Having a headache is a common, universal experience. They can be quite unpleasant but typically subside with over-the-counter medications. Did you know that there are actually many different types of headaches? Headaches can be either primary or secondary to structural lesions, nerve disorders, blood flow disorders, substances, infections, psychiatric disorders, etc. Today I will tell you about the most common types of headaches.
Tension headaches are the most common type of headache. The exact mechanism is unknown but they are often triggered by an internal or environmental stressor. These headaches can be episodic or chronic and can last anywhere from 30 minutes to 7 days. However, they are seldom disabling and do not usually require medical attention. A tension-type headache has two of the following criteria: bilateral location, pressing/tightening quality, mild-moderate intensity, and not aggravated by routine physical activity. These headaches are not associated with nausea/vomiting but can be associated with sensitivity to light or sound. Treatment strategies include stress management, counseling, pain-relief medications (such as acetaminophen or ibuprofen), or possibly antidepressants. Opioid medications should not be used for tension headaches.
Migraines are quite common and are usually recurring. There is a genetic component to migraines and most commonly occur in women. Migraines are classified into two different types: with or without aura. An aura is a symptom that occurs prior to the onset of the headache and can manifest as visual symptoms (like zigzag lines) or symptoms of numbness/tingling on one side of the body or drowsiness/confusion. Migraine headaches typically occur on one side of the head and are pulsating in quality. They are normally associated with nausea/vomiting and sensitivity to light or sound.
Common triggers for migraines include certain foods such as alcohol, caffeine, chocolate, cured meats, pickled foods, and MSG. Other triggers include stress, hormonal changes (such as with menstruation), fatigue, weather changes, and sleep deprivation.
Level and intensity of care depend on the severity of pain and level of disability. Migraines commonly require both acute treatment of symptoms and prevention. Some people require treatment in the emergency room. Treatment goes beyond your typical over-the-counter medications, a class of medications called triptans (e.g. Imitrex) are commonly used for migraines as well as anti-nausea medications. There is also a variety of medications used for prevention. Interestingly, Botox injections can be used for prevention of chronic migraines.
Cluster headaches are not as common as other types of headaches but deserve to be mentioned. These headaches are described as more painful than even childbirth and are known as the “suicide headache”. They are typified by pain around the eye region on one side of the head and are associated with nasal congestion, eye watering, and eye swelling. These headaches are episodic and tend to occur together (hence, cluster) perhaps at a certain time of year. Cluster headaches tend to occur more often in males, smokers, and middle-age. Cluster headaches can be triggered by alcohol, sleep apnea, perfumes, paint fumes, and foods containing nitrates.
Pain relief medications are ineffective against cluster headaches. Actually, inhaled oxygen is the first line of treatment. Medications such as Imitrex given intravenously may also be given. Preventative treatment is also available.
Red Flags for Headaches
Normally, headaches are not a big deal. However, there are some symptoms that if they occur with a headache, require medical attention. These symptoms include:
- Systemic symptoms such as fever, persistent vomiting, stiff neck, pregnancy, or cancer
- Neurologic signs such as altered mental status, seizures, numbness/tingling, inability to speak or move
- New or sudden onset
- Other associated conditions such as head trauma
- Prior headache history that is now different– headaches are now increasing in severity or frequency
These types of headaches will often require imaging of the head by way of CT or MRI scan.
Read more about different types of headaches at the National Headache Foundation
Disclaimer: This post is not to be substituted for medical advice. If you think you are having a problem, contact your own provider who knows your health history