Top 7 reasons you have a headache

When a bad headache strikes, you just want it to end. The aching, throbbing pain can be debilitating and result in missed appointments, work, or time with family and friends.

Regardless of whether you are prone to migraines, tension headaches, or cluster headaches (see “Is this your headache?”), you may be able to reduce their frequency by identifying what brings them on. Here’s a look at the most common triggers for each of these kinds of headaches.

Stress

Stress can cause tight muscles in the shoulders and neck, which often leads to tension headaches. “It’s believed to start in the muscles. When tension headaches become frequent, the pain in shoulder and neck muscles is felt by the brain as pain in the head,” says Dr. Sait Ashina, a neurologist who specializes in headache treatment at Harvard-affiliated Beth Israel Deaconess Medical Center. Stress is also a common trigger for migraines.

Diet

Hunger itself can trigger a migraine or tension headache. But eating certain foods may trigger migraines. It could be just one type of food — like beans or nuts — or many foods, such as avocados, bananas, cheese, chocolate, citrus, herring, dairy products, and onions. “Processed foods with nitrites, nitrates, yellow food dyes, or monosodium glutamate can be especially problematic,” Dr. Ashina notes.

Alcohol intake

Alcohol is a common cause of migraine and cluster headaches. For some people, a few ounces of red wine are all it takes to provoke a headache, although any kind of alcohol can be a trigger. It’s not clear if the alcohol itself is to blame or if another component in the drink causes the problem.

Environment

“Cluster headaches seem to be seasonal and often happen in the spring or fall,” Dr. Ashina says. “It’s something in the environment, but we can’t tell exactly what it is yet.” Environmental factors such as bright light, smoke, humidity, intense scents, or cold weather are associated with migraine headaches.

Hormones

Changes in estrogen levels are associated with migraines in women, and women suffer from migraines more often than men. Menstrual cycles may be tied to migraine in younger women. Varying estrogen levels during perimenopause can sometimes start migraines in women who never experienced them before. Estrogen therapy may also be a migraine trigger. Menopause does seem to end migraines in most women.

Caffeine withdrawal

If you normally consume caffeine in coffee or tea, stopping intake abruptly may trigger a migraine. This may be because caffeine causes blood vessels to constrict; without caffeine, the blood vessels widen and bulge out with each heartbeat — a chief reason for the pounding pain of migraines.

Lack of sleep

A lack of sleep is associated with migraines and tension headaches. “We don’t know why, but we do know there’s a correlation and that sleep can lead to pain relief. Sometimes people feel better after taking a nap,” Dr. Ashina says.

What you can do

Understanding your headache triggers can help you avoid getting headaches in the future. But identifying triggers can be tricky, especially if you have more than one (like several kinds of food). Dr. Ashina recommends keeping a diary to note the day, time, symptoms, and circumstances surrounding a headache (what had you eaten? where did it happen?).

If avoiding triggers isn’t enough to keep headaches at bay, talk to your doctor. There are many prescription medications as well as pill-free treatments (acupuncture, meditation, biofeedback, relaxation therapy) that can help reduce headache frequency.

And you’ll need to go a step further: “Make sure you get enough sleep, exercise, eat a healthy diet, limit alcohol intake, and reduce stress,” Dr. Ashina says. “Headaches are a condition of hypersensitivity, so you need balance in your system to fight triggers.”

Image: © peterschreiber.media/Getty Images

Headache | Johns Hopkins Medicine

A 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. The brain tissue doesn’t have pain-sensitive nerve fibers and doesn’t feel pain. But, other parts of the head can be responsible for a headache including:

• A network of nerves that extends over the scalp

• Certain nerves in the face, mouth, and throat

• Muscles of the head, neck, and shoulders

• Blood vessels found along the surface and at the base of the brain

Different types of headaches include:

Migraine

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.

Tension headaches

Tension headaches are the most common type of headache. Stress and tight muscles are often factors in tension-type headaches. 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 headaches

These are the most common symptoms of a cluster headache:

Cluster headaches usually occur in a series that may last weeks or months.

