What are the most common types of headaches. How can you identify different headache types. What causes various headaches. How are headaches diagnosed and treated. What should you expect after starting headache treatment.

Understanding the Diverse World of Headaches

Headaches are far more intricate than many people realize. With over 150 types identified, each can present its own unique set of symptoms, origins, and required treatments. By understanding the specific type of headache you’re experiencing, you and your healthcare provider can collaborate to find the most effective treatment strategy and potentially prevent future occurrences.

The Most Common Headache Types

While the spectrum of headaches is vast, certain types are encountered more frequently than others. Let’s explore the most common headache types that affect adults and teens:

• Tension headaches
• Migraine headaches
• Cluster headaches
• Chronic daily headaches
• Sinus headaches

Tension Headaches: The Everyday Culprit

Tension headaches reign as the most prevalent type among adults and adolescents. They typically manifest as mild to moderate pain that fluctuates over time. What distinguishes tension headaches from other types? These headaches usually occur without additional symptoms, making them somewhat easier to manage but potentially more challenging to diagnose definitively.

Migraine Headaches: The Throbbing Menace

Migraine headaches are often characterized by a pounding or throbbing sensation. How long can a migraine last? These debilitating headaches can persist anywhere from 4 hours to 3 days and typically occur one to four times a month. Migraines are not just about head pain; they often come with a host of other symptoms:

• Sensitivity to light, noise, or smells
• Nausea or vomiting
• Loss of appetite
• Upset stomach or abdominal pain

In children, migraines may present differently. A child experiencing a migraine might appear pale, feel dizzy, have blurred vision, fever, and stomach discomfort. Interestingly, a small subset of children’s migraines includes digestive symptoms, such as vomiting, occurring approximately once a month.

Cluster Headaches: The Most Severe Form

Cluster headaches are notorious for their intensity, often described as the most severe type of headache. What does a cluster headache feel like? Sufferers typically experience intense burning or piercing pain behind or around one eye. This pain can be throbbing or constant and is often so excruciating that it prevents the individual from sitting still, often leading to pacing during an attack.

Cluster headaches come with distinctive symptoms on the affected side:

• Drooping eyelid
• Reddening of the eye
• Pupil constriction
• Excessive tearing
• Nasal congestion or runny nose

Why are they called cluster headaches? These headaches tend to occur in groups or clusters. During a cluster period, which can last from 2 weeks to 3 months, an individual might experience one to three headaches per day. Each attack typically lasts between 15 minutes to 3 hours and can even wake a person from sleep.

Interestingly, cluster headaches may disappear completely (a period called remission) for months or years, only to return later. It’s worth noting that men are three to four times more likely to experience cluster headaches than women.

Chronic Daily Headaches: The Persistent Pain

Chronic daily headaches are defined by their frequency and duration. How often do chronic daily headaches occur? To meet the criteria, an individual must experience headaches 15 days or more per month for longer than 3 months. These headaches can vary in duration, with some being short-lived while others persist for more than 4 hours.

Chronic daily headaches usually fall into one of four primary headache categories:

1. Chronic migraine
2. Chronic tension headache
3. New daily persistent headache
4. Hemicrania continua

Sinus Headaches: When Inflammation Strikes

Sinus headaches are characterized by a deep and constant pain in the cheekbones, forehead, or bridge of the nose. What causes sinus headaches? These headaches occur when the sinuses, which are air-filled cavities in the skull, become inflamed. Typically, sinus headaches are accompanied by other sinus-related symptoms:

• Runny nose
• Fullness in the ears
• Fever
• Facial swelling

It’s important to note that a true sinus headache results from a sinus infection. How can you differentiate a sinus headache from other types? The key lies in the nasal discharge. In sinus headaches, the nasal discharge is typically yellow or green, unlike the clear discharge often seen in cluster or migraine headaches.

Less Common Headache Types: Expanding the Spectrum

While tension, migraine, cluster, chronic daily, and sinus headaches are the most frequently encountered types, several less common headache varieties exist. Understanding these can be crucial for accurate diagnosis and effective treatment.

