Headaches are a common adult health problem among Americans. Although common tension headaches are well understood, researchers continue to discover causes and potential treatments for all types of headaches. Therefore, it’s important for headache sufferers to work closely with a pain medicine specialist for access to cutting-edge treatments in order to enjoy the best possible quality of life.
A headache is any pain or discomfort originating in the head or upper neck. The pain generally begins quickly and may become worse before going away. There are no pain receptors or nerve fibers in the brain, so the brain itself does not feel pain. Instead, headache pain originates in the tissues and structures that surround the brain and skull.
The parts of the head that can be responsible for a headache include:
Nerves that extend over the scalp.
Certain nerves in the face, mouth, and throat.
Muscles of the head, neck, and shoulders.
Blood vessels found along the surface, and at the base, of the brain.
Headaches vary considerably regarding the location and intensity of the pain and how often they occur. The pain may be dull, sharp, throbbing, constant, intermittent, mild, or intense.
In general, there are two categories of headache classifications: primary and secondary.
Primary headaches are those that originate in structures within the head or neck and are not associated with other conditions affecting another part of the body. Primary headaches can affect the quality of life and include migraine, tension, cluster headaches, and a variety of other less common headaches.
Secondary headaches are those that originate from a medical problem elsewhere in the body. A very broad group of medical conditions ranging from dental pain to life-threatening conditions like bleeding in the brain, or infections (e.g., encephalitis or meningitis), and traumatic headaches (post-concussion) can be the cause. Secondary headaches also include headaches associated with substance abuse (drugs, alcohol, and the overuse of medications to treat headaches).
Types of Headaches
There are over 100 different types of headaches. Some of the more common types of headaches include:
Migraine headache. A migraine begins when impulses from overactive nerve cells in the brain cause blood vessels to narrow and expand. These signals create a pulsing, or throbbing, sensation, usually on just one side of the head.
Tension headache. This is the most common type of headache among adults and teens, causing mild to moderate pain. More common among women than men, tension headaches will come and go over time and usually have no other symptoms. The pain source may be over or behind the eyes, at the base of the skull, in the neck, and in the muscle groups of the face. Stress and tight muscles are often factors in tension-type headaches.
Sinus headache. Sinus headaches occur when sinus cavities in the head become inflamed and produce a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain is usually accompanied by other sinus symptoms (a runny nose, feeling of fullness in the ears, fever, and swelling in the face).
Hormone headache. Women may get this type of headache due to changes in their body’s hormone levels during menstrual cycles, pregnancy, or menopause.
Cluster Headache. This is the least common but most severe type of a primary headache that most commonly affects men in their late 20s; however, women and children can also suffer from cluster headaches. They are called “cluster headaches” because they tend to happen in groups or a series. The headaches may occur one to three times a day, with each attack lasting from 15 minutes to 3 hours. A series of cluster headaches may last a few weeks or months.
Spinal headache. This type of headache is the result of a procedure such as a spinal tap (lumbar puncture) or epidural block (such as that performed during a woman’s labor and delivery). In these procedures, the needle used to perform the procedure allows spinal fluid to leak, changing the fluid pressure around the brain and spinal cord. The headache may occur up to five days after the procedure.
Other types of common headaches include:
Muscle contraction headache. This type of headache is believed to be due to a sustained, tightened muscle contraction of the scalp and neck muscles. Sustained voluntary contraction of skeletal muscles may cause pain after variable periods.
Paroxysmal hemicrania (a type of cluster headache) is also known as Sjaastad syndrome. It is a severely debilitating, one-sided headache that is concentrated near an eye, the temple, and the forehead. It usually consists of multiple severe, yet short, headache attacks.
Cough headache. This type of headache is usually triggered by coughing and other forms of straining (e.g., sneezing, blowing the nose, laughing, or crying). Secondary cough headaches are more serious, as they can be the result of problems within the brain.
Primary stabbing headache. This type of headache is the result of overactivity or problems with pain-sensitive structures in the head. They may occur without an identifiable cause, or they could develop from an underlying disease.
Primarythunderclap headache. This is a severe headache that reaches maximum intensity within seconds or minutes. It may also be referred to as a lone acute severe headache.
Hypnic headache. This is a benign primary headache that generally affects the elderly. These are moderate and throbbing headaches (may be bilateral or unilateral) that wake the sufferer from sleep at night.
Hemicrania Continua. This is a primarily chronic, daily headache characterized by a continuous, fluctuating, unilateral pain. It is generally on just one side of the head (unilateral), but it may be on both sides (bilateral) of the head.
New daily persistent headache (NDPH). This is a type of new (not caused by another condition) chronic headache occurring in a person who does not have a history of frequent headaches. The headache persists daily for more than three months. The headache increases steadily, reaching its peak within a day or two of the onset.
Exertion headache. This is a headache triggered by exertion or physical activities, such as weightlifting or playing tennis.
Trigeminal neuralgia is irritation or inflammation in one of the twelve pairs of cranial nerves in the head and face that causes an intense headache pain, generally on one side of the face.
What Causes Headaches?
The pain felt during a headache is a mix of signals between the brain, blood vessels, and nearby nerves. Specific nerves of the blood vessels and head muscles send pain signals to the brain. However, it’s not clear why these messages are sent in the first place.
A broad set of factors can trigger a headache. These factors can include stress and food; however, many causes of headaches are still unknown. The American Pain Society found frequent severe headaches were often linked to mood disorders like depression or anxiety, which can increase the risk of developing chronic (or especially painful) headaches by as much as 40%.
Some of the factors that can cause a headache include:
Muscle strain in the neck, upper back, or shoulder muscles.
Changes in sleep patterns.
Eating or drinking cold foods and liquids.
Coughing or sneezing.
