Headache Overview
Headache is pain or discomfort in the head or face, headaches vary greatly in terms of the location and intensity of the pain, and how often the headaches occur. Headaches are one of the most common health conditions worldwide. Up to 75% of adults worldwide have had a headache in the past year. Approximately 45 million Americans frequently have severe headaches that can be disabling. Headaches are more common in women than men, 25% of women and 8% of men get migraines sometime in their lifetime. People of any age can be affected, but people between the ages of 25 and 44 years are more likely to report having a headache. Most headaches have more than one contributing factor, some of the more common triggers for headache are lifestyle related, such as poor diet, stress, muscle tension, and lack of exercise.
Headache is Pain or discomfort in the head, face or neck area. Usually head hurts because the nerves, muscles, or blood vessels throughout the face, scalp, or brain are irritated, inflamed, or not functioning properly. Headaches vary greatly in terms of the location and intensity of the pain, and how often the headaches occur. Certain types of headache and headaches associated with specific symptoms, such as a severe or sudden headache associated with a stiff neck, Fever, convulsions, confusion, or pain in the eye or ear, may warrant urgent medical attention. A persistent headache in a person with no previous history of headaches and recurring headaches in children are also cause for concern.
Although most headaches are harmless and last only a few hours, a headache can be a symptom of a serious disease, disorder or condition affecting the neck, eyes, brain, jaw or teeth. Headache can be a symptom of numerous conditions ranging from the common cold, flu, and stress to severe conditions such as meningitis, stroke, or a brain tumor. Frequent and/or severely painful headaches can also decrease quality of life and are linked to mental health problems.
Pain Receptors and Headache
You feel pain Pain when various structures of your head are inflamed or irritated, these structures include:
- Muscles and skin of the head
- Nerves of the head and neck
- Arteries leading to the brain
- Membranes of the ear, nose and throat
- Sinuses, which are air-filled cavities inside the head that form part of the respiratory system.
The sensation of pain can also be ‘referred’, which means that pain occurring in one area can transmit the feeling of pain to a nearby area, for example the referred pain of a headache arising from a sore neck.
There are many different types of headache, they can be categorized into two broad groups:
Primary Headache and Secondary headaches
Primary Headaches
Primary headaches are caused by problems with pain-sensitive structures in the head, and are not due to an underlying illness elsewhere in the body. Primary headaches include migraine, tension or cluster headaches. Primary headaches category includes:
- Cluster headaches
- Migraine
- New daily persistent headaches (NDPH)
- Tension headaches
Secondary Headaches
Secondary headaches, on the other hand, are a symptom of an underlying condition, such as an infection, trauma, injury or tumor and can be potentially life-threatening. Secondary headaches are related to another medical condition, such as:
- Disease of blood vessels in the brain
- Head injury
- High blood pressure (hypertension)
- Infections
- Medication overuse
- Sinus congestion
- Trauma
- Tumor
Causes of Headache
The most common types of headaches (tension, migraine and cluster) are often caused by certain triggers in the body or environment that ultimately affect the pain-signaling nerves in the brain. Current research suggests certain brain chemicals that are released under various conditions alter the way the brain manages pain signals. Anything that stimulates the pain receptors in a person’s head or neck can cause a headache, including:
- Stress
- Muscular tension
- Dental or jaw problems
- Infections
- Diet
- Eye problems
- Hormonal influences
- Medications
- Disorders of the ear, nose or throat
- Disorders of the nervous system
- Injury to the head, neck or spine
- High blood pressure (Hypertension)
- Poor posture – puts unnecessary strain on the muscles of the back and neck
- Hangover from abuse of alcohol or drugs
- Temperature – extremes of heat or cold
- Dehydration – affects blood pressure
- Noise – especially loud noises
- Temporal arteritis – inflammation of the artery at the temple, most common in elderly people
- Arthritis
- Meningitis
Types of Headache
There are many different types of headaches, following are some of the types:
- Tension headaches
- Cluster headaches
- Migraine headaches
- Allergy or sinus headaches
- Hormone headaches
- Caffeine headaches
- Exertion headaches
- Hypertension headaches
- Rebound headaches
- Post-traumatic headaches
The World Health Organization points out that nearly everyone experiences a headache once in a while and the most common headache disorder is tension-type headache.
Tension Headaches
Tension headaches are the most common type of headache, usually the Pain is on both sides of the head, often due to muscle tension and stress, they are often short lived but may recur intermittently over time. These are common symptoms of a Tension-type headache:
- Slow onset of the headache
- Head usually hurts on both sides
- Pain is dull or feels like a band or vice around the head
- Pain may involve the back part of the head or neck
- Pain is mild to moderate, but not severe
- Tension type headaches typically do not cause nausea, vomiting, or sensitivity to light (photophobia).
Cluster Headache
- Cluster Headache: Usually occurs several times a day with pain on one side of the head behind the eye. Cluster headaches affect men more often than women. Cluster headaches usually occur in a series that may last weeks or months.
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 be red and watery with a droopy lid and small pupil
- Swelling of the eyelid
- Runny nose or congestion
- Swelling of the forehead
Migraine Headache
Migraine Headache causes intense and throbbing, usually affecting one area of the head. May last several hours to days and may be preceded by abnormal visual disturbances (aura). Migraine affects three times more women than men.
In this type of headache, symptoms other than pain occur as part of the headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual symptoms typically occur with migraines. Migraines also have distinct phases. Not all people have each phase, however. The phases of a migraine headache may include:
- Premonition or prodromal phase- A change in mood or behavior may occur hours or days before the headache.