Posttraumatic Headaches

Posttraumatic headaches typically emerge 2-3 days following a head injury. What symptoms accompany posttraumatic headaches? Individuals often experience:

• A dull ache that intensifies over time
• Vertigo
• Lightheadedness
• Difficulty concentrating
• Memory problems
• Increased fatigue
• Irritability

While these headaches may persist for several months, it’s advisable to consult a healthcare provider if symptoms don’t improve within a couple of weeks.

Exercise Headaches

Exercise headaches occur during or immediately after physical activity. Why do exercise headaches happen? During intense activity, the muscles in your head, neck, and scalp require increased blood flow. This causes blood vessels to swell, resulting in a pulsing pain on both sides of the head.

How long do exercise headaches last? These headaches can persist anywhere from 5 minutes to 48 hours. Interestingly, they can be triggered by various forms of physical exertion, including sexual activity.

Hemicrania Continua

Hemicrania continua is a chronic, ongoing headache that almost always affects the same side of the face and head. What are the hallmarks of hemicrania continua? This condition is characterized by:

• Pain that varies in severity
• Red or teary eyes
• Runny or stuffy nose
• Droopy eyelid
• Contracted iris
• Response to the pain medication indomethacin
• Worsening pain with physical activity
• Increased pain when consuming alcohol

Some individuals with hemicrania continua also experience migraine-like symptoms such as nausea, vomiting, and sensitivity to light and sound. There are two types of hemicrania continua:

1. Chronic: Daily headaches
2. Remitting: Headaches occur for 6 months, followed by a period of remission lasting weeks or months before returning

Hormone Headaches

Hormone headaches are closely linked to fluctuations in hormone levels. When do hormone headaches typically occur? These headaches can be triggered by hormonal changes during:

• Menstrual cycles
• Pregnancy
• Menopause

Additionally, hormone changes resulting from birth control pills and hormone replacement therapy can also precipitate headaches. When these headaches occur 2 days before menstruation or within the first 3 days after it begins, they are classified as menstrual migraines.

New Daily Persistent Headaches (NDPH)

New Daily Persistent Headaches (NDPH) are characterized by their sudden onset and persistence. How long do NDPHs typically last? These headaches can continue for 3 months or more, often beginning abruptly and remaining constant from that point forward.

Unraveling the Causes of Headaches

Understanding the underlying causes of headaches is crucial for effective management and prevention. What factors contribute to the development of headaches? The causes can be diverse and often multifaceted, including:

• Stress and tension
• Dehydration
• Changes in sleep patterns
• Certain foods and additives
• Alcohol consumption
• Caffeine withdrawal
• Hormonal changes
• Environmental factors (e.g., strong odors, bright lights)
• Medical conditions (e.g., sinusitis, hypertension)
• Medications and their side effects

It’s important to note that the causes can vary significantly depending on the type of headache. For instance, while tension headaches are often triggered by stress and muscle tension, migraines may be sparked by specific foods, hormonal changes, or environmental stimuli.

Diagnosing Headaches: A Multifaceted Approach

Accurate diagnosis is key to effective headache management. How do healthcare providers diagnose headaches? The diagnostic process typically involves several steps:

1. Detailed medical history: Your doctor will ask about your symptoms, their frequency, duration, and any potential triggers.
2. Physical examination: This may include a neurological exam to check for signs of underlying conditions.
3. Headache diary: Keeping a record of your headaches can help identify patterns and triggers.
4. Imaging tests: In some cases, MRI or CT scans may be ordered to rule out structural abnormalities.
5. Blood tests: These can help identify any underlying medical conditions contributing to headaches.