These 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

What causes a headache?

Headaches are classified as primary or secondary.

• A primary headache means the headache itself is the main medical problem, although other factors, such as muscle tension or exposure to certain foods, may be identified. Other contributing factors include medicines, dehydration, or hormone changes.

• A secondary headache is related to an underlying medical condition. An example of this would be a headache due to neck injury, eye problems, jaw, teeth or sinus infection.

What are the symptoms of a headache?

Headache symptoms depend on the type of headache. The frequency of headaches and the intensity of the symptoms may vary, too. Typical headache symptoms include:

• 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).

The symptoms of a headache may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How is a headache diagnosed?

Your doctor will want to do a comprehensive medical evaluation and diagnostic testing. He or she will also ask about your medical history, and do physical exam and certain tests.

Questions commonly asked during the exam may include:

• 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 behavior or personality?

• Do changes in position or sitting up cause the headache?

• Do you have trouble sleeping?

• Do you have a history of stress?

• Is there a history of head injury?

If your doctor suspects migraine or tension-type headaches and the neurological exam is normal, no further testing may be needed. However, if it is not a primary type headache, then other tests may be done to find the cause.

Tests used to find the cause of a headache may include:

• Blood tests. Various blood chemistry and other lab tests may be run to check for underlying conditions.

• Sinus x-rays. An imaging procedure done to evaluate for congestion or other problems that may be corrected.

• Magnetic resonance imaging (MRI). A test 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). An imaging test that uses X-rays and computer technology to produce horizontal, or axial, images (often called slices) 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.

How are headaches treated?

Your healthcare provider will figure out the best treatment based on:

• How old you are

• Your overall health and medical history

• How sick you are

• How well you can handle specific medicines, procedures, or therapies

• How long the condition is expected to last

• Your opinion or preference

The goal of treatment is to stop headaches from occurring. Effective headache management depends on finding what type of headache you have and may include:

• Avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting

• Changing eating habits

• Exercise

• Resting in a quiet, dark environment

• Medicines, as recommended by your healthcare provider

• Stress management

Migraine and cluster headaches may need specific medicine management including:

• Abortive medicines. Medicines prescribed by your healthcare provider act on specific receptors in nerves and blood vessels in the head to stop a headache in progress.

• Rescue medicines. Medicines bought over-the-counter, such as pain relievers, to stop the headache.

• Preventive medicines. Medicines prescribed by your healthcare provider taken daily to reduce the onset of headaches.

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

Can headaches be prevented?

When headache triggers are known, avoiding the triggers can prevent a headache. Reducing stress can minimize or prevent headaches caused by stress. Migraine and cluster headaches may be prevented by taking a daily preventive medicines.

When should I call my healthcare provider?

Most headaches can be managed with over-the-counter pain relievers. However, call your healthcare provider right away if a severe headache is accompanied by:

Symptoms that may suggest a more serious headache include:

• Worst headache ever, or new type of headache

• Recurring headaches in children

• Headaches that start early in the morning

• Headache that follows a head injury

• Pain that is worsened by strain, such as a cough or a sneeze

• Vomiting without nausea

• Sudden onset of pain

• Headache that is becoming more severe or continuous

• Personality changes

• Seizures

Key points about headaches

• A headache is pain or discomfort in the head or face area.

• Types of headaches include migraine, tension, and cluster.

• Headaches can be primary or secondary. If it is secondary, it is caused by another condition.

• Avoiding headache triggers is the best prevention.

• Mild to moderate headaches can be managed with over-the-counter medicines, but tell your healthcare provider if your headache is severe and you have other symptoms.

Headache – causes, in which diseases it occurs, diagnosis and treatment methods

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Headache – the causes of the appearance, in which diseases it occurs, diagnosis and methods of treatment.
The basis of the headache is irritation of pain receptors located in:

• dura mater and brain vessels;
• periosteum of the skull, vessels of the soft tissues of the head, muscles.

