Types of Headaches and What to Do About Them
Headaches affect not only a person's quality of life and ability to function but also have a significant economic impact[1, 2].
Previous studies have shown that annually migraine headaches cause 150 million lost workdays and over 300,000 lost school days every year, in the U.S. alone.
These statistics speak for themselves. A potential contributor to the large number of medical visits is the difficulty finding concise and reliable information in the medical literature (headaches are one of the most common reasons for visiting a doctor).
While there are numerous studies on a variety of approaches to diagnosing and treating headaches, it is difficult for the lay person to interpret this data.
This article is intended to breach this gap and give up-to-date information that anyone can understand and use to help them with this debilitating condition.
A headache is often associated with disability but it's rarely life threatening. However, new, severe, or unusual headaches can be a result of a serious disease and should never be taken lightly. Anyone with such condition should seek medical care from a doctor immediately.
Common Causes of Headaches
Here are some the most common causes of headaches:
- Dehydration - Due to our very busy lifestyles, a large consumption of diuretics (beverages containing caffeine or alcohol that promote the production of urine and cause loss of water from the body), and insufficient water intake, many people get dehydrated during the course of the day. This can lead to the shrinkage of parts of the meninges (membranes covering the brain and spinal cord), which causes their stretching and pain[3,4].
- Stress - Headaches induced by stress (tension-type headaches) are the most common type of headaches seen in adults. Women are twice more likely to suffer from tension-type headaches than men.
- High fever - Headache can occur with a high body temperature (38°C and above) that may be caused by any disease or illness.
- Head or neck trauma - The cause of the headache may arise from head injury. Headache after a small head injury is likely to pass after a few hours. Consult a doctor to rule out a concussion or other serious damage to the brain or the skull.
- Sinusitis - Headache can be caused by sinusitis (inflammation of the mucous membrane that lines the respiratory cavity of the skull), although this condition may also arise from common cold.
- Side effects of medications - Headache can arise as side effects of taking certain medications or contraceptives.
- Glaucoma - If headache occurs followed by nausea or vomiting with vision being clouded, the doctor needs to be contacted immediately.
An acute, severe headache that affects the whole head and is associated with fever, sensitivity to light, and stiff neck indicates an infectious process, such as meningitis, until proven otherwise.
Also, new, severe or unusual headaches can be a result of a serious disease and should never be taken lightly.
If you haven't been diagnosed yet and don't know what your condition is, you should never assume anything based on the things you read on the Internet or things you hear from other people. You should consult a doctor immediately!
Types of Headaches
Almost everyone suffers from headache of different intensities from time to time, which can occur gradually and take several hours to pass. It is unlikely that such headaches are symptoms of any illness. It usually appears after overexertion, fatigue, excessive alcohol consumption, or staying in a stuffy/smoky room.
Headaches can be a primary disorder (migraine, cluster, or tension headache) or a secondary symptom of many disorders, including acute infections and many diseases of the eyes, nose, throat, teeth, ears, and the neck vertebrae. Sometimes, no cause is found.
Headaches as a Primary Disorder
A primary headache usually occurs for a short duration and gets cleared in few minutes or hours; usually medical attention is not required. On the other hand, tension-mediated headaches (which are different from tension-type headaches!) and thunderclap headaches may require quick medical attention, although such headaches are rare.
Tension Headache Characteristics
- Lasts between 30 minutes to 7 days
- Non-throbbing, mild to moderate in severity
- Felt on both sides of the head
- Does not become worse with exertion
Tension-Type Headache (aka "Tension Headache")
Tension-type headache (also know as a tension headache or a stress headache) is the most prevalent headache in the general population.
The typical presentation of an attack is that of a mild to moderate intensity, on both sides of the head or temples and non-throbbing headache.
Descriptions of pain are characteristically nondescript: "dull", "pressure", "head fullness", "head feels large", or, more descriptively, "like a tight cap", "band-like", or a "heavy weight on my head or shoulders".
Tension headaches can sometimes produce throbbing pain such that it mimics migraines.
Heightened sensitivity of pain pathways in the central nervous system, and perhaps in the peripheral nervous system is believed to play a role in tension headaches. Nitric oxide may be a molecular trigger for pain. Genetic factors seem to play a minor role.
Neuroimaging (CT scan or MRI) is not necessary in most patients with tension headaches, particularly those who have a stable headache pattern for over six months and a normal neurologic examination (as performed by a health care provider).
There are 3 subtypes of tension headaches:
- Infrequent episodic with headache episodes less than one day a month
- Frequent episodic with headache episodes 1 to 14 days a month
- Chronic with headaches 15 or more days a month
How to Relieve and Prevent Tension-Type Headaches
Relaxation and light massage of the temples and the scalp can very effectively help relieve a tension headache. Also, a massage of the neck, the shoulders, and upper back helps a lot.
