Headache

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What is a headache?

Headache is any type of discomfort or pain around the head, face, or neck area. In many cases, your head hurts 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 regarding the severity and location of the pain and the duration. Because of the range of possible causes of headaches, a correct diagnosis is important for treatment and relief.

Most headaches are not a cause for concern, but headaches that are due to a serious underlying disorder require urgent medical attention. Pay close attention to any headache that appears different than usual or in its pattern of symptoms. If you develop this type of headache, an excruciating headache, or a headache that does not respond to your normal headache medication, seek immediate medical attention.

Certain types of headache and headaches associated with specific symptoms, such as a severe or sudden headache associated with a stiff neck, fever, convulsions, confusion, or pain in the eye or ear, may warrant urgent medical attention. A persistent headache in a person with no previous history of headaches and recurring headaches in children are also cause for concern.

A severe headache that wakes you in the night or a severe headache on waking up in the morning can also indicate a severe brain condition that may have occurred during sleep. If there is any doubt, seek professional medical help as soon as possible.

What are the different types of headaches?

Headaches can range from the occasional tension headache to migraine with auras. While there are many types of headaches, the three main types include:

  • Cluster headache: usually occurs several times a day with pain on one side of the head behind the eye. Cluster headaches affect men more often than women.
  • Migraine headache: intense and throbbing, usually affecting one area of the head. May last several hours to days and may be preceded by abnormal visual disturbances (aura). Migraine affects three times more women than men.
  • Tension headache: usually pain on both sides of the head, often due to muscle tension and stress; they are often short lived but may recur intermittently over time.

A sinus headache is a throbbing headache that may last a day or longer, accompanied by nasal congestion, nasal discharge, and pressure around the cheeks and eyes. Many people who seek treatment for a sinus headache are suffering from migraine, not a sinus headache.

Although most headaches are harmless and last only a few hours, a headache can be a symptom of a serious disease, disorder or condition affecting the neck, eyes, brain, jaw or teeth. Headache can be a symptom of numerous conditions ranging from the common cold, flu, and stress to severe conditions such as meningitis, stroke, or a brain tumor. Frequent and/or severely painful headaches can also decrease quality of life and are linked to mental health problems.

What are the symptoms of a headache?

Headache may be accompanied by other symptoms, depending on the type of headache and if you have an underlying disease, disorder or condition.

Symptoms that may occur along with headache

Headache, particularly migraine headaches, may be accompanied by other symptoms including:

  • Aura
  • Feeling of fullness in the sinuses
  • Lightheadedness
  • Nasal congestion
  • Sensitivity to light or noise

Serious symptoms that might indicate a life-threatening condition

In some cases, headache may occur with other symptoms that can indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Get immediate help (call 911) if you, or someone you are with, are exhibiting any of these life-threatening symptoms:

  • Convulsions
  • Ear pain
  • Poor concentration
  • Vision problems
  • Vomiting

What causes headaches?

The most common types of headaches (tension, migraine and cluster) are often caused by certain triggers in the body or environment that ultimately affect the pain-signaling nerves in the brain. Current research suggests certain brain chemicals that are released under various conditions alter the way the brain manages pain signals. In addition, if people in your family have a pattern of headache, then you may have an increased risk for headaches at some point in your life.

Headache can also be a symptom of severe conditions, such as meningitis, stroke, or a brain tumor.

Tension headache causes and triggers

The typical causes of a tension headache include:

  • Alcohol overuse
  • Eyestrain
  • Fluctuating hormone levels, particularly estrogen and progesterone in women
  • Tightening of the muscles in the head, neck, jaw and shoulders, which can be due to injury, stress, poor posture, and jaw clenching

Cluster headache causes and triggers

The exact cause of cluster headaches is not known, but both genetic and environmental factors are at play. One theory behind the cause of cluster headaches centers on problems with the body’s circadian rhythm, which is controlled by the hypothalamus in the brain. The typical triggers of a cluster headache include:

  • Alcohol, particularly red wine
  • Heat
  • High altitude
  • Preserved food that is high in nitrites
  • Vigorous exercise or exertion

Migraine headache causes and triggers

Migraine is a neurological condition marked by headaches and other symptoms, such as aura. Like cluster headaches, the exact cause of migraine is not known. There is evidence migraine headaches may be caused by brain chemicals (e.g., serotonin) and nerve pathways that lead to blood vessel narrowing and reduced blood flow, followed by dilation or widening of these arteries. Another theory is that migraine headaches progress along a pattern of electrical activity in the brain.

