Headaches - Types, Causes, Symptoms, Diagnosis, Treatment (original) (raw)

Headaches refer to pain in your head or face. They can feel like pressure, throbbing, a constant ache, or even sharp pain. The type of pain, how bad it is, where it hurts, and how often you get headaches can vary from person to person.

Headaches can be more complicated than most people realize. Different kinds have different 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 it.

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:

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, such as 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 often pace during an attack. On the side of the pain, the eyelid may droop, the eye may redden, the pupil may get smaller, or the eye may tear up. 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:

Sinus headaches

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 with other sinus symptoms, such as 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:

Headaches may last a few months. But if it doesn’t get better within a couple of weeks, call your doctor.

Exercise headaches

When you’re active, the muscles in your head, neck, and scalp need more blood, so 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 that almost always affects the same side of your face and head. Other symptoms include:

Some people also notice migraine symptoms such as:

There are two types:

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 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 for 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.

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 a symptom of something else.

Spinal headaches

Talk to your doctor if you get a headache after a spinal tap, a spinal block, or an epidural. Your doctor might call it a puncture headache because these procedures involve piercing the membrane surrounding 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:

Take a sudden new headache seriously. It’s often the only warning sign of a serious problem.

Pain on one side of your head

Headaches on one side of your head can be migraines, which are more common in women and the most common type of headache. Symptoms may include:

Common triggers for migraines include stress, hormonal changes, and weather changes.

Pain on both sides of your head

Tension headaches can cause pain on both sides of your head, near the front or back. These headaches often start slowly and cause a dull ache on both sides. Stress and fatigue commonly trigger this condition. If you can manage stress, it can help ease tension headaches.

Pain around one eye

Serious pain around one eye, which tends to happen from time to time, can be a cluster headache. They're more common in men and often go undiagnosed. Symptoms may include:

Triggers for cluster headaches include alcohol, weather changes, and smoking.

Pain near your forehead, cheeks, and eyes

The pain near your forehead, cheeks, and around the eyes may be a sinus headache due to sinus inflammation. These headaches can come with a fever and nasal congestion. Weather changes and allergies typically trigger them.

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 such as sinusitis (inflammation of the sinuses), a throat infection, or an ear infection. In some cases, headaches can result from a blow to the head. Rarely, they can be 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, can trigger headaches. Other causes include neck or back strain due to poor posture.

Your environment. This includes 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 migraines, 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 what exactly causes migraines. One theory suggests 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 adults.

Why does pregnancy cause headaches?

It's common to get mild headaches when you're pregnant. The biggest cause for this is a change in hormones, which happens in the first few months of pregnancy. For people who usually get migraines, there's a possibility that the pain will get worse after the first trimester.

You may also experience headaches due to:

These may trigger mild pain on both sides of your head, also known as tension headaches. If you have frequent headaches after 5 months of pregnancy, it might be a serious condition of preeclampsia, which happens if you have high blood pressure, affecting your kidneys and other parts of your body.

To address frequent headaches, you need to figure out which type you have. Headaches can be a symptom of another condition; other times, there's no clear cause. Test your headache signs and symptoms carefully. Keeping a headache diary can help identify your headache type. Record when headaches happen, your symptoms, and potential triggers such as food, stress, or sleep changes.

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 about your symptoms and how often they happen. It’s important to be as detailed 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 electroencephalogram (EEG) 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.

Your doctor may recommend different types of treatments. They might also suggest more testing or refer you to appropriate experts, such as ear, nose, and throat specialists, neurologists, optometrists, physical therapists, or 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:

Addressing underlying issues such as high blood pressure and neck or jaw problems is also crucial. Your doctor will make a treatment plan to meet your specific needs.

In addition to medication, you may try alternative headache treatments such as:

Pressure points for headaches

Acupressure, like acupuncture, is a massage technique from traditional Chinese medicine. It involves pressing specific points on the body, called acupoints, to relax muscles, improve blood flow, and ease symptoms such as pain and headaches. Acupoints include pressure point LI-4 (Hegu), which is on the back of your hand between the thumb and index finger. You shouldn't do acupressure in this area if you're pregnant, or if your skin around the point is damaged or infected.

To do it, place your hand with your fingers outstretched and the back of your hand facing up. Use your thumb on your opposite hand to locate the space between the thumb and index finger. Press gently on this point with your thumb, moving in circles for 2-3 minutes. Use a pencil eraser if necessary. Repeat on the other hand. Do this a few times daily until your headache symptoms are gone.

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, such as foods or smells. And it’s important to stick to healthy habits that will keep you feeling good, such as 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.

Here are some ways to avoid headaches:

Avoid headache triggers. Maintaining a headache diary can help you identify what causes your headaches and avoid those triggers. Record details about each headache, including when it began, what you were doing at the time, and how long it lasted.

Don't use too much medication. Using headache medications, including over-the-counter ones, more than two times a week can make your headaches worse and more often. Talk to your doctor about how to reduce your medication, as stopping it improperly can cause serious side effects.

Get enough sleep. Most adults need 7-8 hours of sleep each night. It's best to go to bed and wake up at the same time every day. If you have sleep issues such as snoring, consult your doctor.

Watch what you eat. Eat healthy meals at regular times every day, and avoid food and drinks with caffeine.

Stay physically active. Regular aerobic exercise may enhance your physical and mental well-being and ease stress. Choose an exercise regimen with the help of your doctor.

Lower stress. Organize your tasks, simplify your routine, keep a positive attitude, and practice stress-lowering methods such as yoga, tai chi, or meditation.

If you can't see your doctor right away, seek emergency help if you have:

Headaches, which can show as pressure or sharp pain in the head or face, vary widely in their type, intensity, location, and how often they happen. Common types include tension headaches, migraines, cluster headaches, chronic daily headaches, and sinus headaches. There are many causes of headaches, including stress, illness, environmental factors, genetics, changes in sleep patterns, and what you eat. Proper diagnosis involves tracking symptoms and triggers, which helps in knowing the type of headache and deciding the best treatment. To avoid a headache, you may need medications, lifestyle changes, stress management techniques, and avoiding known triggers.