What specific questions might a healthcare provider ask during diagnosis? They may inquire about:

• The location and intensity of your pain
• How often you experience headaches
• Any associated symptoms (e.g., nausea, visual disturbances)
• Potential triggers you’ve noticed
• Your family history of headaches
• Any medications you’re currently taking

Treatment Strategies for Headaches

Once a diagnosis is established, treatment can begin. How are headaches typically treated? Treatment approaches often involve a combination of the following:

Medication

Depending on the type and severity of headaches, various medications may be prescribed:

• Over-the-counter pain relievers (e.g., acetaminophen, ibuprofen)
• Triptans for migraines
• Preventive medications for chronic headaches
• Anti-nausea drugs for headaches accompanied by nausea

Lifestyle Changes

What lifestyle modifications can help manage headaches? Consider implementing the following:

• Stress management techniques (e.g., meditation, deep breathing exercises)
• Regular exercise
• Maintaining a consistent sleep schedule
• Staying hydrated
• Avoiding known triggers (e.g., certain foods, environmental factors)

Alternative Therapies

Some individuals find relief through alternative treatments such as:

• Acupuncture
• Massage therapy
• Biofeedback
• Cognitive-behavioral therapy

Preventive Measures

For those with frequent or severe headaches, preventive strategies may be recommended. These could include:

• Daily medications to reduce headache frequency
• Botox injections for chronic migraines
• Lifestyle modifications to avoid known triggers

What to Expect After Starting Headache Treatment

Beginning headache treatment is an important step, but it’s crucial to have realistic expectations. What should you anticipate after starting treatment?

• Gradual improvement: Most treatments take time to show full effect. Be patient and consistent with your treatment plan.
• Potential side effects: Some medications may cause side effects. Discuss any new symptoms with your healthcare provider.
• Ongoing monitoring: Your doctor may want to follow up regularly to assess the treatment’s effectiveness and make any necessary adjustments.
• Lifestyle adjustments: You may need to make ongoing changes to your daily habits to support your treatment plan.
• Keeping a headache diary: Continuing to track your headaches can help you and your doctor evaluate the treatment’s success.

How long does it typically take to see results from headache treatment? The timeline can vary depending on the type of headache and the treatment approach. Some people may experience relief within days, while others might need several weeks or even months to see significant improvement.

Remember, headache management is often an ongoing process. It may take time to find the most effective combination of treatments for your specific situation. Stay in close communication with your healthcare provider and don’t hesitate to discuss any concerns or changes in your symptoms.

Types, Causes, Symptoms, Diagnosis, Treatment

Written by WebMD Editorial Contributors

Medically Reviewed by Jennifer Robinson, MD on September 14, 2022

• Common Types of Headaches
• Less Common Headaches
• Rare Headaches
• What Causes Headaches?
• Getting a Diagnosis
• How Are Headaches Treated?
• What Happens After I Start Treatment?
• More

Headaches can be more complicated than most people realize. Different kinds can have their own set of 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 them.

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 sensitivity to light, noise, or smells; nausea or vomiting; loss of appetite; and upset stomach or belly pain. 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, like 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 will often pace during an attack. On the side of the pain, the eyelid droops, the eye reddens, pupil gets smaller, or the eye makes tears. 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:

• Chronic migraine
• Chronic tension headache
• New daily persistent headache
• Hemicrania continua

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 along with other sinus symptoms, like 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:

• A dull ache that gets worse from time to time
• Vertigo
• Lightheadedness
• Trouble concentrating
• Memory problems
• Tiring quickly
• Irritability

Headaches may last for 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. 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 almost always affects the same side of your face and head. Other symptoms include:

• Pain that varies in severity
• Red or teary eyes
• Runny or stuffy nose
• Droopy eyelid
• Contracted iris
• Responds to the pain medication indomethacin
• Worse pain with physical activity
• Worse pain with drinking alcohol

Some people also notice migraine symptoms like:

• Nausea and vomiting
• Sensitivity to light and sound

There are two types:

• Chronic: You have daily headaches.
• Remitting: You have headaches for 6 months. They go away for a period of weeks or months and come back.

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 that 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 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 they can be a symptom of something else.

