Headache

Headaches are characterized by pain in any part of the head. They are second only to the common cold as the most frequently-heard medical complaint and manifest in many different forms – all with their own causes, triggers and characteristics. 1

A headache can be localized to one part of the head or affect the whole head; the pain can also vary in sensation, severity and frequency. 2 A range of treatment options are available for headaches, with the chosen method dependent on the type of headache and its causes. In most instances, headaches can be managed effectively through medication, lifestyle changes or a combination of the two.

There are many different types of headaches – some estimate as many as 150 – with differing causes, triggers, and symptoms. 3 However, all can be sorted into two overarching categories: primary and secondary. 4

1. Primary headaches are headaches that are due to the headache condition itself and not to any other cause.
2. Secondary headaches are headaches that are symptomatic of another condition, e.g. a sinus headache from sinusitis.

The most common types of headache include:

• Tension headache
• Migraines
• Cluster headache
• Sinus headache
• Hormonal headache
• Caffeine-triggered headache
• Hypertension headache
• Hangover headache
• Exertion headache
• Tumor headache
• Post-traumatic headache
• Chronic, progressive headache
• Medication-overuse headache

Let's understand the causes and symptoms of the 13 most common types of headache:

Tension headaches, or stress headaches, are the most common type of headache in adults. They are classified as a primary headache, as they are not a symptom of another condition or injury. The principal trigger of tension headaches is thought to be stress, either a single stressful situation or a buildup of stress over a long period of time. Additional triggers may include lack of sleep, weather changes, excessive muscular tension, especially in the neck and shoulder area, and, in some people, the after effects of drinking alcohol. 5 6

The sensation associated with a tension headache is often described as a dull pain or pressure around the head, usually on both sides, or the neck. Although they can be considerably painful, in most cases, the pain of a tension headache is mild to moderate and will not affect an individual’s ability to work or carry out daily tasks. If tension headaches occur under 15 times per month, they are classified as episodic tension headaches, whereas if they occur 15 times or more per month they are classified as chronic tension headaches. Both can last anywhere from around 30 minutes to a number of days, though chronic headaches will generally last longer.

Pain medication such as aspirin, ibuprofen, acetaminophen and naproxen can be effective in treating a tension headache. 7 Taking measures to reduce stress, such as exercise, meditation, therapy or using breathing techniques, can also be effective in preventing the onset of a tension headache, but are most effective when practiced on a regular basis.

If tension headaches are frequent and continuously treated with analgesics, there is a chance that the headaches may become chronic. This may be due to medicine-overuse syndrome, otherwise known as analgesic rebound, in which medication ceases to provide relief and may actually contribute to the headaches themselves.

Read more about Tension Headaches »

Medication-overuse headaches are headaches caused by taking of painkillers or triptan medications typically used to treat headaches and migraines. Although named an overuse headache, in most cases, these headaches will occur as a result of taking the medication in the correct quantity, as prescribed by the doctor. Once identified, the treatment method is to stop the consumption of the medication and for an alternative to be found.

Migraines are powerful primary headaches which are often accompanied by severe pain and throbbing, nausea, light sensitivity, hypersensitivity to sounds and vomiting. 8 In 60 percent of cases, a migraine is limited to one side of the head, and can be triggered by stress, hormonal changes, certain foods (including alcohol, cheese and certain additives), caffeine, changes in the weather and tiredness, among other factors. They can also have a significant hereditary component, with the approximate calculation that, if both parents suffer from migraines, a child has a 75 percent chance of inheriting the condition. A migraine can last anywhere from a few hours to a number of days.

Pain relievers such as triptans, ergotamine, aspirin and ibuprofen are the usual drugs prescribed to individuals experiencing migraines. In extreme cases, when migraines are frequent and intensely painful, preventative medication may be prescribed. These can include drugs like beta blockers (e.g. propanolol), antidepressants, e.g. amitriptyline, and certain anti-seizure drugs (e.g. topiramate). 9

Read more about Migraines »

Cluster headaches are a type of primary headache without a known cause. 10 Cluster headaches occur as a series of relatively short but severely painful headaches, often during the night. They will generally occur every day for a number of weeks or months at a time. In most cases, cluster headaches will happen at the same time each year. However, some people will go for long periods without experiencing headaches; 2 years is the average length of remission, but this can be anywhere between 2 months and 20 years.

The pain associated with cluster headaches is often described as a powerful burning or throbbing sensation, which is usually limited to one side of the head, as well as behind or around one eye. Pain will usually also be accompanied by the secretion of tears, a red eye, nasal stuffiness, a swollen eyelid, a drooping eyelid, constriction of the pupil, and/or sweating from the face and forehead, all limited to the same side of the head as the headache. A cluster headache will tend to last for a short period of time – roughly 30 to 90 minutes – most often one to three times per day over a number of weeks or months.

