Headache Basics
Headaches can be more complicated than most people realize. Different kinds can have their own set of symptoms, happen for unique reasons, and need different treatments.
Once you know the type of headache you have, you and your doctor can find the treatment that’s most likely to help and even try to prevent them.
Common Types of Headaches
There are over 150 types of headaches, but the most common types include:
Tension Headaches
Tension headaches are the most common type of headache among adults and teens. They cause mild to moderate pain and come and go over time. They usually have no other symptoms.
Migraine Headaches
Migraine headaches are often described as pounding, throbbing pain. They can last from 4 hours to 3 days and usually happen one to four times a month. Along with the pain, people have other symptoms, such as sensitivity to light, noise, or smells; nausea or vomiting; loss of appetite; and upset stomach or belly pain. When a child has a migraine, they may look pale, feel dizzy, and have blurry vision, fever, and an upset stomach. A small number of children's migraines include digestive symptoms, like vomiting, that happen about once a month.
Cluster Headaches
These headaches are the most severe. You could have intense burning or piercing pain behind or around one eye. It can be throbbing or constant. The pain can be so bad that most people with cluster headaches can’t sit still and will often pace during an attack. On the side of the pain, the eyelid droops, the eye reddens, pupil gets smaller, or the eye makes tears. The nostril on that side runs or stuffs up.
They’re called cluster headaches because they tend to happen in groups. You might get them one to three times per day during a cluster period, which may last 2 weeks to 3 months. Each headache attack lasts 15 minutes to 3 hours. They can wake you up from sleep. The headaches may disappear completely (your doctor will call this remission) for months or years, only to come back later. Men are three to four times more likely to get them than women.
Chronic Daily Headaches
You have this type of headache 15 days or more a month for longer than 3 months. Some are short. Others last more than 4 hours. It’s usually one of the four types of primary headache:
- Chronic migraine
- Chronic tension headache
- New daily persistent headache
- Hemicrania continua
With sinus headaches, you feel a deep and constant pain in your cheekbones, forehead, or on the bridge of your nose. They happen when cavities in your head, called sinuses, get inflamed. The pain usually comes along with other sinus symptoms, like a runny nose, fullness in the ears, fever, and a swollen face. A true sinus headache results from a sinus infection so the gunk that comes out of your nose will be yellow or green, unlike the clear discharge in cluster or migraine headaches.
Posttraumatic Headaches
Posttraumatic stress headaches usually start 2-3 days after a head injury. You’ll feel:
- A dull ache that gets worse from time to time
- Vertigo
- Lightheadedness
- Trouble concentrating
- Memory problems
- Tiring quickly
- Irritability
Headaches may last for a few months. But if it doesn’t get better within a couple of weeks, call your doctor.
Less Common Headaches
Exercise Headaches
When you’re active, the muscles in your head, neck, and scalp need more blood. Your blood vessels swell to supply them. The result is a pulsing pain on both sides of your head that can last anywhere from 5 minutes to 48 hours. It usually hits while you’re active or just afterward, whether the activity is exercise or sex.
Hemicrania Continua
Hemicrania continua is a chronic, ongoing headache almost always affects the same side of your face and head. Other symptoms include:
- Pain that varies in severity
- Red or teary eyes
- Runny or stuffy nose
- Droopy eyelid
- Contracted iris
- Responds to the pain medication indomethacin
- Worse pain with physical activity
- Worse pain with drinking alcohol
Some people also notice migraine symptoms like:
- Nausea and vomiting
- Sensitivity to light and sound
There are two types:
- Chronic: You have daily headaches.
- Remitting: You have headaches for 6 months. They go away for a period of weeks or months and come back.
Hormone Headaches
You can get headaches from shifting hormone levels during your periods, pregnancy, and menopause. The hormone changes from birth control pills and hormone replacement therapy can also trigger headaches. When they happen 2 days before your period or in the first 3 days after it starts, they’re called menstrual migraines.
New Daily Persistent Headaches (NDPH)
These may start suddenly and can go on for 3 months or longer. Many people clearly remember the day their pain began.
Doctors aren't sure why this type of headache starts. Some people find that it strikes after an infection, flu-like illness, surgery, or stressful event.
The pain tends to be moderate, but for some people, it's severe. And it's often hard to treat.
Symptoms can vary widely. Some are like tension headaches. Others share symptoms of migraine, such as nausea or sensitivity to light.
Call your doctor if your headache won't go away or if it's severe.
