What Are Headaches?
Headaches are painful discomfort that affects people of all ages and backgrounds. They can range from mild to disabling and may be accompanied by nausea, vomiting, or sensitivity to light (photophobia). They can occur alone or with other symptoms, such as numbness or tingling. They can be triggered by stress, certain foods, medications, or even changes in sleep patterns. Some headaches are more frequent or severe than others and, depending on the type of headache, can last from 30 minutes to a few days.
Migraines and cluster headaches are the most common primary headaches, but many other forms can also occur. They can be caused by stress, dehydration, medication, hormones, or other medical conditions such as neck injury or eye problems.
It is essential to see your doctor if a headache is getting progressively worse or if you have other symptoms along with your headache. If you suffer from headaches regularly, your doctor may recommend dietary modifications, lifestyle changes, and preventive medication to help manage them. These medications may include pain relievers, anti-nausea, or anti-seizure drugs. These are usually taken daily rather than as needed when the headache occurs.
Causes of Headaches
Many things, including stress, anxiety, poor diet, hunger, and lack of sleep, can trigger headaches. They may also be a sign of an underlying health issue, such as a brain tumor, or they can be a side effect of certain medicines, such as steroids and antidepressants.
Doctors classify headaches as primary (they happen independently) or secondary, meaning they occur due to another disease or condition, such as dehydration or a brain tumor. Cluster headaches, migraines, and medication overuse are examples of secondary headaches.
The most common type of primary headache is tension-type head pain, which affects both sides of the head and can range from mild to severe. It can be made worse by stress, anxiety, and tight muscles in the neck and shoulders. Over-the-counter painkillers such as paracetamol and ibuprofen are usually enough to ease these types of headaches.
Migraines are a type of headache that is triggered by nerve pathways and chemicals in the brain. They can be aggravated by alcohol, bright lights, and some foods that release neurotransmitters. Some people suffer from a rare migraine called paroxysmal hemicrania or cluster headaches. This is a trigeminal autonomic nervous system disorder characterized by intense throbbing on one side of the face accompanied by autonomic features such as red and watery eyes or drooping eyelids on that same side.
Symptoms of Headaches
Headaches often cause pain that is dull or throbbing and affects one or both sides of the head. Sometimes, headaches are accompanied by nausea and vomiting. They may be aggravated by light, sound, and touch, lasting from a few minutes to a few days. Other headache symptoms include sensitivity to smells and tastes, fatigue, dizziness, and weakness.
Migraines are characterized by a pulsing, throbbing headache that is typically on one side of the head. Weather changes, foods, or certain medications can trigger them. Women are three times more likely than men to experience migraines, and they tend to get worse with age. Hormonal changes during the menstrual cycle, pregnancy, and menopause are common triggers.
Diagnostics and Tests
Headaches can be difficult to diagnose. Your doctor will ask you about your headache history and perform a physical exam. If you have a history of migraines, your doctor may suggest that you keep a headache diary to help pinpoint the cause of your pain. The diary can help you keep track of things like how long your headaches last, what they feel like, and how much your symptoms affect your life. It can also help you identify any food, drink, or activity that triggers your headaches.
Your doctor will probably order lab tests and imaging studies to rule out conditions that might be causing your headaches. MRI scans use magnetism, radio waves, and computer technology rather than X-rays to produce detailed images of brain tissues, bones, soft tissue, and other internal organs. These scans are beneficial for diagnosing headaches caused by vascular abnormalities, such as an aneurysm.
CT scans can rule out tumors, infections, and other problems. A lumbar puncture involves injecting cerebrospinal fluid into the spinal canal and can help identify subarachnoid bleeding, disease, and high or low CSF pressure syndromes that cause headaches. Blood tests may be used to check for inflammatory disorders, such as giant cell arteritis or rheumatoid arthritis, which can cause headaches.
Treatment
When a frequent headache interferes with daily life and does not respond to over-the-counter medicines, it may be time to see a doctor. A doctor can review your symptoms and do a physical exam. Tests, such as blood and urine tests, can help diagnose infections or other conditions that can cause headaches. Other tests, such as a computed tomography scan (also called a CT or CAT scan), can produce horizontal or axial images of the brain and head to identify injuries or conditions that may be causing a headache.
Medications, such as pain relievers and anti-seizure drugs, can help treat headaches. Other treatments, such as biofeedback, yoga, massage, and cognitive behavioral therapy, can also reduce stress and tension, which can be the cause of headaches.
Headaches caused by stress, poor posture, or a lack of sleep can be prevented by getting enough rest and changing these habits. Some people with chronic daily headaches benefit from taking anti-seizure medications, such as topiramate (Topamax), valproate sodium (Depakote), or gabapentin (Neurontin, Gralise). Botulinum toxin A injections also help prevent headaches in some people. Episodic TN and chronic TTH are usually treated with over-the-counter medicines. Still, some doctors prescribe abortive medication to stop an attack in progress and preventative drugs to decrease the frequency of headaches.
Complications
Headaches can vary in their pain type, severity, and location. Although most headaches aren't severe, some can be signs of a medical condition, such as a brain tumor or an aneurysm that could rupture and cause a hemorrhagic stroke. A "sentinel" headache, a sudden, harrowing warning that an aneurysm is about to rupture, may occur as a precursor to a catastrophically deadly stroke and requires emergency attention.
One of the most severe primary headache disorders is cluster headache, a condition with bursts of intense, throbbing, claw-like, or piercing pain on one side of the face or head. The pain strikes in a short period and lasts two to 45 minutes per episode, which can occur five to 40 times a day. A migraine-like aura, nausea, and vomiting often precede it. During an attack, the nose runs or is blocked on the affected side, and the eyelid droops. The pain can also elicit a sensation of pressure, heaviness, or tightness in the jaw, neck, or shoulders.
Prevention
Headache prevention is not always easy, but avoiding your triggers and taking medication can help. For example, drinking enough water is vital to prevent dehydration, which can trigger headaches. Limiting caffeine may help. Avoiding foods known as triggers, such as aged cheeses, chocolate, and red wine, can also help. Keeping a headache journal, which records each headache and the time of day, it occurs, can help identify behavioral or environmental factors contributing to your headaches.
Strauss says some medications can be used for headache prevention, including blood pressure medications, antidepressants, and some types of pain relievers. There are also new medications that have been developed specifically to prevent migraines, such as Aimovig (erenumab), Emgality (fremanezumab), and Galcanezumab (galcanezumab), which are taken once a month by injection at home. Magnesium supplements have also been found to help prevent migraines.
For many people, lifestyle changes are all that's needed to prevent headaches. If you're getting headaches frequently, see your primary care doctor or a neurologist for advice about how to manage them. They can refer you to a headache specialist for specialized treatment, such as trigger point injections or nerve blocks, which are practical tools to break up chronic headache cycles.