Inheriting certain genes from your parents may increase the risk of developing migraine, as the condition tends to run in families. Migraines are often triggered by one or more specific substances or situations.

Known triggers for migraine include:

  • Alcohol
  • Altitude changes, or changes in air pressure
  • Environmental factors, such as smoke, bright lights, or loud noise
  • Fluctuating hormone levels, particularly estrogen and progesterone in women; hormone replacement therapy can also be a trigger.
  • Foods that contain specific chemicals or preservatives, such as processed foods, chocolate, dairy, red wine, aged cheese, and nuts
  • Migraine medication overuse
  • Missed meals
  • Previous brain injury
  • Stress
  • Vigorous exercise or exertion

Sinus headache causes and triggers

Many people who feel they have a sinus headache have a migraine, which can cause nasal congestion and pressure around the eyes, forehead and cheeks. A true sinus headache is caused by sinusitis, which is inflammation or infection of the sinus cavities.

Other causes of headache

Some other causes of headache are serious and potentially life-threatening:

  • Brain tumor
  • Head or brain injury
  • Hypoglycemia (low blood sugar)
  • Intracranial bleeding (bleeding inside the skull)
  • Meningitis
  • Stroke

What are risk factors for headaches?

Headache risk factors vary for the type of headache. A risk factor increases the chances of headaches, but not all people with risk factors develop headaches. Typically, the more risk factors you have, the more likely you are to develop headaches.

Tension headache

Risk factors for tension headaches, which are commonly due to tightness (tension or strain) in the muscles of the head and neck, include:

  • Changing hormone levels for females, which can be due to the menstrual cycle, pregnancy, and menopause, among other situations and conditions
  • Fatigue from sleep deprivation or other causes
  • Injury to the head or neck area
  • Poor posture
  • Stress

Cluster headache

Risk factors for cluster headaches include:

  • Age 20 to 50 years
  • Head trauma, such as an injury or surgery
  • Male biological sex
  • Smoking

Migraine

Known risk factors for developing this neurological condition include:

  • Age younger than 40
  • Family history of migraine
  • Female biological sex

Sinus headache

Risk factors for a sinus headache include:

  • Family history of sinus headaches or migraine headaches
  • History of migraine headaches
  • History of headaches due to hormonal changes

Reducing your risk of headaches

Keeping a headache diary can help you identify the trends and triggers of your headaches. Some risk factors are out of your control. This is especially true if the type of headaches you experience run in your family. But, you do have control over some of the triggers.

You may be able to lower your risk of headaches by:

  • Adjusting your medication regimen, after consulting with your doctor
  • Correcting your posture
  • Eating meals at a consistent time
  • Getting enough sleep, you should feel rested when you wake up, at least most days of the week
  • Not drinking alcohol, or limiting it
  • Not smoking
  • Physical activity most days of the week, which will help reduce your stress level among other benefits
  • Reducing your stress level, which may include a variety of different techniques and possible counseling
  • Seeking treatment for mental health conditions

Your healthcare provider can help you manage your headache risk factors and triggers. For more serious causes of headaches, such as head trauma, a comprehensive approach to an accurate diagnosis and treatment plan may help reduce the frequency of headaches. See a neurologist with expertise treating people with the type of headaches you are experiencing.

How is a headache treated?

Headache treatment options range from over-the-counter pain relievers for an occasional tension headache to nerve surgery for cluster headaches or migraine. Treatment depends on the type, cause and frequency of headache. The goal of treatment is to reduce the frequency and intensity of the headaches. Here is a general approach to finding the right treatment.