Illness (infection, cold, or fever).
Neck or back strain from poor posture.
Alcohol, caffeine, and other drug use or withdrawal.
Medical procedures, such as the after-effects of a spinal tap.
Dental problems or procedures, such as pain from grinding the teeth or from a root canal.
Changes in the levels of chemicals in the body (neurotransmitters).
Strong smells of household chemicals or perfumes.
Noise and light pollution.
Although rare, headaches could be a sign of a serious illness. Symptoms, such as vomiting, dizziness, or changes in vision, may be present in addition to a headache. Some serious illnesses or injuries that can cause headaches include:
A head injury that damages the brain, fractures the skull, or causes bleeding in or around the brain.
Brain tumor (growth in the brain that creates pressure in the skull).
Alcohol, caffeine, or drug abuse.
Problems with pregnancy.
Aneurysm (bulging in a blood vessel of the brain).
High blood sugar (hyperglycemia) or low blood sugar (hypoglycemia).
Low blood calcium levels (hypocalcemia).
Kidney failure (uremia).
Glaucoma (nerve damage at the back of the eye).
Lyme disease (a bacterial infection spread by ticks).
Inflammatory problems (lupus or temporal arteritis).
Secondary headaches (headaches caused by another condition) can be due to:
Structural problems with the bones of the face, teeth, eyes, ears, nose, sinuses, or other structures.
Substance abuse or withdrawal.
What are the Symptoms of a Headache?
Headache symptoms depend on the type of headache. In many cases, the symptoms of a headache may be similar to other medical conditions.
Typical headache symptoms include:
Slow onset of the headache.
Head usually hurts on both sides.
Pain is dull or feels like a band or vice around the head.
Pain may involve the back part of the head or neck.
Pain is mild to moderate, but not always severe.
Common tension headache symptoms include:
Generally, there is pain on both sides of the head.
They often develop after a difficult day at work or school.
The can often be recurrent or chronic.
They may have extreme pressure around the forehead or head (like a vice or tight band).
The pain is described as a throbbing, stabbing, or grinding pain in the facial muscles.
Tension headaches generally do not cause nausea, vomiting, or sensitivity to light (photophobia).
Neck, upper back, and shoulder muscles may feel tense and tight.
The scalp may feel sensitive or painful.
Common symptoms of a cluster headache include:
Severe pain on one side of the head, usually behind one eye.
The pain is often a deep, stabbing pain around the temple or eye.
The eye that is affected may be red and watery with a droopy lid and small pupil.
Swelling of the eyelid.
A runny nose or congestion.
Swelling of the forehead.
Pain so intense the patient may not be able to sit still during an attack.
The headache lasts about 30 to 60 minutes and then quickly subsides.
Common symptoms of a spinal headache include:
The pain is often described as “a headache like no other.”
The pain is more severe when in an upright position.
The pain subsides when the sufferer lies down.
How Are Headaches Diagnosed?
The first step is to talk to a doctor about your headaches. The doctor will want to do a comprehensive medical evaluation, including a medical history. Questions commonly asked during the exam may include:
When do headaches occur?
What is the location of the headache?
Describe how the headaches feel.
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?
Note: a “headache diary” can be a great diagnostic aid. It’s important to be thorough when providing the doctor information about what causes the headaches, makes them worse, and makes you feel better.
If you are having secondary headaches that are caused by an underlying medical condition, the doctor may want to perform tests, depending on what is discovered from the exam and medical history. These tests can include:
Blood tests. Various blood chemistry and other lab tests can help detect any underlying medical conditions.
Sinus x-rays. This is an imaging procedure to check for congestion or other problems that may need correcting.
Magnetic Resonance Imaging (MRI). This test produces detailed images of organs and structures within the body.
Computed tomography scan (CT or CAT scan). This is an imaging test using X-rays and computer technology to produce horizontal images (slices) of the body. The scan can show detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
EEG (electroencephalogram) is only necessary if a patient has fainted during a headache.
How Are Headaches Treated?
Many treatment options are available today. The treatment is based on the specific characteristics of the headache. For pain that is not severe or debilitating, patients should first attempt conservative, at-home treatments to manage pain.
Most headaches are treated with prescription or over-the-counter medicines. However, if a frequent headache sufferer maintains regular use of non-steroidal anti-inflammatory drugs (NSAIDs), ulcers may develop as well as other gastrointestinal disturbances.
More specific recommendations to treat pain from headaches depends on the type of headache. Patients may find relief using stress management techniques, massage therapy, and alternative medicines.
Treatment options will depend on:
The patient’s age.
The patient’s overall health and medical history.
The current health of the patient.
How well the patient can handle specific medicines, procedures, or therapies.
How long the condition is expected to last.
The patient’s preferences.
The goal of treatment is to stop the headaches. Effective headache management depends on diagnosing the headache and determining how to prevent its return. Some of the techniques include:
Avoiding known triggers (certain foods and beverages, lack of sleep, etc.).
Changing the patient’s eating habits.
Medicines recommended by the doctor.
When headache triggers are known, avoiding the triggers can prevent a headache. Another way to help minimize headaches is to reduce stress.
Is It Possible to Prevent a Headache?
At some point, everyone suffers an occasional headache. However, some things can help reduce the chances of getting one.
Doctors recommend getting adequate rest and drinking plenty of water to help prevent headaches. A nutritious diet and daily exercise can also help. Trying to reduce and manage stress also goes a long way to avoiding some of the more common types of headaches. It is also possible to beat a headache with relaxation techniques, meditation, or massage instead of relying on medicine or caffeine.
If you regularly get headaches, keep a headache diary that includes what you eat and what seems to help relieve the pain. To learn more about headaches, the National Headache Foundation has comprehensive information on headaches that is freely available to the public.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating headache pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.