Headache Center

Headaches are a near universal occurrence. Within a given year over 90 percent of men and 95 percent of women will have a headache. A headache is a pain or discomfort that localizes around the hand and/or face area. Headaches can be episodic or recurrent in nature. They can also be present on one or both sides of the head.

What causes a headache?

The exact causes of primary headaches (migraine, tension and cluster) are not completely understood. It is thought that many headaches are the result of tight muscles and dilated, or expanded, blood vessels in the head. Secondary headaches may be caused by an actual problem in the brain, such as a tumor or malformation of the brain, although this is much less common.

The way a person exhibits a headache may be related to many factors, such as genetics, hormones, stress, diet, medications and dehydration. Recurrent headaches of any type can cause school problems, behavioral problems, and/or depression.

What are the different types of headache?

There are many different ways to classify headaches. One method divides headaches into two categories:

Primary Headache

Primary headaches may be caused by tight muscles, dilated blood vessels or inflammation of the structures in the brain. Types of primary headaches include:

  • Migraine headache. Migraines may start early in childhood. The average age of onset is between five to eight years of age. There is often a family history of migraines. Some females may have migraines that correlate with their menstrual periods. While every person may experience symptoms differently, the following are the most common symptoms of a migraine:
    • Pain on one or both sides of the head (some younger children may complain of pain all over)
    • Pain may be throbbing or pounding in quality
    • Sensitivity to light or sound
    • Nausea and/or vomiting
    • Abdominal discomfort
    • Sweating
    • Some people have an aura before the migraine, such as a sense of flashing lights, a change in vision or funny smells
  • Tension headache. Tension headaches are the most common type of headache. This type of headache occurs most often between 9 and 12 years of age. People with tension headaches typically do not experience nausea, vomiting, or light sensitivity. While every person may experience symptoms differently, the following are the most common symptoms of a tension headache:
    • Slow onset of the headache
    • Head usually hurts on both sides
    • Pain is dull or feels like a band around the head
    • Pain may involve the posterior (back) part of the head or neck
    • Pain is mild to moderate, but not severe
    • Change in sleep habits
  • Cluster headache. Cluster headaches may begin at any age but the usual age of onset is between the second and fourth decade of life. This condition is more common in adolescent males. Cluster headaches get their name because they tend to "cluster" around a point in time (frequently at night) and a certain time of year. While every person may experience symptoms differently, the following are the most common symptoms of a cluster headache:
    • Severe pain on one side of the head, usually behind one eye
    • The eye that is affected may have a droopy lid, small pupil or redness and swelling of the eyelid
    • Runny nose or congestion
    • Swelling of the forehead

Secondary Headache

Secondary headaches are the least common type of headache. They are called "secondary" because they are caused by some other medical condition. In fact, secondary headaches could be symptoms of a potentially serious, even life-threatening, medical condition. Secondary headaches are typically caused by an underlying condition in the head or neck, such as bleeding in the brain, tumor or an infection like meningitis, sinusitis and encephalitis.

What are the symptoms of a headache?

People may have varying degrees of symptoms associated with the severity of the headache and depending on the type of headache. Some headaches may be more serious. Symptoms that may suggest a more serious underlying cause of the headache may include the following:

  • A very young child with a headache
  • A child that is awakened by the pain of a headache
  • Headaches that start very early in the morning
  • Pain that is worsened by strain, such as a cough or a sneeze
  • Vomiting without nausea
  • Sudden onset of pain and the "worst headache" ever
  • Headache that is becoming more severe or continuous
  • Personality changes
  • Changes in vision
  • Weakness in the arms or legs
  • Seizures or epilepsy

The symptoms of a headache may resemble other conditions or medical problems. Always consult a physician for a diagnosis.

How are headaches diagnosed?

The full extent of the problem may not be completely understood immediately, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a headache is made with a careful history and physical examination and diagnostic tests.

Questions commonly asked during the examination may include the following:

  • When do headaches occur?
  • What is the location of the headache?
  • What do the headaches feel like?
  • How long do the headaches last?
  • Have there been changes in walking and behavior patterns, or personality?
  • Do changes in positioning or sitting-up cause the headache?
  • Are you having trouble sleeping?
  • Do you have a history of stress?
  • Is there a history of trauma to your head or face?

If the history is consistent with migraine or tension type headaches and the neurological exam is normal, no further diagnostic testing may be necessary.

Other diagnostic tests may include:

  • Blood tests
  • X-ray: A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film
  • Magnetic resonance imaging (MRI):  diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body
  • Computed tomography scan (also called a CT or CAT scan): A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays

What are the treatment options for headaches?

Specific treatment for headaches are determined by your physician based on:

  • Age, overall health and medical history
  • Extent of the headaches
  • Type of headaches
  • Your tolerance for specific medications, procedures or therapies
  • Your opinion or preference

The ultimate goal of treatment is to stop the headache from occurring. Medical management relies on the proper identification of the type of headache and may include:

  • Rest in a quiet, dark environment
  • Medications, as recommended by your physician
  • Stress management
  • Avoid known triggers, such as certain foods and beverages, lack of sleep and fasting
  • Diet changes
  • Exercise

Migraine headaches may require specific medication management including:

  • Preventive treatments. Frequently medications but may include vitamins or supplements, that are taken daily to reduce the frequency and severity of your headaches.
  • Abortive medications. Medications, over the counter or prescriptions, that stop the headache. These can include aspirin, acetaminophen, naproxen, ergots or the migraine specific drugs the triptans. The triptans act on specific receptors in blood vessels in the head and can stop a headache in progress.
  • Rescue medications. Usually provided in the clinic or in an emergency room when a patients abortive medications have failed.

Some headaches may require immediate medical attention including hospitalization for observation, diagnostic testing or even surgery. Treatment is individualized depending on the extent of the underlying condition that is causing the headache. The extent of the recovery is individualized depending upon the type of headache and other medical problems that may be present.

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Sally Borucki
Jeffrey W. Clark
George B. Creel