The brain tissue itself does not contain pain receptors.

Types of headaches (cephalgia)

Headaches are divided into primary and secondary. Headache is considered primary if it is the main manifestation of brain disease, such as migraine and tension-type headache.

Secondary headache is a symptom of other disorders, such as head trauma, chronic cerebral ischemia, viral diseases, diseases of the cervical spine, etc.

Let’s take a look at the four most common types of headaches.

Possible causes

Tension headache

Tension headache is the most common form of primary headache. Psycho-emotional stress, depression, anxiety and various phobias, overstrain of the muscles of the shoulder girdle are the main causes of tension headaches.

Migraine headache

Migraines are about three times more common in women than in men, and about 60-70% of all migraines in women are so-called menstrual migraines. However, the causes and mechanism of development of migraine attacks are not fully understood. At any age, both in men and women, migraine attacks can be provoked by emotional and physical overload, malnutrition, drinking alcohol, changing weather conditions, harsh noise, strong odors, etc.

Headache with colds

Headache with colds is caused by hyperthermia and the damaging effect of microbial toxins on brain cells.

Headache in chronic cerebral ischemia

The cause of this pain, which is the most common secondary headache in elderly patients, is the pathology of the cerebral vessels, in which blood circulation is disturbed and the blood supply to the brain tissues deteriorates.

The result is progressive brain dysfunction.

What diseases occur

Tension headache

Tension headache is based on irritation of the structures of the central nervous system (CNS), called the nociceptive system. Myogenic, stress, psychogenic headaches are tension headaches.

Most often, tension headache occurs at a young and working age.

In cases of tension headache, the person experiences bilateral, usually mild, pressing and squeezing, monotonous and dull headaches. Attacks of such pain are accompanied by fatigue, nervousness, impaired appetite and sleep, and decreased performance. The duration of the attack is from 30 minutes to several days.

Migraine headache

Indicates only one disease – migraine, since the attacks of such cephalalgia have a peculiar character. Migraine pain is paroxysmal, throbbing, of moderate or severe intensity. It covers half of the head.

The pain may be aggravated by physical activity, tilting the head, often accompanied by nausea, vomiting.

Bright light, sharp sound, strong smell increase the pain. A migraine attack may be preceded by an aura lasting up to one hour – a collection of visual, auditory, olfactory or other neurological symptoms.
Headache with colds

Occurs with most acute and chronic diseases of the upper and lower respiratory tract caused by bacteria or viruses. In some cases, the intensity of such cephalgia correlates with the severity of fever, the strength of the cough, sore throat and other symptoms. The pain most often spreads throughout the head.

Headache in chronic cerebral ischemia

ic brain injury). In the clinical picture of chronic cerebral ischemia, dizziness, cognitive decline, emotional lability (unstable mood), motor-coordination disorders, and perception disorders (tinnitus, “flies” before the eyes) become indispensable companions of headaches. Headaches are usually mild, distributed throughout the head, and prolonged.

Diagnostics and examinations

Tension headache and migraine headache, headache with colds

Diagnosis is made by a neurologist based on the analysis mnesia and evaluation of patient complaints.

Headache in chronic cerebral ischemia

Radiological examination (doppler ultrasound of cerebral vessels) is the key in chronic cerebral ischemia

Duplex scanning of the brachiocephalic arteries with color Doppler flow mapping

Examination to evaluate blood flow in the vertebral and carotid arteries.

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USG recognizes only relatively large stenoses of cerebral vessels caused by atherosclerotic plaques. CT

CT of the brain and skull

Scanning of the brain, skull and surrounding tissues, which allows diagnosing various pathologies.

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and MRI

CT scan of the brain and skull

Scanning of the brain, skull and surrounding tissues, which allows diagnosing various pathologies.

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Contrast injection

The contrast agent is administered intravenously.

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MRI of the brain

Safe and informative scanning of brain structures for the diagnosis of its pathologies.

