A headache involves pain
in the head which can arise from many disorders or may be a disorder in and of itself.
There are three types of primary headaches: tension-type (muscular contraction headache), migraine (vascular headaches), and cluster. Virtually everyone experiences a tension-type headache at some point. An estimated 18% of American women suffer migraines, compared to 6% of men. Cluster headaches affect fewer than 0.5% of the population, and men account for approximately 80% of all cases. Headaches caused by illness are secondary headaches and are not included in these numbers.
Approximately 40-45 million people in the United States suffer chronic headaches. Headaches have an enormous impact on society due to missed workdays and productivity losses.
Causes and symptoms
Traditional theories about headaches link tension-type headaches to muscle contraction, and migraine and cluster headaches to blood vessel dilation (swelling). Pain-sensitive structures in the head include blood vessel walls, membranous coverings of the brain, and scalp and neck muscles. Brain tissue itself has no sensitivity to pain. Therefore, headaches may result from contraction of the muscles of the scalp, face or neck; dilation of the blood vessels in the head; or brain swelling that stretches the brain's coverings. Involvement of specific nerves of the face and head may also cause characteristic headaches. Sinus inflammation is a common cause of headache. Keeping a headache diary may help link headaches to stressful occurrences, menstrual phases, food triggers, or medication.
Tension-type headaches are often brought on by stress, overexertion, loud noise, and other external factors. The typical tension-type headache is described as a tightening around the head and neck, and an accompanying dull ache.
Migraines are intense throbbing headaches occurring on one or both sides of the head, usually on one side. The pain is accompanied by other symptoms such as nausea, vomiting, blurred vision, and aversion to light, sound, and movement. Migraines often are triggered by food items, such as red wine, chocolate, and aged cheeses. For women, a hormonal connection is likely, since headaches occur at specific points in the menstrual cycle, with use of oral contraceptives, or the use of hormone replacement therapy after menopause
. Research shows that a complex interaction of nerves and neurotransmitters in the brain act to cause migraine headaches.
Cluster headaches cause excruciating pain. The severe, stabbing pain centers around one eye, and eye tearing and nasal congestion occur on the same side. The headache lasts from 15 minutes to four hours and may recur several times in a day. Heavy smokers are more likely to suffer cluster headaches, which also are associated with alcohol consumption.
Since headaches arise from many causes, a physical exam assesses general health and a neurologic exam evaluates the possibility of neurologic disease as a cause for the headache. If the headache is the primary illness, the doctor asks for a thorough history of the headache. Questions revolve around its frequency and duration, when it occurs, pain intensity and location, possible triggers, and any prior symptoms. This information aids in classifying the headache.
Warning signs that should point out the need for prompt medical intervention include:
- "Worst headache of my life." This may indicate subarachnoid hemorrhage from a ruptured aneurysm (swollen blood vessel) in the head or other neurological emergency.
- Headache accompanied by one-sided weakness, numbness, visual loss, speech difficulty, or other signs. This may indicate a stroke. Migraines may include neurological symptoms.
- Headache that becomes worse over a period of 6 months, especially if most prominent in the morning or if accompanied by neurological symptoms. This may indicate a brain tumor.
- Sudden onset of headache. If accompanied by fever and stiff neck, this can indicate meningitis.
Headache diagnosis may include neurological imaging tests such as computed tomography scan (CT scan) or magnetic resonance imaging
Headache treatment is divided into two forms: abortive and prophylactic. Abortive treatment addresses a headache in progress, and prophylactic treatment prevents headache occurrence.
Tension-type headaches can be treated with aspirin
, acetaminophen, ibuprofen, or naproxen. In early 1998, the FDA approved extra-strength Excedrin, which includes caffeine
, for mild migraines. Physicians continue to investigate and monitor the best treatment for migraines and generally prefer a stepped approach, depending on headache severity, frequency and impact on the patient's quality of life. A group of drugs called triptans are usually preferred for abortive treatment. About seven triptans are available in the United States and the pill forms are considered most effective. They should be taken as early as possible during the typical migraine attack. The most common prophylactic therapies include antidepressants, beta blockers
, calcium channel blockers and antiseizure medications. Antiseizure medications have proven particularly effective at blocking the actions of neurotransmitters that start migraine attacks. Topiramate (Topamax) was shown effective in several combined clinical trials in 2004 at 50 to 200 mg per day.
In 2004, a new, large study added evidence to show the effectiveness of botulinum toxin type A (Botox) treatment to prevent headache pain for those with frequent, untreatable tension and migraine headaches. Patients were treated every three months, with two to five injections each time. They typically received relief within two to three weeks.
Cluster headaches may also be treated with ergotamine and sumatriptan, as well as by inhaling pure oxygen. Prophylactic treatments include prednisone, calcium channel blockers, and methysergide.
Alternative headache treatments include:
- acupuncture or acupressure
- herbal remedies using feverfew (Chrysanthemum parthenium), valerian (Valeriana officinalis), white willow (Salix alba), or skullcap (Scutellaria lateriflora), among others
- homeopathic remedies chosen specifically for the individual and his/her type of headache
- magnesium supplements
- regular physical exercise
- relaxation techniques, such as meditation and yoga
- transcutaneous electrical nerve stimulation (TENS) (A procedure that electrically stimulates nerves and blocks the signals of pain transmission.)
