A headache is pain or discomfort in the head, scalp or neck. Most Americans have at least 1 headache in a given year.
There are many different kinds of headaches and they range from being an infrequent annoyance to a persistent, severe and disabling medical condition.
Headaches fall into 2 categories:
Primary: A headache is considered primary when it is not caused by another medical condition or disease. The 3 main types of primary headaches are tension, migraine and cluster.
Secondary: Secondary headaches are brought on by other medical conditions, such as an infection, neurological problem or tumor. Some conditions that can cause secondary headaches include trigeminal neuralgia, temporal arteritis and sinusitis.
The most common type of headache is a tension headache.
The pain associated with a tension headache can range from mild to severe and can last anywhere from a few minutes to several days. The pain tends to be on both sides of the head and may feel dull or squeezing, like a tight band or vice. A tension headache is not accompanied by nausea or vomiting, and the pain is not increased by routine physical activity such as walking or climbing stairs.
Women are more likely to get tension headaches than men. Nearly everyone will have at least 1 tension headache at some point in their lives and more than a third of people will experience a tension headache each year. Tension headaches are rare before age 4 but become more common throughout childhood, reaching a peak around age 13. Learn more about headaches in children and the pediatric expertise offered by the Wake Forest Baptist Comprehensive Headache Program.
Migraines are the second most common type of primary headache. Migraines are extremely painful, recurring headaches that are sometimes accompanied by other symptoms such as visual disturbances or nausea.
Migraines usually occur as isolated episodic attacks which can happen once a year or several times in 1 week. Migraines become chronic when they occur at least 15 days in a month, often on a daily or near-daily basis.
Migraine symptoms include pain that may be throbbing, pounding or pulsating. Migraines tend to begin on the side of the head and may spread to both sides. They can last from 4 to 72 hours and may be accompanied by:
- Nausea or vomiting
- Dizziness, lightheadedness, or vertigo
- Loss of appetite
- Visual disturbanges (aura)
- Sensitivity to light, noise or movement
Recent research shows that migraine sufferers have abnormally excitable brain nerve cells that fire off electrical pulses at the back of the brain causing blood flow to jump. These firings ripple across the top of the brain and back down to the brainstem, the location of important pain cells. The migraine pain comes either from the activity in the brain stem or from inflamed blood vessles or both.
Migraines most often affect women ages 20 to 45. Women are nearly 3 times more likely to get migraines than men. There may be a genetic link to migraine headaches. More than half of people with migraines have an affected family member.
Cluster headaches are among the most painful, and least common, types of headache. Their signature is a pattern of periodic cycles (“clusters”) of headache attacks. A single cluster attack is usually brief but extremely painful.
Cluster headaches belong to a group of primary headaches called trigeminal autonomic cephalgias (TACs). TACs share certain characteristics such as pain on 1 side of the head, eye watering, nasal congestion and short duration of symptoms.
Other TACs that resemble cluster headaches include:
- Paroxysmal Hemicrania - Paroxysmal hemicranias cause multiple, short, and severe daily headaches with symptoms resembling those of cluster headaches. As compared to cluster headaches, the attacks are shorter (1 to 2 minutes) and more frequent (occurring an average of 9 to 15 times a day).
- SUNCT Syndrome - SUNCT syndrome (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) causes stabbing or burning eye pain that may resemble cluster headaches, but attacks are very brief (lasting about a minute) and may occur more than 100 times per day. Red and watery eyes, sweating forehead and congestion are typical.
A cluster headache usually occurs on one side of the head with pain that is burning, sharp, stabbing or steady. It often involves tearing of the eyes, a droopy eyelid and a stuffy nose. The headache tends to happen daily at the same time of day.
The cause of cluster headaches is unknown. They are likely due to an interaction of abnormalities in the blood vessels, nerves and chemicals that affect regions of the face.
Cluster headaches are rare, affecting less than 1 percent of the population. More men than women are affected. The headaches occur at any age, but are most common in the 20s through middle age.
The diagnosis of primary headaches begins with a medical history, physical exam and neurological exam.
Headache symptoms vary and can overlap. In fact, many people get both migraines and tension headaches. Because of this, a careful headache history is often the most helpful diagnostic tool. Patients who keep a diary can provide their doctor with valuable information:
- Frequency of headaches
- Description of pain (stabbing, throbbing, etc.)
- Location of pain
- Duration of pain
- Associated symptoms (nausea, tearing eyes, vomiting, sweating)
- Any measures that bring relief (applying pressure, fresh air)
- Any events that preceded or may have triggered the attack
- Current medications
For chronic, severe, or unusual headaches, or to rule out other conditions or problems, your provider may order additional tests.
When to Contact a Medical Professional
Sometimes a headache can indicate a more severe or even life-threatening problem. If you should experience any of the following symptoms, please call 911 or seek treatment at an emergency department.
- Your headache comes on suddenly and is explosive or violent.
- Your headache is accompanied with fever, stiff neck, severe neck pain, persistent vomiting or unrelenting diarrhea, loss of vision, weakness, loss of consciousness, confusion, seizure or trouble speaking.
- You experience a headache after a head injury, especially if the headache gets worse.
- You cannot tolerate your headache even after taking your rescue medications.
Treatment depends on the frequency and severity of the headaches and focuses on both preventing frequent headaches and reducing pain once an attack starts.
Over-the-counter medicines such as aspirin, ibuprofen (Advil, Motrin, generic) or naproxen (Aleve, generic) may help with milder headaches. However, these medications, especially those that contain caffeine, should not be used more than twice a week because they can cause rebound headaches. These headaches may complicate every type of headache, including migraines.
If the headaches are severe and recurring, several medications can be taken on a regular basis to prevent them. These drugs include calcium channel blockers, beta blockers, antidepressants, serotonin antagonists and anticovulsants.
To treat an acute headache and prevent it from getting worse, patients may be advised to take medication soon after the headache begins.
Other treatments may include change of diet, avoidance of triggers, stress management, relaxation techniques, acupuncture, massage and physical therapy, botox injections, exercise and biofeedback.
Wake Forest Baptist Approach
The Comprehensive Headache Program at Wake Forest Baptist is one of only a few academic, multi-disciplinary headache programs in the region. Our team of headache-trained specialists offer the latest diagnoses and treatments for all types of headaches and for patients of all ages. You may be referred to the program by your own doctor or you can request an appointment with one of our headache specialists.