At-home remedies and self-care

When you develop a headache, try these techniques:

  • Apply cold: Apply a cold washcloth over your eyes or across the nape of your neck to relieve tension.
  • Apply warmth: Some people respond better to warmth. Take a warm shower or apply a warm compress over your face. You can also try placing a heating pad over your neck and shoulders.
  • Drink a glass of water or sports drink (without caffeine) to help relieve a headache from dehydration.
  • Protect your senses: Avoid bright lights, loud noises, and strong smells.
  • Be quiet: Stop what you’re doing if possible, and lie down.
  • Practice relaxation techniques: If you don’t know of any, close your eyes and focus on your breathing for 5 minutes.
  • Massage: Gently rub your temples, forehead and nape of your neck to help relieve tension.

Alternative and complementary treatments

Headache treatments include many types of alternative therapies, such as:

  • Chiropractic techniques to relieve tension in the head and neck
  • Guided imagery
  • Massage
  • Supplements, including butterbur, coenzyme Q10, feverfew, magnesium and riboflavin, all of which are “probably” or “possibly” beneficial for migraine, according to the National Center for Complementary and Integrative Health
  • Tai chi

Medication

Both prescription and over-the-counter headache medications are available for both headache treatment and prevention:

  • Pain relievers, including acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn), according to package directions (overuse of headache medicine can cause headaches)
  • Cluster headache therapies include oxygen (100% by mask); triptans (chemicals that promote constriction of dilated blood vessels); octreotide (Sandostatin) and dihydroergotamine (D.H.E. 45); and pain relievers. There are several medication options for prevention of cluster headaches.
  • Migraine therapies include triptans, pain relievers, and drugs to control nausea and vomiting. Drugs approved for prevention of migraines include erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality), among others. Other options include tricyclic antidepressants, beta blockers, Botox injections and lidocaine injections.

Surgery

Headache surgery may be an option for people with migraine headaches that do not respond to other treatments or for people who cannot tolerate the side effects of standard migraine medications. Surgery for headaches is nerve decompression. The surgeon first identifies the nerve site, or trigger of pain. These are nerves of the head and face, outside the brain and skull. Botox injections may be used to identify the problem area. The surgeon “releases” the nerve and/or the muscle it controls, which stops the trigger and improves migraine pain. Common headache trigger sites include:

  • Frontal (forehead)
  • Temporal (either side of head)
  • Rhinogenic (nasal)
  • Occipital (back of head)

Side effects and complications are usually minor and temporary. Nerve surgery may also be an option for people with cluster headaches not controlled with standard therapies, as well as sinus-type headaches diagnosed as migraine. Sinus surgery, including septoplasty and endoscopic sinus surgery are other options for sinus headaches related to structural problems in the nasal and sinus cavities.

When should you see a doctor for headache?

An occasional tension headache is not cause for concern; you can usually find relief with self-care and over-the-counter remedies. But, it’s best to get a medical evaluation if you experience frequent or long-lasting tension headaches or cluster or migraine-type headaches. Your doctor will perform a physical exam and ask you questions to diagnose potential causes of your headaches. He or she may refer you to a neurologist.

Questions for diagnosing the cause of headache

To help diagnose the type and cause of your headache, it is important to describe your specific symptoms to your healthcare provider, including:

  • Did your headache develop abruptly or over several hours?
  • How do you normally treat your headache symptoms?
  • How often do you have headaches?
  • Is your headache throbbing or sharp?
  • What time of day does your headache occur?
  • What activities did you participate in prior to the headache?

Once you have a diagnosis, talk with your doctor and learn about all your treatment options. Your doctor can help you decide what is best for you personally. However, it can take some trial and error to find the right combination of lifestyle changes and treatments to bring relief. Schedule and keep regular checkups with your doctor to monitor your progress and treatment plan.

What are the potential complications of a headache?

Fortunately, the most likely cause of your headache—tension—can often be prevented or at least minimized by lifestyle changes, such as stress reduction, diet, or altering your work environment. However, in some cases, the degree and frequency of your headaches may become overwhelming and affect your everyday living. In addition, migraine headache is a risk factor for stroke in both men and women.

Over time, any type of chronic headache can lead to complications including:

  • Absenteeism from work or school
  • Poor quality of life
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Dec 2
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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