- Aura phase- A group of visual, sensory, or motor symptoms can precede the headache. Examples include vision changes, hallucinations, numbness, changes in speech, and muscle weakness.
- Headache phase- Period during the actual headache with throbbing pain on one or both sides of the head. Sensitivity to light and motion are common, as are depression, fatigue, and anxiety.
- Resolution phase- Pain lessens during this phase, but may be replaced with fatigue, irritability, and trouble concentrating. Some people feel refreshed after an attack, others do not.
Known triggers for Migraine include:
- Alcohol
- Altitude changes, or changes in air pressure
- Environmental factors, such as smoke, bright lights, or loud noise
- Fluctuating hormone levels, particularly estrogen and progesterone in women; hormone replacement therapy can also be a trigger.
- Foods that contain specific chemicals or preservatives, such as processed foods, chocolate, dairy, red wine, aged cheese, and nuts
- Migraine medication overuse
- Missed meals
- Previous brain injury
- Stress
- Vigorous exercise or exertion
Allergy or Sinus Headaches
Headaches sometimes happen as a result of an allergic reaction. The pain from these headaches is often focused in your sinus area and in the front of your head. Migraine headaches are commonly misdiagnosed as sinus headaches, most of “sinus headaches” are actually migraine. People who have chronic seasonal allergies or sinusitis are susceptible to these kinds of headaches. Sinus headaches are treated by thinning out the mucus that builds up and causes sinus pressure. A sinus headache can also be a symptom of a sinus infection.
Hormone Headaches
Women commonly experience headaches that are linked to hormonal fluctuations. Menstruation, birth control pills, and pregnancy all affect your estrogen levels, which can cause a headache. Headaches associated specifically with the menstrual cycle are also known as menstrual migraine. These can occur right before, during, or right after menses, as well as during ovulation.
It’s estimated that about 60% of women with migraine also experience menstrual migraine, so alternative remedies may have a role in decreasing overall headaches per month. Relaxation techniques such as yoga, acupuncture and eating a modified diet my help prevent migraine headaches.
Caffeine Headaches
Caffeine affects blood flow to the brain, having too much can give you a headache, as can suddenly quitting caffeine. People who have frequent migraine are at risk of triggering a headache due to their caffeine use. When you’re used to exposing your brain to a certain amount of caffeine, a stimulant, each day, you might get a headache if you don’t get your caffeine fix. This maybe because caffeine changes the brain chemistry, and withdrawal from it can trigger a headache. Not everyone who cuts back on caffeine will experience a withdrawal headache. Keeping your caffeine intake at a steady, reasonable level or quitting caffeine entirely can prevent these headaches from happening.
Exertion Headaches
Exertion headaches occur quickly after periods of intense physical activity. For example lifting weights, running, and sexual intercourse are all common triggers for an exertion headache. It’s thought that these activities cause increased blood flow to the skull, which can lead to a throbbing headache on both sides of the head. An exertion headache shouldn’t last too long.
Hypertension Headaches
High blood pressure can cause a headache, and this kind of headache signals an emergency, this occurs when your blood pressure becomes dangerously high. A hypertension headache will usually occur on both sides of the head and is typically worse with any activity. It often has a pulsating quality. You may also experience changes in vision, numbness or tingling, nosebleeds, chest pain, or shortness of breath. These types of headaches typically go away soon after the blood pressure is normal and under control, they shouldn’t reoccur as long as high blood pressure continues to be managed.
Rebound Headaches
Rebound headaches, also known as medication overuse headaches, can feel like a dull, tension-type headache, or they may feel more intensely painful, like a migraine. People may be more susceptible to this type of headache if they frequently use OTC pain relievers, overuse of these medications leads to more headaches, rather than fewer. Rebound headaches are likelier to occur any time OTC medications like acetaminophen, ibuprofen, aspirin, and naproxen are used more than 15 days out of a month. They’re also more common with medications that contain caffeine.
The only treatment for rebound headaches is to wean yourself off of the medication that you’ve been taking to control pain. Although the pain may worsen at first, it should completely subside within a few days.
Post-Traumatic Headaches
Post-traumatic headaches can develop after any type of head injury. These headaches feel like migraine or tension-type headaches, and may last up to 6 to 12 months after the injury occurs, post-traumatic headaches can become chronic.
Signs and Symptoms of Headache
Headache symptoms vary, depending on the type of headache you have.
Tension Headaches
Tension headaches are the most common type of headache, in this type of headache the Pain tends to be:
- Consistent without throbbing.
- Mild to moderate.
- On both sides of the head (bilateral).
- Responsive to over-the-counter treatment.
- Worse during routine activities (such as bending over or walking upstairs).
Migraines
Migraines are the second most common type of primary headaches, symptoms of migraines include:
- Pain that lasts four hours to three days
- Pounding or throbbing pain
- Moderate to severe pain
- Nausea and vomiting
- Sensitivity to light, noise or odors
- Upset stomach upset or abdominal Pain
Cluster Headaches
Cluster headaches are the most severe type of primary headache. Cluster headaches come in a group or cluster, usually in the spring or fall. They occur one to eight times per day during a cluster period, which may last two weeks to three months. The headaches may disappear completely, go into remission for months or years, only to recur later. The Pain of a cluster headache is:
- Intense with a burning or stabbing sensation
- Located behind one of your eyes or in the eye region, without changing sides.
- Throbbing or constant.
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