What is a headache? Headache is discomfort or pain around the head, face or neck area. A headache can happen because the nerves, muscles, or blood vessels throughout your face, scalp, or brain are irritated, inflamed, or not functioning properly. The American College of Physicians reports that seven out of 10 people suffer from at least one headache a year. And 45 million Americans suffer from chronic headaches. Headaches vary greatly in severity, location of the pain, and duration. Because of the range of possible causes of headaches, a correct diagnosis is important. Most headaches are not a cause for concern. But headaches due to a serious underlying disorder require urgent medical attention. Pay close attention when a headache is different than usual. Seek immediate medical care under these circumstances: Excruciating headache or a headache that does not respond to typical treatment Severe or sudden headache with a stiff neck, fever, convulsions, confusion, or pain in the eye or ear Persistent headache in a person with no previous history of headaches Recurring headaches in children are also cause for concern. A severe headache that wakes you in the night or develops on waking in the morning needs evaluation as well. If there is any doubt, seek medical help as soon as possible. What are the different types of headaches? There are over 150 different types of headaches. However, there are two main categories of headache—primary and secondary. Primary headaches have no underlying cause. Secondary headaches are due to another medical condition. The three most common types of primary headache include: Cluster headaches occur in groups or clusters daily or several times a day for weeks or months. Headache-free periods, which can last for months to years, separate episodes. Migraine headaches are intense headaches that may last several hours to days. There are four phases of migraine headaches—prodrome, aura, attack and postdrome. About 25 to 30% of migraineurs will have an aura before the headache. Tension headaches are the most common type of headache. They are usually short-lived and may recur periodically. Most headaches are harmless and last only a few hours. However, a headache can be a symptom of numerous diseases, disorders or conditions affecting the neck, eyes, brain, jaw or teeth. This includes conditions ranging from the common cold, flu, and stress to severe conditions, such as meningitis, stroke, or a brain tumor. What are the symptoms of a headache? Headache symptoms vary with the type of headache. Common symptoms of cluster headaches Cluster headaches often develop during sleep. They typically last 30 to 90 minutes at the same time each day. Common symptoms can include: Severe, piercing, unbearable pain on one side of the head, usually behind or around the eye Eye redness or tearing Facial sweating or flushing Nasal congestion or runny nose Common symptoms of migraine headaches Migraine headaches can last from a few hours to a few days. Common symptoms can include: Prodrome with subtle symptoms a day or two before the headache, such as constipation, difficulty concentrating, fatigue, mood changes, and sleep problems Aura, which usually involves such visual symptoms as flashing lights, sensitivity to light, and seeing halos, bright spots, shapes or zig zags Headache ‘attack’ with severe pain that can be throbbing, pulsating or pounding usually on one side of the head and often spreading to both sides Postdrome with fatigue, confusion, low mood, and problems concentrating or comprehending Common symptoms of tension headaches Tension headaches are usually short-lived, but can last for hours and become chronic. Common symptoms can include: Dull, aching or squeezing mild or moderate pain that typically affects both sides of the head Feeling of tightness or pressure in the scalp, forehead, neck, jaw or shoulders Tenderness in the muscles of the head, neck or shoulders Serious symptoms that might indicate a life-threatening condition In some cases, headache occurs with other symptoms that may indicate a serious or life-threatening condition. Seek immediate medical care (call 911) if you, or someone you are with, have a headache with any of these potentially life-threatening symptoms: Nausea, vomiting, fever, and stiff neck Seizures Slurred speech, vision problems, confusion, or difficulty moving one side of the body Sudden or explosive headache pain Worst headache pain of your life or headache pain that worsens with time You should also get immediate medical attention for a head injury with or without a headache. What causes headaches? Primary headaches are not associated with any other disease or condition. However, the exact cause is not well understood. It is likely a combination of genetic and environmental factors that affect pain-signaling nerves in the brain. Certain events, things you sense (smell, taste, feel, see, hear), and substances you eat or drink may trigger the headache. Cluster headache causes Cluster headaches may be related to abnormal activity in the hypothalamus, an area of the brain that helps regulate key body processes, including the body’s internal clock. Typically, there are no triggers with cluster headaches. However, during a cluster period, smoking and even small amounts of alcohol can set off a headache. Migraine headache causes Migraine headaches may involve imbalances in brain chemicals, such as serotonin, that regulate pain. Changes in brain activity may also affect pain pathways and blood vessels in the brain. A wide variety of triggers are known to bring on a migraine. Common ones include alcohol, caffeine, certain foods, hormonal changes, stress, and weather changes. Some medications can also trigger a migraine. Tension headache causes In the past, the theory behind tension headaches was that muscle tension brought on the headache. However, research does not support this idea. Today, experts believe changes in pain-sensing nerves in the head, neck and shoulders play a role. Changes in the way the brain interprets pain signals from the area may also be a part of the cause. All of these changes may cause muscular tension, not the other way around. Stress and depression can act as triggers. Secondary headaches These headaches are related to an underlying disease, disorder or condition. Possible causes of secondary headaches include: Concussion and head or brain injury Infection, sinusitis and meningitis Low blood sugar and dehydration Stroke, brain aneurysm, and bleeding in the brain Trigeminal neuralgia and dental problems, such as TMJ (temporomandibular joint) disorder Tumors, carbon monoxide poisoning, and panic disorders What are risk factors for headaches? Tension headaches can happen to anyone. Most people have experienced a tension headache at one time or another. However, there are a number of factors that increase the risk of developing migraine headache and cluster headache. A family history of these headaches increases the likelihood of developing them. Other risk factors include age and sex: Age: Both migraines and cluster headaches can develop at any age. However, migraines most often start during adolescence and peak in the 30s. Cluster headaches usually start between ages 20 and 50. Sex: Migraines are three times as common in women as in men. In contrast, 80% of cluster headache sufferers are men. Reducing your risk of headache It is not always possible to reduce your risk of headaches. However, you may be able to prevent them or reduce their frequency by avoiding known triggers. Keeping a headache diary can help you identify your triggers. Talk with your doctor, as well, to discover what could be triggering your headaches and how to avoid them. How is a headache treated? The goals of headache treatment are to relieve the pain and other symptoms and prevent or reduce their occurrence or at least the frequency. The strategies can vary with the type of headache. In general, pain relievers are useful for all types of headaches. Several other types of medicines can help relieve pain and other symptoms with cluster headaches and migraine headaches. Examples include triptans and ergot drugs. Preventive medicines are available for chronic tension headaches, cluster headaches, and migraines. The specific medicines vary with the type of headache. In general, antidepressants, antiseizure medicines, and drugs that treat high blood pressure can be helpful. Several other options are available, depending on the type of headache. Home remedies can also help relieve and prevent headaches. This includes applying heat and ice, drinking plenty of fluids, and avoiding alcohol. Managing stress, practicing relaxation techniques, keeping a regular sleep schedule, and exercising regularly may help reduce headache frequency. What are the potential complications of a headache? Fortunately, most headaches are a brief interference daily life. However, in some cases, the degree and frequency of headaches can become overwhelming and affect everyday functioning. This can lead to poor quality of life and absenteeism from work or school. In addition, migraine headache is a risk factor for stroke in both men and women. If headaches are affecting your quality of life, talk with your doctor. Find out about the most effective management and try it out. If you have migraines, ask about your risk of stroke and what you need to know to prevent it.