Headaches are typically resolved through the use of analgesics
and other treatments. Research in 2004 showed that people who have migraine headaches more often than once a month may be at increased risk for stroke.
Some headaches may be prevented by avoiding triggering substances and situations, or by employing alternative therapies, such as yoga and regular exercise. Since food allergies
often are linked with headaches, especially cluster headaches, identification and elimination of the allergy-causing food(s) from the diet can be an important preventive measure.
— Referring to treatment that relieves symptoms of a disorder.
— A class of pain-relieving medicines, including aspirin and Tylenol.
— A technique in which a person is taught to consciously control the body's response to a stimulus.
— Referring to a condition that occurs frequently or continuously or on a regular basis.
— Referring to treatment that prevents symptoms of a disorder from appearing.
Kruit, Mark C., et al. "Migraine as a Risk Factor for Subclinical Brain Lesions." JAMA, Journal of the American Medical Association January 28, 2004: 427-435.
Norton, Patrice G. W. "Botox Stops Headache Pain in Recalcitrant Cases." Clinical Psychiatry News March 2004: 72.
Taylor, Frederick, et al. "Diagnosis and Management of Migraine in Family Practice." Journal of Family Practice January 2004: S3-S25.
American Council for Headache Education (ACHE). 19 Mantua Road, Mt. Royal, NJ 08061. (800) 255-2243. http://www.achenet.org.
National Headache Foundation. 428 W. St. James Place, Chicago, IL 60614. (800) 843-2256. http://www.headaches.org.
pain in the head; see also migraine
. One of the most common ailments of humans, it is a symptom rather than a disorder in itself; it accompanies many diseases and conditions, including emotional distress. Although recurring headache may be an early sign of serious organic disease, relatively few headaches are caused by disease-induced structural changes. Most result from vasodilation of blood vessels in tissues surrounding the brain, or from tension in the neck and scalp muscles.
Immediate attention by a health care provider is indicated when (1) a severe headache comes on suddenly without apparent cause; (2) there are accompanying symptoms of neurological abnormality, for example, blurring of vision, mental confusion, loss of mental acuity or consciousness, motor dysfunction, or sensory loss; or (3) the headache is highly localized, as behind the eye or near the ear, or in one location in the head. Fever and stiffness of the neck accompanying the headache may indicate meningitis
cluster headache a migraine-like disorder marked by attacks of unilateral intense pain over the eye and forehead, with flushing and watering of the eyes and nose; attacks last about an hour and occur in clusters.
exertional headache one occurring after exercise.
lumbar puncture headache headache in the erect position, and relieved by recumbency, following lumbar puncture, due to lowering of intracranial pressure by leakage of cerebrospinal fluid through the needle tract.
migraine headache migraine.
organic headache headache due to intracranial disease or other organic disease.
tension headache a type due to prolonged overwork or emotional strain, or both, affecting especially the occipital region.
toxic headache headache due to systemic poisoning or associated with illness.
a classification for certain types of headaches, based on a proposed etiology involving abnormal functioning of the blood vessels or vascular system of the brain; included are migraine
, cluster headache
, toxic headache
, and headache caused by elevated blood pressure.
Patient discussion about headache
Q. Are there different Kinds of Headaches? I noticed that my headaches don't always feel the same way. Are there different kinds of headaches?
A. There are a few kinds of headaches:
1. Tension headaches: caused by stress, fatigue, poor posture, eye strain, tobacco and alcohol use or before and after a period (for women).
2. Migraine headache: Migraine is the cause of 20 per cent of all headaches. This type of headache occurs when blood vessels of the head and neck constrict, resulting in a decrease in blood flow to the vessels.
Q. What are some ways to treat headaches? I have been suffering from headaches for a long time now. How can I treat them?
A. If the doctor has examined you without finding any serious cause for the headaches, these tips might help:
• Avoid excessive use of alcohol and tobacco.
• Engage in correct posture while sitting and working. The type of chair you use is important. It should be one that maximizes comfort and good posture and may need to be adjusted to suit your needs.
• Perform relaxation techniques on a consistent basis.
• Get plenty of fresh air and exercise.
• Some people find that taking the natural herbal treatment Feverfew is very effective at reducing or preventing their headaches occurring. This needs to be taken daily – even if no headache is present – to have an effect. Consult your GP before starting this.
Q. How common are headaches in fibromyalgia? Recently my friend was diagnosed as fibromyalgia. He often suffers from headaches. How common are headaches in fibromyalgia?
A. Yes, headaches are seen in person with fibromyalgia which is called as tension-type or recurrent migraine headaches. These headaches are seen in about seventy percent of fibromyalgia. For some people, aggressive treatment of the migraines also provides tremendous relief of the overall pain of fibromyalgia. A comprehensive article on the causes and treatments of headaches in people with fibromyalgia was provided in the July 2005 issue of the Fibromyalgia Network Journal.More discussions about headache