Headache

What is a headache?

A headache is pain or discomfort in the head or face area. Headaches vary greatly in terms of pain location, pain intensity, and how frequently they occur. As a result of this variation, several categories of headache have been created by the International Headache Society (IHS) to more precisely define specific types of headaches.

What aches when you have a headache?

There are several areas in the head that can hurt when you have a headache, including the following:

  • a network of nerves that extends over the scalp
  • certain nerves in the face, mouth, and throat
  • muscles of the head
  • blood vessels found along the surface and at the base of the brain (these contain delicate nerve fibers)

The bones of the skull and tissues of the brain itself do not hurt because they do not have pain-sensitive nerve fibers.

What causes a headache?

Headaches may be caused by a number of conditions, such as disorders of the neck, eyes, brain, jaw, or teeth. Headaches with an underlying medical condition are classified as secondary headaches because they are related to the condition. An example of this would be a headache due to neck injury or sinus infection.

Other headaches are classified as primary because the headache itself is the main medical problem, although underlying non-medical causes, such as muscle tension or foods, may be identified. Other contributing factors may include medications, dehydration, or changing levels of hormones. These factors that influence headaches are sometimes called headache triggers.

What are some of the different types of primary headaches?

  • migraines
    This type of headache is distinguished by the fact that symptoms other than pain occur as part of the headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual symptoms typically occur.

    Migraines are also unique in that they have distinct phases. Not all individuals experience each phase, however. The phases of a migraine headache may include:
    • premonition phase - a change in mood or behavior that may occur hours or days before the headache.
    • aura phase - a group of visual, sensory, or motor symptoms that immediately precede the headache. Examples include hallucinations, numbness, changes in speech, and muscle weakness.
    • headache phase - period during the actual headache. Throbbing pain on one or both sides of the head. Sensitivity to light and motion are common, as are depression, fatigue, and anxiety.
    • headache resolution phase - pain lessens during this phase, but may be replaced with fatigue, irritability, and difficulty concentrating. Some individuals feel refreshed after an attack, while others do not.
  • tension headaches
    Tension headaches are the most common type of headache. Stress and muscle tension are often factors in tension-type headaches. While symptoms may differ, the following are common symptoms of a tension-type headache:
    • 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 (posterior) part of the head or neck
    • pain is mild to moderate, but not severe
    Tension type headaches typically do not cause nausea, vomiting, or sensitivity to light (photophobia).
  • cluster headaches
    Cluster headaches usually occur in a series that may last weeks or months, and the headache series may return every year or two. While people often experience symptoms differently, the following are the most common symptoms of a cluster headache:
    • severe pain on one side of the head, usually behind one eye
    • the eye that is affected may have a droopy lid, small pupil, or redness and swelling of the eyelid
    • runny nose or congestion
    • swelling of the forehead

What are the most serious symptoms of a headache?

Headache symptoms depend upon the type of headache. The frequency of headaches and the intensity of the symptoms may vary as well. Symptoms that may suggest a more serious headache include any of the following:

  • headaches that start early in the morning
  • pain that is worsened by strain, such as a cough or a sneeze
  • vomiting without nausea
  • sudden onset of pain and the "worst headache" ever
  • headache that is becoming more severe or continuous
  • personality changes
  • changes in vision
  • weakness in the arms or legs
  • seizures or epilepsy

The symptoms of a headache may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How are headaches diagnosed?

The full extent of the problem may not be understood immediately, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a headache is made with a careful history, physical examination and diagnostic tests.

Questions commonly asked during the exam may include, but are not limited to, the following:

  • When do headaches occur?
  • What is the location of the headache?
  • What do the headaches feel like?
  • 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?

If the history is consistent with migraine or tension-type headaches and the neurological exam is normal, no further diagnostic testing may be necessary. However, if it is not a primary type headache, then other tests may be needed to determine the cause.

Tests used to determine the cause of a headache may include:

  • blood tests - various blood chemistry and other laboratory tests may be run to check for underlying conditions.
  • sinus x-rays - a diagnostic imaging procedure to evaluate for congestion or other problems that may be corrected.
  • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • computed tomography scan (Also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment for headaches:

Specific treatment for headaches will be determined by your physician based on:

  • your age, overall health, and medical history
  • type of headaches
  • severity and frequency of the headaches
  • your tolerance for specific medications, procedures, or therapies
  • your opinion or preference

The ultimate goal of treatment is to stop headaches from occurring. Adequate headache management depends on the accurate identification of the type of headache and may include:

  • avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting
  • changing eating habits
  • exercise
  • resting in a quiet, dark environment
  • medications, as recommended by your physician
  • stress management

Migraine headaches may require specific medication management including:

  • abortive medications - medications, prescribed by your physician, that act on specific receptors in nerves and blood vessels in the head to stop a headache in progress.
  • rescue medications - medications purchased over-the-counter, such as analgesics (pain relievers), to stop the headache.
  • preventive medications - medications, prescribed by your physician, that are taken daily to reduce the onset of severe migraine headaches.

Some headaches may require immediate medical attention including hospitalization for observation, diagnostic testing, or even surgery. Treatment is individualized depending on the underlying condition causing the headache. Full recovery depends on the type of headache and other medical problems that may be present.

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