Ordinary pain relievers such as aspirin, ibuprofen, and opioids tend to be ineffective against this type of headache. To treat an acute cluster headache, the inhalation of oxygen or lidocaine nasal drops are two of the preferred methods.

Read more about Cluster Headaches »

The sinuses are hollow cavities in the cheekbones, behind the forehead and in the nose. When they become inflamed, most commonly as a consequence of an infection or an allergic reaction, the pressure that builds up can result in headache-like pain, termed as sinus headaches. 11 The pain of a sinus headache can be constant, range from mild pressure to severe pain, and is sometimes accompanied by a fever, runny nose and swelling of the face as signs that the sinuses are inflamed.

Decongestants are the prefered method of treatment. Antibiotics may also be prescribed in cases where headaches are being caused by bacterial sinusitis.

Fluctuating levels of the hormone estrogen during the menstrual cycle, pregnancy and menopause, as well as a result of certain contraceptives (contraceptive pills, for example) and hormone replacement therapy, can lead to acute or chronic headaches in women. When particularly severe, these headaches are described as menstrual migraines and may be accompanied by some of the other symptoms of a migraine, such as nausea and vomiting. 12

Pain relievers and triptans can be effective in treating hormone headaches. 13

Caffeine headaches are typically a symptom of caffeine withdrawal or sensitivity. Those who consume caffeine sporadically or who consume a large amount of caffeine within a short amount of time, are typically more at risk of caffeine headaches. 14 A caffeine headache can be painful – normally beginning behind the eyes and progressing into the forehead area. In severe cases, a caffeine headache can develop into a migraine.

Treating a caffeine headache may involve the use of over-the-counter (OTC) pain relievers, drinking plenty of fluids or avoiding caffeine completely.

Hypertension, or high blood pressure, can cause headache in some cases. These headache typically occur in the morning and are located in the back of the head. Malignant hypertension, a condition in which the body’s blood pressure reaches critical levels, can lead to a buildup of pressure in the cranium, which in turn can also trigger head pain or a migraine. This may be accompanied by nausea, chest pain and blurred vision. Those experiencing malignant hypertension should seek medical treatment immediately. 15

Treating hypertension headaches will invariably involve treating the underlying cause: high blood pressure. However, for immediate relief, pain relievers may be effective.

Read more about Hypertension »

Hangover headaches, or alcohol-induced headaches, are a common form of headache that typically manifests the day after excessive consumption of alcohol. The pain will, in most cases, be felt on both sides of the head, be throbbing or pulsating in sensation and worsen with physical activity. Alcohol can also act as a trigger for migraines. 16

A hangover headache can be treated with over-the-counter (OTC) pain medications and rehydration, as in drinking plenty of water over the day.

Read more about a hangover »

Exertion headaches – or activity-related headaches – are typically triggered by lengthy periods of physical exercise and are most common in younger people under 50. 17 The headache will usually develop as the exercise reaches its peak, and fade when the exertion stops. However, in rare cases, the headache can last significantly longer. An exertion headache can be painful and may be accompanied by symptoms such as nausea and vomiting.

Anti-inflammatory drugs can be effective in treating an exertion headache. In rare cases, this type of headache can be a sign of a more serious condition, including aneurysm and brain tumors, so professional medical advice should be sought if the problem persists. 18

Headaches are one of the most common symptoms of a brain tumor. Tumor headaches are typically characterized by their persistence, yet may still fade after a number of hours or days, and may be accompanied by vomiting. Moreover, tumor headaches are unlikely to respond to traditional treatment methods. Individuals experiencing headaches, who suspect the presence of a tumor, should seek medical advice promptly. 19

Tumor headaches may be managed through medications prescribed by doctors and surgery.

Chronic progressive headaches – also known as traction or inflammatory headaches – are a rare headache type, which can in some cases be a sign of more serious conditions such as brain tumors, strokes and head trauma. They typically worsen and occur more frequently over time.

It may be necessary for tests such as an MRI scan, CT scan or eye exam to be performed in order to diagnose chronic progressive headaches. 20 It is always advisable to visit a doctor promptly if headaches recur or worsen over time, so that any underlying condition can be diagnosed and treated.

A post-traumatic, or post-concussion, headache is described as a headache that develops within seven days of head trauma or regaining consciousness following a head trauma. 21 The severity of a post-traumatic headache can vary, however, these headaches are often more intense in nature, like migraines, and may be accompanied by symptoms such as vomiting, nausea, and light sensitivity, as well as further symptoms like dizziness, insomnia, and memory problems.