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also distinguish between extensive brain lesions due to strokes, but not finely diffuse foci characteristic of chronic cerebral ischemia. In chronic cerebral ischemia, conservative treatment is prescribed.

What should you do when you see one?

Pain is always a sign of a malfunction in the body. You can not tolerate pain or self-medicate. With regular headaches (more than five times a month), it is necessary to consult a doctor as soon as possible.

Tension headache

Stop pain attack with analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), antispasmodics. It is important to remember that many analgesics cannot be taken in the presence of chronic diseases (in particular, with lesions of the gastrointestinal tract, liver and kidneys). Indications and contraindications for the use of certain drugs should be discussed with your doctor.

Migraine headache

Patients with mild attacks are recommended to use NSAIDs and analgesics, with moderate and severe manifestations – specific anti-migraine drugs prescribed by a neurologist after a comprehensive examination.

Cold headache

The main way to deal with such pain is to treat a cold.

Headache in chronic cerebral ischemia

An important aspect of therapy is the fight against atherosclerotic changes in the vessels and cerebral ischemia. It is also necessary to monitor the manifestations of concomitant diseases, for example, arterial hypertension and diabetes mellitus.

Which doctors should I contact?

Tension headache:

• neurologist, psychotherapist;

Migraine headache:

• see a neurologist,
  therapist

Headache with colds:

• k
  therapist, ENT doctor;

Headache with chronic cerebral ischemia:

• k
  neurologist, and
  cardiologist and
  endocrinologist.

Mandatory control of diseases included in the metabolic syndrome group: type 2 diabetes mellitus (DM 2), hypertension, obesity and atherosclerosis.

Treatment

Tension-type headache

Most patients with tension-type headache require therapy prescribed by a psychotherapist and a neurologist. It is also important to pay attention to relaxation and adequate physical activity.

Migraine headache

Treatment includes relief and prevention of attacks.

Headache with colds

Therapy is aimed at treating the underlying disease.

Headache in chronic cerebral ischemia

As a rule, most patients suffer from several diseases, each of which negatively affects the state of cerebral vessels. Thus, the most reliable way to stop the progression of chronic cerebral ischemia is to prevent complications of diseases that are part of the metabolic syndrome group (arterial hypertension, diabetes mellitus, etc. ), which are dangerous in terms of worsening cerebral blood flow.
It is important to give up bad habits (smoking, alcohol abuse, drug use) and follow a diet that includes a large amount of fresh fruits and vegetables and a minimum amount of trans fats.

If chronic ischemia is accompanied by hypertension or diabetes mellitus, daily monitoring of blood pressure and blood glucose levels is advisable. It is necessary to undergo laboratory and instrumental examinations with a certain frequency. You should visit a cardiologist and an endocrinologist at least once a year.

Once every three months, you should take a clinical

Clinical blood test: general analysis, leukoformula, ESR (with microscopy of a blood smear in the presence of pathological changes)

Synonyms: Complete blood count, UAC. Full blood count, FBC, Complete blood count (CBC) with differential white blood cell count (CBC with diff), Hemogram.
Brief description of the study CBC: general a. ..

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and blood chemistry,

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in which attention to the level of glucose

Glucose (in the blood) (Glucose)

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glycated hemoglobin,

Glycated hemoglobin (HbA1С, Glycated Hemoglobin)

Synonyms: Blood test for glycated hemoglobin. Glycohemoglobin; HbA1c; Hemoglobin A1c; A1c; HgbA1c; Hb1c.

Brief characteristics of the analyte Glycated hemo…

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lipid metabolism indicators

Lipid profile: extended

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and blood coagulation system,

Hemostasiogram (coagulogram), screening

Synonyms: Hemostasiogram, coagulogram.
Coagulation studies (coagulation profile, coag panel, coagulogram).
Profile Composition:
No. 2 Prothrombin (prothrombin time, prothrombin (according to Quick), INR . ..

