Headache Types, Causes, Symptoms & Treatment

What is a Headache?

A headache is a pain or discomfort in the head, scalp, or neck. It is one of the most prevalent medical complaints and can significantly impact daily life. Headaches are broadly categorized into two groups: primary and secondary.

Description of the Condition

Primary headaches are independent conditions caused by overactivity of, or problems with, pain-sensitive structures in the head. They are not a symptom of an underlying disease. The most common types include tension-type headache, migraine, and cluster headache.

Secondary headaches are symptoms of another health disorder that activates the pain-sensitive nerves of the head. Numerous conditions can cause them, ranging from dehydration and sinus infections to more serious issues like hypertension, meningitis, or stroke. Identifying whether a headache is primary or secondary is a crucial step in diagnosis.

• Neurological and Vascular Dysfunction: Primary headaches like migraines are linked to abnormal brain activity affecting nerve signals, chemicals, and blood vessels. Tension-type headaches are associated with muscle contraction and heightened pain sensitivity.
• Underlying Medical Condition: The headache is a direct symptom of another issue. Common causes include hypertension, acute sinusitis, medication overuse, dehydration, and eye strain.
• Medication-Overuse Headache (MOH): Also known as rebound headache, this is a secondary headache caused by frequent, excessive use of pain-relief medication (like NSAIDs or triptans) for treating headache episodes. Paradoxically, the medication itself begins to trigger headaches.

• Family History: A family history of migraines, in particular, is a strong risk factor, suggesting a genetic component to the condition.
• Stress and Poor Sleep: High stress levels, anxiety, irregular sleep patterns, and poor sleep quality are major triggers for tension-type headaches and migraines. Resources on managing anxiety may be relevant.
• Use of Certain Medications: Regular use of pain relievers can lead to Medication-Overuse Headache (MOH). Additionally, some drugs, such as vasodilators used for erectile dysfunction, are known to cause headaches as a side effect. Information on this can be found in a urologist's guide to ED pill side effects.

• Tension-Type Headache: Dull, aching, non-throbbing pain. Pressure or tightness across the forehead or at the back of the head and neck. Usually bilateral.
• Migraine: Moderate to severe throbbing or pulsating pain, often on one side of the head. Commonly accompanied by nausea, vomiting, and sensitivity to light (photophobia) and sound (phonophobia).
• Cluster Headache: Excruciating, sharp, burning, or piercing pain strictly around one eye. Occurs in cyclical patterns or clusters. May cause eye redness, tearing, and nasal congestion on the affected side.
• Sinus Headach: Deep, constant pain and pressure in the cheekbones, forehead, or bridge of the nose. Pain often worsens with sudden head movement or straining. Associated with symptoms of sinusitis.

• Thunderclap Headache: A sudden, severe headache that peaks in intensity within 60 seconds, often described as "the worst headache of my life." This is a medical emergency.
• Headache with Neurological Deficits: Headache accompanied by confusion, weakness, numbness, vision loss, difficulty speaking, or loss of balance. These can be signs of a stroke.
• Headache After Head Injury: Any headache that begins after a trauma to the head, even if minor.
• Headache with Systemic Symptoms: Headache with fever, stiff neck, rash, or seizures. This combination can indicate an infection like meningitis.
• New Headache in Older Adults: A new or changed headache pattern in someone over 50, which could be related to conditions like giant cell arteritis.

• Medical History and Symptom Analysis: The healthcare provider will ask about headache frequency, duration, location, intensity, triggers, and associated symptoms. Keeping a headache diary can be very helpful.
• Neurological Examination: This exam checks cranial nerves, reflexes, coordination, sensation, and muscle strength to identify any neurological abnormalities.
• Diagnostic Imaging (if indicated): A CT scan or MRI may be ordered if the history or exam suggests a secondary cause like a tumor, bleed, or structural issue. They are not routinely needed for typical primary headaches.

• Over-the-Counter (OTC) Analgesics: For mild to moderate headaches. Includes acetaminophen, aspirin, ibuprofen, and naproxen. Safe use of common analgesives is covered in guides like this paracetamol safety guide.
• Prescription Medications: For migraines and severe headaches. Includes triptans, ergotamines, and stronger NSAIDs like diclofenac or toradol. Use must be monitored to prevent MOH.
• Daily Medications: For frequent headaches. Includes various classes such as beta-blockers (propranolol), anticonvulsants, antidepressants, and CGRP inhibitors.
• Non-Pharmacological Therapies: Cognitive-behavioral therapy (CBT), biofeedback, acupuncture, and physical therapy can be effective, especially for tension-type headaches.

• Rest in a Quiet, Dark Environment: Especially useful for migraines. Reducing sensory input (light, sound) can help alleviate pain.
• Apply a Cold or Warm Compress: A cold pack on the forehead or a warm compress on the neck or shoulders can provide relief for some individuals.
• Hydrate: Drink water, as dehydration is a common headache trigger.
• Consider a Single Dose of OTC Pain Reliever: Use according to package instructions. Avoid frequent use. For more on responsible pain management, see this guide.

• Maintain a Regular Sleep Schedule: Aim for consistent sleep and wake times, even on weekends. Both lack of sleep and oversleeping can trigger headaches.
• Manage Stress Effectively: Practice relaxation techniques such as deep breathing, meditation, yoga, or progressive muscle relaxation.
• Stay Hydrated and Eat Regularly: Avoid skipping meals, as low blood sugar can trigger headaches. Drink adequate water throughout the day.
• Exercise Regularly: Moderate, consistent aerobic exercise can help reduce the frequency and intensity of headaches.

• Prophylactic Medication: As described in the treatment section, daily medications like beta-blockers (e.g., propranolol HCL) can be prescribed to prevent migraines.
• Avoid Medication Overuse: Strictly follow prescribed limits for acute headache medications to prevent the development of Medication-Overuse Headache (MOH).
• Identify and Avoid Personal Triggers: Common triggers include specific foods (aged cheese, processed meats), alcohol (especially red wine), caffeine withdrawal, strong smells, and weather changes. A headache diary is key for identification.

References and Medical Sources

1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202. View source
2. American Migraine Foundation. Migraine & Headache Disorders. https://americanmigrainefoundation.org/. Accessed May 2024.
3. National Institute of Neurological Disorders and Stroke. Headache: Hope Through Research. https://www.ninds.nih.gov/health-information/disorders/headache. Updated November 28, 2023. Accessed May 2024.
4. World Health Organization (WHO). Headache disorders. https://www.who.int/news-room/fact-sheets/detail/headache-disorders. Published April 8, 2016. Accessed May 2024.
5. Mayo Clinic Staff. Headache. Mayo Clinic. https://www.mayoclinic.org/symptoms/headache/basics/definition/sym-20050800. Accessed May 2024.
6. Ashina M, Terwindt GM, Al-Karagholi MA, et al. Migraine: disease characterisation, biomarkers, and precision medicine. Lancet. 2021;397(10283):1496-1504. doi:10.1016/S0140-6736(20)32162-0. View source
7. U.S. Food and Drug Administration (FDA). Nonsteroidal Anti-inflammatory Drugs (NSAIDs). https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/nonsteroidal-anti-inflammatory-drugs-nsaids. Updated December 4, 2023. Accessed May 2024.
8. Burch R. Migraine and Tension-Type Headache: Diagnosis and Treatment. Med Clin North Am. 2019;103(2):215-233. doi:10.1016/j.mcna.2018.10.003. View source