It is important to seek medical attention for any head trauma. Headaches should fade and desist as a result of treatment for the head trauma itself, though pain medications and anti-inflammatories like ibuprofen can be used in the short term to alleviate pain. These should only be used if prescribed by the doctor who performed the examination after the head trauma/injury.

In some cases, it may be possible to identify a particular type of headache based on which part of the head is affected.

The following is a breakdown of headache types based on location. It should be noted that some types of headaches can affect multiple locations. Moreover, some types of headaches, such as post-traumatic headaches or tumor headaches are generalized, meaning they affect the whole of the head.

1. Frontal (front of the head): tension headache, migraine, sinus headache, caffeine-triggered headache, hangover headache, hypertension headache
2. Temporal (side of the head): tension headache, hangover headache
3. Occipital (back of the head): tension headache, hypertension headache
4. Middle or top of the head: tension headache
5. One side of the head: migraine, cluster headache
6. Behind or around the eyes: cluster headache, caffeine-triggered headache

In order to receive appropriate treatment, it is important to describe the nature of a headache to the doctor fully, making sure to include information such as: 22

• How long a person has been experiencing headaches
• Age of onset
• How often the headaches occur
• Suspected triggers for the headaches (foods, medication, etc.)
• If any family members experience similar headaches
• The location and severity of the pain
• How long the headaches last
• Whether there are any other symptoms that occur besides the headaches

Following the investigation of a person’s medical history, a doctor will typically perform a comprehensive physical and neurological exam in order to identify any underlying conditions that may be causing the headaches.

This will involve testing for conditions such as high blood pressure, infection, brain tumors and head trauma. If no underlying condition can be found, the diagnosis will likely conclude that an individual is suffering from a primary headache type (tension, cluster or a migraine).

In rare cases, further tests may be called for. The decision to have someone undergo these tests is the responsibility of the doctor and will depend on their analysis of an individual’s medical history, symptoms and initial test results. These tests may include a CT scan, MRI scan, blood tests, urinalysis or sinus X-ray (sinus series).

To help doctors and the affected person themselves to further understand the headaches and track any changes over time, it may also be useful to keep a headache diary. The diary should note the time, duration and severity of the headaches, as well as any accompanying symptoms.

If you are experiencing headaches, try using the free Ada app to find out what the problem is.

Headache triggers such as hormone fluctuation and the weather cannot be controlled, however, once identified, other triggers can be managed to help prevent the risk of headaches.

The most common triggers to avoid include: 23

• Stress: Learn and apply a relaxation technique or meditate on a regular basis.
• Dehydration: Drink adequate amounts of non-alcoholic and non-caffeinated beverages.
• Foods: Maintain a nutritionally sound, balanced diet.
• Environment: Whenever possible, spend time in calming environments with fresh air. Bright lights and loud noises can trigger headaches in some people.

By taking steps to avoid triggers, headaches may be prevented or their frequency at least reduced.

In most cases, a headache need not be a serious concern. However, as they can sometimes be indicators of more serious conditions, individuals experiencing regular or semi-regular headaches should keep track of their symptoms and seek medical attention, if they notice any of the following symptoms: 24

• Fatigue, dizziness, numbness, tingling, sudden loss of balance, immobility
• Seizures, trouble with speech, confusion, changes in disposition
• Blurred vision, double vision, blind spots
• Fever, rashes, neck-stiffness, shortness of breath
• Nausea, vomiting

If none of these symptoms are present, but headaches or migraines become more frequent or gradually worsen, medical attention is advised, nevertheless.

Q: Are there any home remedies for headaches?
A: Yes, there are a number of home remedies for headaches. Two of the most regularly cited include: 25

• Thyme, peppermint and rosemary oil: Rub a small amount of thyme, peppermint, or rosemary oil onto the temples. After a short period, a headache should begin to lessen in intensity. These oils contain a natural anti-inflammatory agent.
• Ginger: Ginger is thought to be effective against migraines and especially against the nausea they are often accompanied by. Make tea using fresh ginger for the best results.

If headaches persist, professional medical attention should always be sought.

Q: What is the difference between a migraine and a headache?
A: A migraine is one of many types of headaches. However, it is important to differentiate between a migraine and any other type of headache, as this will allow the sufferer to seek appropriate treatment more quickly. The level and type of pain being experienced is the main way to tell the difference. The pain associated with a migraine will typically be severe, throbbing and, in 60 percent of cases, affect just one side of the head. A migraine may also be accompanied by nausea, pain in one eye or ear and pain in the temples, among other symptoms. A tension headache, another common type of headache, on the other hand, will typically involve less intense pain (though can be severe) and will generally affect both sides of the head. A doctor’s opinion should always be sought when a new type of headache occurs. A doctor will be able to differentiate between a migraine and other types of headache and recommend appropriate treatment options.