If your head is throbbing, you’re not alone. Headache is one of the most common pain conditions in the world. Up to 75% of adults worldwide have had a headache in the past year.
Headaches are a major cause of absenteeism from work and school. They also take a toll on social and family life. For some people, continually battling headaches can lead to feeling anxious and depressed.
There are several distinct types of headaches.
Most people experience the occasional tension headache. Some people, however, have tension headaches just about every day, and these are considered to be chronic. Symptoms for tension headaches usually include pressure or muscle tension on both sides of the head or the back of the neck. The pain is usually constant, not sharp or throbbing. Many people describe tension headaches as having a band squeezed around their head.
Hormones play a role in the pain response to headaches in both men and women. However, women can suffer from hormone headaches, also known as menstrual migraines. These migraines may start before a woman’s period or during menstruation. Symptoms include sharp, throbbing pain on one side of the head, nausea, vomiting, and sensitivity to light, sound, and even touch.
Cluster headaches affect men more often than women. They are extremely intense, very severe headaches that last between 30 and 45 minutes; a person can have several in one day. They usually come on with no warning, catching people by surprise. The pain is piercing and usually located on one side of the head, often around the eye. People also report teary eyes on the affected side and sinus congestion. The headaches will recur over a period of time, almost always on the same side, and are followed by a headache-free period of varying length.
Primary vs. Secondary Headaches
Headaches may be primary or secondary.
A primary headache is caused by pain or a disorder that originates from the head itself — for example, a migraine or tension headache.
A secondary headache originates outside the head, such as a headache related to nausea from the flu or as a side effect of hormonal fluctuations in the body.
Neurologists have identified 17 discrete types of headaches, each with their own causes and treatments:
- Primary tension headaches that are episodic
- Primary tension headaches that are chronic
- Primary muscle contraction headaches
- Primary migraine headaches with aura
- Primary migraine headaches without aura
- Primary cluster headaches
- Primary paroxysmal hemicranias (a type of cluster headache)
- Primary cough headaches
- Primary stabbing headaches
- Primary headaches associated with sexual intercourse
- Primary thunderclap headaches
- Hypnic headaches (headaches that awaken a person from sleep)
- Hemicranias continua (headaches that are persistently on one side only, right or left)
- New daily-persistent headaches (a type of chronic headache)
- Headaches from exertion
- Trigeminal neuralgia and other cranial nerve inflammation (causing facial pain)
- Secondary headaches due to trauma; disorders; infection; structural problems with the bones of the face, teeth, eyes, ears, nose, sinuses, or other structures; substance abuse or withdrawal; or systemic poisoning (toxic headache)
How Are Headaches Treated and Prevented?
The key to getting treatment for a headache is identifying the underlying cause.
Headaches can be caused by inflammation or irritation of structures that surround the brain or affect its function. They can also be caused by colds or the flu, fever, muscle stiffness in the head or neck area, dental or jaw pain, trauma to the head or neck, sinus infections, bleeding in the brain, or infections like encephalitis or meningitis.
Headaches can also be brought on by toxins, such as too much alcohol, smoking, or the consumption of allergenic or spoiled foods. Headaches can be the first sign of carbon monoxide or other environmental poisons, and they may be triggered by substance abuse or withdrawal.
General treatment for a minor headache includes rest, stress reduction, cold compresses, massage to the temples and head area, acetaminophen (Panadol), and nonsteroidal anti-inflammatory medications (NSAIDs).
Headache prevention includes good habits such as eating healthy foods and avoiding alcohol and cigarettes. Eliminate external stressors as much as possible, and try to practice regular sleep habits. Additional treatment for headaches may include medications for migraine headaches and narcotic pain medications.
Medications for Headaches
Medications for migraine and headache relief can be divided into two groups: pain-relieving (also known as abortive medications) and preventive (prophylactic medications).
Pain-relieving medications are taken once symptoms begin. Preventive medications are taken regularly, sometimes daily, to stop headaches before they start. Headache relief medications are available over-the-counter or by prescription.
Doctors believe this group of medications works by blocking a chemical in the body that causes inflamed tissue to swell and, in the case of headaches, signaling the brain when there is pain.
NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve, Anaprox). Aspirin is another NSAID sometimes used in combination with acetaminophen and caffeine for strong headache relief, as in Excedrin, and in products designed to treat migraines.
Three anti-inflammatory drugs have been approved as migraine relief medications: Excedrin Migraine, Advil Migraine, and Motrin Migraine Pain.
The most common side effects of NSAIDs are nausea, indigestion, and heartburn. Be sure to take NSAIDs with food to offset the risk of an upset stomach. In high doses or when used for a long time, NSAIDs can also damage the kidneys and worsen heart conditions.
Triptans are often the first prescription choice for migraine relief. They constrict, or narrow, the blood vessels and keep chemicals that are thought to cause migraines from being released.
Sumatriptan (Imitrex), zolmitriptan (Zomig), eletriptan (Relpax), and almotriptan (Axert) are frequently used triptans.
If taken often, triptans can cause a boomerang effect known as “rebound headaches.” Other potential side effects include nausea, dizziness, muscle weakness, and abnormal heart rhythms.
If you mainly rely on pain-relieving migraine medications, be sure to follow the directions on the label closely. Speak with your doctor if you find you need them more than occasionally. If that is the case, your doctor may recommend a daily preventive medication in place of pain-relieving medicines.
When Should You See a Doctor?
Head pain can be frightening because people often think that it could be the sign of something serious.
“A person with headaches should always discuss this issue with their physician,” says Steven P. Herzog, MD, an attending neurologist at Baylor University Medical Center in Dallas. "In turn, their physician can make a correct diagnosis of the type of headaches the patient is suffering with and whether or not they should see a headache specialist.”
Call your doctor if the quality or type of headache symptoms change or if you feel that you are having migraines, which may need prescription-strength treatment.
Other reasons to contact your doctor include these events:
- Any changes in the type of headaches you usually get
- Headaches that don’t go away or that get worse as each day passes
- Headaches that occur with physical activity (including sex)
- Headaches that happen after injury or illness
- Headaches accompanied by a fever, a stiff neck, signs of a stroke (such as difficulty speaking, numbness, or weakness), seizures, or changes in your vision
- Worsening of your headache if you have to strain, as when having a bowel movement, sneezing, or coughing
- New headaches if you’re over 40
- The headache is the worst in your life
- Headaches associated with very high blood pressure (if you are checking it at home)
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