Headache

Headache causes

You may be familiar with some of the more common physical contributors to headaches such as fatigue, lack of sleep or oversleeping, hunger or skipping meals, eye strain, or high blood pressure, as well as emotional factors such as stress.

There are other physical contributors as well ranging from allergies and hormonal changes to sudden, strenuous exercise or neck or jaw problems such as teeth grinding or poor posture. Some headaches are symptoms of related health problems, such as a head cold, the flu, or a sinus infection.

Many prescribed and over the counter drugs (OTC) list headaches among their side effects. Certain medications prescription, such as nitroglycerin and female hormones (prescribed for contraception or menopausal symptoms), are notorious causes of headache.

Environmental factors and sensory stimuli such as bright or flickering lights, loud noises, strong smells, and changing weather like rising humidity and heat can be triggering for many people. Keep in mind that some food and drink can contribute to headaches. In addition to an increase or decrease in caffeine consumption, consider your intake of alcohol and tobacco products, foods high in additives, and those that are highly processed.

Headache red flags

Some less common but serious causes of headache include bleeding, infection, or a tumor. Seek medical care promptly if you experience symptoms such as

• a sudden headache that feels like a blow to the head (with or without a stiff neck)
• headache with fever
• convulsions
• persistent headache following a blow to the head
• confusion or loss of consciousness
• headache along with pain in the eye or ear
• relentless headache when you were previously headache-free
• headache that interferes with routine activities.

What are common headache types and symptoms?

Headache symptoms can vary depending on the type, although there is some overlap. Most headaches fall into four main categories: tension, migraine, cluster, and sinus. Here are the trademark symptoms for the most common headaches.

Tension headache. Tension headaches are the most common headache, affecting about three of every four adults at some point in their lives. The typical tension headache produces a dull, squeezing pain on both sides of the head. People with severe tension headaches may feel like their head is trapped in a vise. The shoulders and neck can also ache. The discomfort usually lasts 20 minutes to two hours. Most episodes are mild to moderate in severity and occur infrequently, but some people can get severe tension headaches three or four times a week.

Migraine headache. Migraines are typically less common than tension headaches but are usually much more severe. In typical cases, migraine pain occurs on one side of the head, often beginning around the eye and temple before spreading to the back of the head. The throbbing or pulsating may be severe. Nausea is common, and many migraine sufferers also have watery eyes, a running nose, or congestion. One way to remember the symptoms of migraine is the acronym POUND:

• P: Pulsating pain
• O: One-day duration of severe untreated attacks
• U: Unilateral (one-sided) pain
• N: Nausea and vomiting
• D: Disabling intensity.

About 20% of migraine sufferers also experience auras, a sequence of visual or sensory disturbances such as temporary loss of vision, halos, sparkles or flashing lights, wavy lines, and numbness or tingling on one side of the body, especially in the face or hand. The aura can occur before and during an attack.

Migraine episodes usually last four to 24 hours or even longer. They often begin in the evening or during sleep. In some people, the attacks are preceded by several hours of fatigue, depression, and sluggishness, or by irritability and restlessness. Specific trigger(s) can vary, but a migraine sufferer usually remains sensitive to the same ones.

Women are three times more likely to get migraine headaches than men, in part because of hormones. Genetics also plays a role; in fact, approximately 70% of migraine sufferers have at least one close relative with the condition. Neurologists believe migraines are caused by changes in blood flow and nerve cell activity in the brain.

Cluster headache. Cluster headaches are uncommon yet severe. The deep and explosive pain of cluster headaches starts abruptly and always strikes one side of the head, often near the temple. The eye on the painful side becomes red and watery, the eyelid may droop, and the nose runs or is blocked. Nausea and sensitivity to light and sound also may accompany the pain. A cluster headache attack lasts for approximately 30 minutes to three hours.

As the name suggests, these headaches tend to come in clusters. About 90% of cluster attacks follow a pattern of one or two headaches a day over two to eight weeks, alternating with headache-free stretches. Usually, the remission time between episodes lasts six months to a year but can be as short as a few weeks or as long as several years. Cluster headaches occur five times more often in men than women.