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it is also necessary to undergo an electrocardiographic study (ECG),

ECG in 5 minutes

Examination of the functional capabilities of the heart – quickly, painlessly and informatively.

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Echocardiography.

Echocardiography

Examination to assess functional and organic changes in the heart, its contractility, as well as the state of the valvular apparatus.

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If abnormalities occur, you may need to take antidiabetic drugs, statins, or anticoagulants. Ultrasound should be performed at least twice a year

Duplex scanning of the brachiocephalic arteries with color Doppler flow mapping

Examination to evaluate blood flow in the vertebral and carotid arteries.

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to control the progression of atherosclerosis of cerebral and aortic vessels.

Sources:

1. Clinical guidelines “Migraine”. Developed by: All-Russian Society of Neurologists, Russian Society for the Study of Headache. – 2021.
2. Clinical guidelines “Acute respiratory viral infections (ARVI) in adults.” Developed by: National Scientific Society of Infectionists, Russian Scientific Medical Society of Therapists. – 2021.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories can use different research methods and units of measurement to perform the same analyzes.

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HEADACHE – Hadassah Medical Moscow

Traditional migraine therapy consists of behavioral therapy, relief of an already developed attack and preventive treatment aimed at preventing attacks. Behavioral therapy, a necessary step in effective patient management, is carried out during a conversation with the patient and includes: explaining the benign nature of migraine, dissuading the presence of an organic disease, discussing the role of attack triggers and the need to avoid them, risk factors for migraine chronicity (taking a large number of painkillers, stress , psycho-emotional states), as well as the rationale for treatment tactics (mechanisms of action of prescribed drugs).

Treatment of a migraine attack is prescribed depending on its intensity and the degree of maladaptation of the patient. With infrequent attacks of mild or moderate intensity, simple or combined analgesics are indicated; with severe nausea and vomiting – antiemetics. With a high intensity of pain and significant maladaptation, triptans are prescribed.

New drug groups have been approved worldwide for the treatment of migraine attacks. This, in turn, enables doctors to treat their patients more effectively, and for patients to reduce the number of days with a headache, improve quality of life, sleep, mood and performance.

Lasmiditan is a selective serotonin 1F receptor agonist that does not have vasoconstrictive activity. The role of lasmiditan in clinical practice has not yet been determined, but it is probably best suited for patients with relative contraindications to triptans due to cardiovascular risk factors.

In October 2019, the US Food and Drug Administration (FDA) approved lasmiditan oral tablets for the treatment of acute migraine in adults. The drug is currently not registered in the Russian Federation.

CGRP antagonists (Rimegepant and Ubrogepant) Monoclonal antibodies directed against the CGRP receptor or ligand. These are oral options available for the acute treatment of migraine in patients with insufficient response or contraindications (eg coronary artery disease) to triptan treatment.

Ubrogepant received US Food and Drug Administration (FDA) approval for the treatment of acute migraine in adults in December 2019year, and rimegepant received a similar FDA approval in February 2020. This group of drugs is not registered in the territory of the Russian Federation.

Preventive therapy is aimed at reducing the frequency, duration, intensity of attacks, the number of doses of painkillers and improving the quality of life of patients.

The main indications for course treatment: the frequency of days with GB > 4 per month, the lack of effectiveness of drugs for the relief of migraine attacks, the presence of risk factors for migraine chronicity (abuses, depression), prolonged aura (> 60 min). The duration of the course of treatment is from 3 to 12 months (an average of 4-6 months for episodic, 8-12 months for chronic migraine), then an attempt is made to gradually withdraw the drug (s) or reduce their dosage.

CGRP antagonists is a human monoclonal antibody that binds to and inhibits the calcitonin gene-related CGRP receptor (CGRP) and is a therapeutic target in migraine due to its putative role in mediating the transmission of trigeminovascular pain and the vasodilator component of neurogenic inflammation

90 003

Large molecules in the form of monoclonal antibodies directed against the CGRP receptor or ligand are injected to prevent migraine.