Acupressure and acupuncture have been found to not only relieve a tension headache but also very effectively prevent it.
Apart from regular exercise, techniques like relaxation therapy and biofeedback training can help prevent tension-type headaches and reduce stress.
Maintain a "headache diary". It proves worthy to determine the pattern of triggers for the headaches. After identifying them, it is possible to take preventive measures for those triggering factors.
Common Tension-Type Headache Triggers
- Eye strain
- Poor posture
- Anxiety and depression
- Lasts between 4 to 72 hours
- Throbbing moderate to severe pain
- Usually felt on a single side of the head
- Sensitivity to noise and light
- Nausea or vomiting
- Becomes worse with exertion
- May be associated with an aura
Migraine headaches last between 4 to 72 hours. The symptoms include sensitivity towards excess noise and light. There may be vomiting or nausea, along with throbbing moderate to severe pain usually felt on a single side of the head. It becomes worse with exertion.
Only three or four of the above criteria must be present for accurate diagnosis. Migraine may be associated with an aura, which is a transient, reversible neurological visual, sensory, motor, or language deficit. An aura usually precedes the headache by no more than 1 hour but is often concurrent.
The exact cause of migraine headache is unknown, although it is believed to be associated with changes in the brain as well as with genetic causes. Migraine headache is triggered by factors like bright light, strong or unpleasant sound, fatigue, weather changes, etc.
Some of the more common migraine triggers include:
- Sensitivity to specific foods chemicals and preservatives. Certain beverages (e.g., alcohol), foods like aged cheese, and also food additives like monosodium glutamate (MSG) are often triggers of migraines.
- Emotional stress. It is one of the common triggers of migraine. During stressful events, there are certain chemicals released in the brain to counter the situation. This may induce vascular changes that can trigger migraine. Factors like repressed emotions, worry, anxiety, fatigue, and excitement can dilate blood vessels and increase muscle tension and may intensify the migraine severity.
- Caffeine. Excessive caffeine or alcohol consumption, or its withdrawal, can cause headaches.
- Menstrual periods
- Bright or flickering lights
How to Relieve and Prevent Migraines
Unfortunately there's very little one can do when hit by a migraine headache. A good idea is to take the prescribed pain medication immediately after the first symptoms, go in a quiet and dark place and lie down. Many times a strong cup of coffee can help together with medication but you have to consult your doctor about that.
There's much more you can do to prevent attacks of migraines by keeping a journal. After a headache, retrace your steps during the day and write down every single detail you can remember that happened before the attack. After a while it might become apparent what your specific triggers are.
Cluster headache symptoms
- Lasts between 15 to 180 minutes
- Felt on one side of the head
- Centred on the eye and/or temples
- Repeats up to 8 times a day
- Associated with at least one of the following symptoms: tearing, red eye, stuffy nose, facial sweating, drooped eyelid, or constriction of the pupil
Cluster headache is not very common. It affects less than one in a thousand people. Such headaches typically affect young people, starting before the age of 30. It is more common in men.
Typically it lasts from 15 to 180 minutes, is severe, affects only one side of the head, is centered on the eye and/or at the temples, occurs up to 8 times a day, and is associated with at least one of the following symptoms: tearing, red eye, stuffy nose, facial sweating, drooping of the eyelid, or constriction of the pupil.
Unlike in migraine attacks, which make a person to want to lie down, those affected by cluster headaches often pace about, and because of the severity of the pain, in their desperation, they want to bang their heads against the wall.
The attacks often occur at night and awaken the sufferer from sleep.
Cluster headache falls under the category of "Trigeminal Autonomic Headaches", referring to the trigeminal nerve, one of the twelve cranial nerves in the human body.
Cluster headaches occur when the trigeminal nerve (or fifth cranial nerve) is activated. This nerve is responsible for sensations like heat and pain.
In activated state, this nerve causes eye pain associated with cluster headaches and may stimulate another nerve group that may causes redness and tearing in eye, nasal discharge and congestion and associated with cluster attacks.
Trigeminal nerve is activated by the hypothalamus. Hypothalamus plays role in the control of body temperature and release of hormones. Imaging studies show stimulation or activation of hypothalamus during a cluster attack. Such headaches are also not caused by tumor or aneurysm.
Cluster Headache Causes
It is still not clear what causes cluster headaches. However, it is believed that certain substances affects blood circulation, and may trigger cluster headaches.