Sinus headache. The sinuses are air-filled spaces above, between, and beneath your eyes, on either side of your nose. Sinus headaches can trigger pain over the forehead, the bridge of the nose, in the center of the face over the cheeks, behind the eyes, and/or in the upper teeth and gums. This type of headache can occur when the thin inner membranes of the nose and sinuses becomes inflamed and fluid buildup is unable to drain out through the nose, or if pressure in the sinuses is lower than environmental air pressure.

Other headache types and symptoms include:

Thunderclap. As the name suggests, a thunderclap headache strikes suddenly with excruciating pain. It is a serious situation that requires immediate medical attention because it could indicate bleeding in or around the brain.

Cervicogenic. With this type of headache, pain begins in the neck and travels to the head and face. Cervicogenic headaches are sometimes confused with migraines and tension headaches, which can also cause neck pain. They result from structural problems at the top of the spine involving the cervical vertebrae. Injuries like whiplash, arthritis, and infections are thought to be common causes.

What are the best headache treatments?

If you have a headache or feel one coming on, nondrug remedies include eating a snack and drinking water or a caffeinated beverage like coffee. Some people find relief from placing a cold compress on their head and/or a heating pad or warm towel around their neck and shoulders. Taking a warm shower or a nap may also help. Relaxation techniques such as deep breathing, meditation, and visualization can ease headache pain by relaxing muscles and reducing tension.

For the occasional, mild to moderately painful headache, an over-the-counter (OTC) pain medication is often sufficient treatment. These include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, naproxen (Aleve), and ibuprofen (Motrin, Advil). Always follow the label's instructions and take these medications only as directed. Consult your doctor if you use OTC drugs more than a couple of times a week to manage headaches.

Depending on the type of frequency of a person’s of headaches, doctor-prescribed pain medication or a muscle relaxant might be necessary.

Most doctors recommend triptan drugs, which are available as tablets, nasal sprays, or injections. Examples include sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt). Triptans act on specific serotonin receptors to constrict dilated blood vessels throughout the body. Most people feel the effects after 20 to 30 minutes and complete relief within one to two hours. Still, the sooner you take them once symptoms appear, the better. Some people require a second dose within 12 to 24 hours.

Other prescription drugs used to treat migraines are calcitonin gene-related peptide (CGRP) inhibitors.

CGRP inhibitors (known informally as “gepants”) block the CGRP chemical that inflames nerve endings and causes blood vessels to dilate. Currently three gepants have been approved for migraines: ubrogepant (Ubrelvy), rimegepant (Nurtec ODT), and atogepant (Qulipta).

For cluster headaches, sumatriptan (also used to treat migraines) is often effective, particularly when given by injection. Another option is inhaling oxygen, administered in an emergency room or at home from a portable tank, which can be prescribed by a doctor. If there's no improvement after 15 minutes of inhaling, further oxygen therapy may not help.

Headache prevention

Nobody enjoys having a headache and most people would like to do whatever they can to prevent one from coming on. When considering how to prevent a headache, the easy answer is to try to avoid the causes of headaches in the first place. Pay attention to the basics: Get enough sleep, don't skip meals, and be sure to pace yourself to avoid stress and fatigue. Movement and mindfulness can help reduce stress and anxiety which can contribute to headaches.

Nonpharmacological activities such as practicing relaxation techniques on a regular basis can help stave off headaches, particularly tension ones. Physical approaches include applying a heating pad to your neck and shoulders to relax the muscles. Exercising these muscles also helps by strengthening and stretching them.Guided imagery exercises that help you focus your attention on various parts of your body in order to relax them and release tension and stress can also help.

If you get frequent headaches, a headache diary you help you pinpoint potential triggers. Keeping track of information can show any patterns and help you develop a better idea of how to avoid your triggers and possibly prevent or lesson symptoms. To keep a headache diary, note when they occur, characteristics including their frequency, duration, and intensity, as well as the circumstances surrounding your headaches. Share this information with your doctor so that you can develop a prevention plan that works for you.

For migraine headaches, prescription beta blockers or calcium-channel blockers, certain seizure medicines, and some antidepressants can potentially reduce how often you get attacks. Common examples are amitriptyline (Elavil), topiramate (Topamax), and propranolol (Inderal). Doctors usually start with a low dose and increase slowly, based on how well the medicine works and any side effects. Neuromodulation devices are a newer, nondrug option that use mild electrical or magnetic pulses to change how certain nerves work, which can help some people prevent (or stop) migraine attacks. Talk to your doctor about whether these preventive treatment options are right for you.