Rebound Headaches
You might also hear these called medication overuse headaches. If you use a prescription or over-the-counter pain reliever more than two or three times a week, or more than 10 days a month, you’re setting yourself up for more pain. When the meds wear off, the pain comes back and you have to take more to stop it. This can cause a dull, constant headache that’s often worse in the morning.
Rare Headaches
Ice Pick Headaches
These short, stabbing, intense headaches usually only last a few seconds. They might happen a few times a day at most. If you have one, see the doctor. Ice pick headaches can be a condition on their own, or they can be a symptom of something else.
Spinal Headaches
Talk to your doctor if you get a headache after you have a spinal tap, a spinal block, or an epidural. Your doctor might call it a puncture headache because these procedures involve piercing the membrane that surrounds your spinal cord. If spinal fluid leaks through the puncture site, it can cause a headache.
Thunderclap Headaches
People often call this the worst headache of your life. It comes suddenly out of nowhere and peaks quickly. Causes of thunderclap headaches include:
- Blood vessel tear, rupture, or blockage
- Head injury
- Hemorrhagic stroke from a ruptured blood vessel in your brain
- Ischemic stroke from a blocked blood vessel in your brain
- Narrowed blood vessels surrounding the brain
- Inflamed blood vessels
- Blood pressure changes in late pregnancy
Take a sudden new headache seriously. It’s often the only warning sign you get of a serious problem.
What Causes Headaches?
The pain you feel during a headache comes from a mix of signals between your brain, blood vessels, and nearby nerves. Specific nerves in your blood vessels and head muscles switch on and send pain signals to your brain. But it isn’t clear how these signals get turned on in the first place.
Common causes of headaches include:
- Illness. This can include infections, colds, and fevers. Headaches are also common with conditions like sinusitis (inflammation of the sinuses), a throat infection, or an ear infection. In some cases, headaches can result from a blow to the head or, rarely, a sign of a more serious medical problem.
- Stress. Emotional stress and depression as well as alcohol use, skipping meals, changes in sleep patterns, and taking too much medication. Other causes include neck or back strain due to poor posture.
- Your environment, including secondhand tobacco smoke, strong smells from household chemicals or perfumes, allergens, and certain foods. Stress, pollution, noise, lighting, and weather changes are other possible triggers.
- Genetics. Headaches, especially migraine headaches, tend to run in families. Most children and teens (90%) who have migraines have other family members who get them. When both parents have a history of migraines, there is a 70% chance their child will also have them. If only one parent has a history of these headaches, the risk drops to 25%-50%.
Doctors don’t know exactly what causes migraines. One theory suggest that a problem with the electric charge through nerve cells causes a sequence of changes that cause migraines.
Too much physical activity can also trigger a migraine in
Getting a Diagnosis
Once you get your headaches diagnosed correctly, you can start the right treatment plan for your symptoms.
The first step is to talk to your doctor about your headaches. They’ll give you a physical exam and ask you about the symptoms you have and how often they happen. It’s important to be as complete as possible with these descriptions. Give your doctor a list of things that cause your headaches, things that make them worse, and what helps you feel better. You can track details in a headache diary to help your doctor diagnose your problem.
Most people don’t need special diagnostic tests. But sometimes, doctors suggest a CT scan or MRI to look for problems inside your brain that might cause your headaches. Skull X-rays won’t help. An EEG (electroencephalogram) is also unnecessary unless you’ve passed out when you had a headache.
If your headache symptoms get worse or happen more often despite treatment, ask your doctor to refer you to a headache specialist.
How Are Headaches Treated?
Your doctor may recommend different types of treatment to try. They also might suggest more testing or refer you to a headache specialist.
The type of headache treatment you need will depend on a lot of things, including the type of headache you get, how often, and its cause. Some people don’t need medical help at all. But those who do might get medications, electronic medical devices, counseling, stress management, and biofeedback. Your doctor will make a treatment plan to meet your specific needs.
What Happens After I Start Treatment?
Once you start a treatment program, keep track of how well it’s working. A headache diary can help you note any patterns or changes in how you feel. Know that it may take some time for you and your doctor to find the best treatment plan, so try to be patient. Be honest with them about what is and isn’t working for you.
Even though you’re getting treatment, you should still steer clear of the things you know can trigger your headaches, like foods or smells. And it’s important to stick to healthy habits that will keep you feeling good, like regular exercise, enough sleep, and a healthy diet. Also, make your scheduled follow-up appointments so your doctor can see how you’re doing and make changes in the treatment program if you need them.
