance of a physician. Take only the recommended dose no more than 10 to 15 times a month, or as otherwise directed by your doctor.

    Some people prefer to avoid medications altogether for their headaches and find that rest, a walk, food, temple massage, or other home remedies can soothe their head pain. These may also be beneficial in conjunction with medication.

    Complementary therapies, which are mainly intended to prevent headaches, include cognitive-behavioral therapy (CBT), biofeedback, acupuncture, physical therapy, and relaxation therapy.

    Coping

    While your headaches may seem unpredictable and out of control because you don't know when an attack will occur, there are some lifestyle habits you can engage in to regain control. Maintaining a healthy weight, getting daily exercise, and enjoying good nutrition may help. Be good to yourself. Take the time to de-stress and enjoy life.

    By keeping a headache diary, you may be able to identify one or more of your headache triggers and avoid them. This will also be useful in appointments with your headache specialist. While there may not be a cure for your headaches or migraines, most people can learn to manage them. Still, you need a plan that works for you. If yours starts to fail you, be sure to get in touch with your doctor.

    If you do slip and trigger a headache or migraine (you didn't get enough sleep or overworked yourself), don't be hard on yourself—it happens, you are human.

    A Word From Verywell

    While being diagnosed with a headache disorder or migraine can be overwhelming, there are effective treatments available, and headache and migraine research is constantly evolving. Remain hands-on in your headache health. As always, if you or someone you know struggles with headaches or migraines, seek guidance from a healthcare professional.

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