- Cigarette smoke
- Head or neck injury
- Certain drugs and medication
- Surgical operation
Relieving and Preventing Cluster Headaches
There's very little one can do when experiencing a cluster headache attack. But in recent years there have been some advances in the understanding and treatment of cluster headaches[6,7].
Headaches as a Secondary Symptom
Headache, like chest pain or back ache, has many causes, mostly arising from changes in pressure in the blood vessels leading to and from the brain.
There is pain in the head, above the eyes and ears, back of the upper neck, and behind the head (occipital). Common causes of secondary headaches are:
- Fever: Except migraines, fevers with strong headaches are usually symptoms of underlying problems, and fever typically does not cause headaches directly. If fever is accompanied with strong headache, it requires proper diagnosis and treatment.
- Medication and Radiation Therapy: Many medications can cause headache. For example, drugs that contain nitrates, (e.g., blood pressure medications) increase vasodilation (swelling of blood vessels), which may result in migraine. Medications and/or therapies like “blood-thinning” medicines (e.g., aspirin), oral contraceptives, blood pressure medicines, hormone therapy, chemotherapy, etc., are also contributing factors. Overuse of medications may also cause headaches. In addition, overuse of fat-soluble vitamins, like vitamin A and D, can also cause headaches. A "rebound headache" is a type of chronic headache that may result from the overuse of painkiller medicines.
- Caffeine: Caffeine can be either good or bad for the person having a headache. It can either reduce the headache, or alternatively, cause withdrawal or rebound headaches. On the positive side, caffeine can increase the absorption of medications, but if coffee is taken habitually, it can cause the person to eventually suffer from "caffeine withdrawal headache". In such cases, stopping habitual caffeine consumption produces changes in the blood flow in the brain that gives rise to the typical caffeine withdrawal symptoms of headache, decreased alertness, and drowsiness. More specifically, acute caffeine abstinence increases the brain blood flow, which is commonly associated with withdrawal headaches.
- Alcohol: Ethanol contained in beer, wine, and other alcoholic beverages causes the blood vessels in the body to dilate, leading to the feeling of "flushing" most drinkers may experience with their first drink. Such dilation of the blood vessels in the brain may cause headaches, and alcohol is considered to be a trigger for migraines.
- Stiff Neck: Headaches from stiff necks can arise from injury, or in cases of bacterial meningitis and viral meningitis. In case of injury, stiff necks and headache can be accompanied with unconsciousness, tingling, or burning in ears. Meningitis is an inflammation in a membrane in the brain that can also cause stiff neck and headaches.
- Sinusitis: Sinuses are the air-filled cavities (spaces) located in the different places inside the face. Sinuses secrete mucus that moisturize the channels of the nose. In case of sinus-inflammation (such as allergic reaction or infection), the outflow of mucus is prevented, which results in headache. There can also be fever, nasal discharge, facial swelling, and feeling of "fullness" in the ears. The pain aggravates with sudden head movement or straining. Read more on why you get sinus headaches and how to get rid of them here: Sinus headaches.
Glaucoma: Glaucoma is an eye disease that very often causes headache. In case of glaucoma, either there is over-production of the eye-fluid, or the fluid in the eye does not drain properly, leading to increased pressure within the eye. This increased pressure can cause visual loss if not corrected. Nausea and vomiting also can accompany the headache. Such glaucoma-headaches may be felt in or around the eyes or at the forehead, and can vary in intensity from mild to severe.
What kind of headaches do you suffer from?
Please let us know
Have you ever tried or considered alternative methods to relieve and/or prevent headaches?
Did you have any success with the alternative method(s) if you tried them?
 M. Leonardi, A. Raggi (2013) Burden of migraine: international perspectives. Neurological Sciences (http://link.springer.com/article/10.1007/s10072-013-1387-8/fulltext.html)
 D. Kantor (2012) The impact of migraine on school performance. Neurology 79(18):e168-e169 (http://www.neurology.org/content/79/18/e168.long)
 Blau JN et al (2004) Water-deprivation headache: a new headache with two variants. Headache 44(1):79-83
 Spigt MG et al (2005) Increasing the daily water intake for the prophylactic treatment of headache: a pilot trial. Eur J Neurol 12(9):715-8
 Linde K et al. (2009) Acupuncture for tension-type headache. Cochrane Database Syst Rev 21;(1):CD007587
 Jürgens TP (2014) [Therapy of trigeminal autonomic headaches]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 57(8):983-95 (article in German but abstract in English: http://www.ncbi.nlm.nih.gov/pubmed/25005009)
 Fofi L et al. (2014) Acupuncture in cluster headache: four cases and review of the literature. Neurol Sci 35 Suppl 1:195-8 (abstract available here: http://link.springer.com/article/10.1007%2Fs10072-014-1769-6)