Headache

Headaches are one of the most common health complaints, affecting people of all ages. While most headaches are not serious, they can significantly impact quality of life. Understanding the type of headache you have is key to finding effective treatment and knowing when to seek medical care.

Quick Facts

  • 90% of people experience headaches
  • Over 150 types identified
  • Most are primary headaches
  • Can be acute or chronic
  • Many effective treatments

Understanding Headaches

A headache is pain or discomfort in the head, scalp, or neck. Headaches can vary greatly in terms of location, intensity, frequency, and cause. They are classified into two main categories: primary headaches, which are not caused by another condition, and secondary headaches, which are symptoms of an underlying health issue.

The pain from headaches results from signals interacting between the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain.

While headaches can be painful and disruptive, most are not dangerous. However, certain types of headaches can signal a serious problem and require immediate medical attention.

Types of Headaches

Primary Headaches

Tension Headaches

  • Most common type
  • Mild to moderate pain
  • Feels like tight band around head
  • Both sides of head
  • Can last 30 minutes to days

Migraines

  • Moderate to severe throbbing pain
  • Often one side of head
  • Nausea and light sensitivity
  • Can have aura
  • Lasts 4-72 hours

Cluster Headaches

  • Severe burning pain
  • Behind or around one eye
  • Occur in clusters
  • Last 15 minutes to 3 hours
  • Same time each day

Secondary Headaches

Secondary headaches are symptoms of other conditions, including:

  • Sinus headaches: From sinusitis or sinus infections
  • Medication overuse headaches: From frequent pain medication use
  • Thunderclap headaches: Sudden, severe headaches that may indicate serious conditions
  • Cervicogenic headaches: Originating from neck problems
  • Post-traumatic headaches: Following head injury or concussion

Common Causes

Lifestyle Factors

  • Stress: Physical or emotional tension
  • Poor posture: Neck and shoulder strain
  • Sleep issues: Too little or too much sleep
  • Dehydration: Inadequate fluid intake
  • Skipped meals: Low blood sugar
  • Eye strain: Computer work, reading
  • Weather changes: Barometric pressure shifts

Medical Conditions

Neurological Conditions

  • Stroke or transient ischemic attack
  • Brain tumors or cancer
  • Meningitis or encephalitis
  • Multiple sclerosis
  • Epilepsy
  • Trigeminal neuralgia

Vascular Conditions

Infections

  • Common cold and flu
  • COVID-19
  • Sinus infections
  • Ear infections
  • Dental infections
  • Lyme disease

Other Conditions

  • Fibromyalgia
  • Temporomandibular joint (TMJ) disorder
  • Carbon monoxide poisoning
  • Concussion or head injury
  • Glaucoma
  • Pregnancy complications

Triggers

  • Foods: Aged cheese, chocolate, MSG, nitrates
  • Drinks: Alcohol (especially red wine), caffeine
  • Sensory stimuli: Bright lights, loud sounds, strong smells
  • Hormonal changes: Menstruation, pregnancy, menopause
  • Medications: Birth control pills, vasodilators
  • Environmental: Smoke, pollution, altitude changes

Warning Signs - When to Seek Emergency Care

Seek Immediate Medical Attention If Your Headache:

  • Is sudden and severe ("thunderclap" headache)
  • Is accompanied by fever, stiff neck, confusion, or vision changes
  • Follows a head injury
  • Gets progressively worse despite treatment
  • Is accompanied by weakness, numbness, or difficulty speaking
  • Is different from your usual headache pattern
  • Occurs with seizures
  • Is accompanied by shortness of breath
  • Happens with severe nausea and vomiting
  • Is the worst headache of your life

Associated Symptoms

Headaches often occur with other symptoms that can help identify the type and cause:

Common Accompanying Symptoms

  • Nausea and vomiting: Common with migraines
  • Light and sound sensitivity: Photophobia and phonophobia
  • Visual disturbances: Aura, blurred vision, flashing lights
  • Dizziness: Feeling off-balance or lightheaded
  • Neck pain or stiffness: May indicate tension or serious conditions
  • Fatigue: Exhaustion before or after headache
  • Mood changes: Irritability, depression, euphoria
  • Nasal congestion: With sinus headaches
  • Tearing or red eye: With cluster headaches
  • Jaw or facial pain: TMJ-related headaches

Diagnosis and Evaluation

Medical History

Your doctor will ask about:

  • Headache frequency, duration, and intensity
  • Location and quality of pain
  • Triggers and relieving factors
  • Associated symptoms
  • Family history of headaches
  • Current medications
  • Impact on daily activities

Physical Examination

  • Neurological exam
  • Blood pressure check
  • Eye examination
  • Head, neck, and shoulder assessment
  • Sinus palpation

Diagnostic Tests

May be ordered if secondary headache suspected:

  • CT scan: To rule out bleeding or tumors
  • MRI: Detailed brain imaging
  • Blood tests: Check for infections or inflammation
  • Lumbar puncture: If meningitis suspected
  • Eye pressure test: For suspected glaucoma

Headache Diary

Tracking your headaches can help identify patterns:

  • Date and time of headache
  • Duration and intensity (1-10 scale)
  • Location and type of pain
  • Possible triggers
  • Medications taken and effectiveness
  • Associated symptoms

Treatment Options

Over-the-Counter Medications

  • Acetaminophen (Tylenol)
  • Ibuprofen (Advil, Motrin)
  • Aspirin
  • Naproxen (Aleve)
  • Combination medications
  • Topical pain relievers

Prescription Medications

  • Triptans for migraines
  • Ergotamines
  • Preventive medications
  • Anti-nausea drugs
  • Muscle relaxants
  • Nerve blocks

Non-Drug Treatments

  • Rest in quiet, dark room
  • Cold or hot compresses
  • Massage therapy
  • Acupuncture
  • Biofeedback
  • Cognitive behavioral therapy

Lifestyle Modifications

  • Regular sleep schedule
  • Stress management
  • Regular exercise
  • Proper hydration
  • Avoid triggers
  • Improve posture

Prevention Strategies

  • Identify and avoid triggers: Keep a headache diary
  • Maintain regular schedule: Sleep, meals, and exercise
  • Manage stress: Relaxation techniques, meditation, yoga
  • Stay hydrated: Drink plenty of water throughout the day
  • Limit caffeine: Avoid excessive intake and withdrawal
  • Exercise regularly: But avoid overexertion
  • Practice good posture: Especially during computer work
  • Take breaks: From screens and repetitive tasks
  • Consider preventive medication: For frequent headaches
  • Manage underlying conditions: Control blood pressure, treat infections

When to See a Doctor

Schedule an appointment if you experience:

  • Headaches that are becoming more frequent or severe
  • Headaches that don't respond to over-the-counter treatments
  • Need for pain medication more than 2-3 times per week
  • Headaches that interfere with work, school, or daily activities
  • New headache pattern after age 50
  • Headaches with unexplained symptoms
  • History of cancer or immune system disorders
  • Chronic daily headaches

Related Conditions

Migraine

A neurological condition causing severe headaches with other symptoms.

High Blood Pressure

Can cause headaches, especially when severely elevated.

Sinusitis

Sinus inflammation often causes facial pain and headaches.

Anxiety

Stress and anxiety are common triggers for tension headaches.