Spinal Headaches

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

• Blood vessel tear, rupture, or blockage
• Head injury
• Hemorrhagic stroke from a ruptured blood vessel in your brain
• Ischemic stroke from a blocked blood vessel in your brain
• Narrowed blood vessels surrounding the brain
• Inflamed blood vessels
• Blood pressure changes in late pregnancy

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

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 like sinusitis (inflammation of the sinuses), a throat infection, or an ear infection. In some cases, headaches can result from a blow to the head or, rarely, 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. Other causes include neck or back strain due to poor posture.
• Your environment, including 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 migraine headaches, 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 exactly what causes migraines. One theory suggest 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.

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 you about the symptoms you have and how often they happen. It’s important to be as complete 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 EEG (electroencephalogram) 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 treatment to try. They also might suggest more testing or refer you to 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 medications, electronic medical devices, counseling, stress management, and biofeedback. Your doctor will make a treatment plan to meet your specific needs.

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

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Constant or Chronic Headaches: Symptoms, Causes, and More

We’ve all felt the symptoms of a headache at some point in our lives. Usually, they’re a minor annoyance that can be relieved using over-the-counter (OTC) pain medication.

But what if your headaches are constant, occurring almost every day?

Chronic daily headaches are when you have a headache for 15 days or more per month during a 3-month period. Both adults and children can have chronic, or constant, headaches. They can become debilitating and can interfere with your day-to-day activities.

The term “chronic daily headache” is rather broad and includes several different types of headaches that can occur on a daily basis:

• tension headache, which feels like a tightening band has been placed around your head
• migraine attacks, which feel like a very intense throbbing headache that can occur on one or both sides of your head and may sometimes be preceded by a collection of symptoms called aura
• cluster headache, which can occur on and off over a period of weeks or months and can cause severe pain on one side of your head, often in the area around or behind an eye
• hemicrania continua, which is a constant, or daily, headache that occurs on one side of your head and may feel similar to migraine
• new daily persistent headache, which involves headache pain that comes on suddenly and continues to occur daily, lasting for months without easing

Read on to learn more about constant headaches, what may cause them, and how you can manage them.

The symptoms of a constant headache can vary depending on the type of headache you’re experiencing. They include head pain that can:

• involve one or both sides of your head
• feel like a pulsing, throbbing, or tightening feeling
• vary in intensity from mild to severe

Other symptoms can include:

• nausea or vomiting
• sweating
• sensitivity to lights, sounds, or smells
• a stuffy or runny nose
• redness or tearing up of the eyes
• lightheadedness
• feeling restless or agitated

Doctors still don’t know what exactly causes daily headache symptoms. Some possible causes include one or a combination of the following:

• Trigeminal nerve activation. The trigeminal nerve is a major nerve that’s found in your head and face. One of its functions is sending sensory information from the various structures and tissues in these areas to the brain. Activation of this nerve can lead to the symptoms of many types of headache.
• Muscle tension. Tightening of the muscles of the head and neck can create tension and lead to headache pain.
• Hormones. Changes in the levels of certain hormones, such as estrogen, are associated with the onset of some types of headache. For example, naturally occurring changes in estrogen levels likely play a role in the increased prevalence of migraine in women.
• Genetics. Although more research is needed, experts believe that genetics can influence your susceptibility to certain types of headache, particularly migraine.

Regardless of the exact mechanism, it’s known that headaches are often triggered by lifestyle or environmental factors. A few examples include:

• stress
• lack of sleep
• skipped meals
• physical exertion
• changes in weather
• caffeine or alcohol use
• feelings of anxiety or depression
• certain types of medications

While pain medication is often used to ease headache pain, overuse can also cause a constant headache. This is called a medication overuse headache or a rebound headache. You’re at risk for this type of headache if you take OTC or prescription pain medication more than 3 days per week, according to the National Institute of Neurological Disorders and Stroke.

Experts currently believe that constant, or chronic, headaches result when an episodic headache disorder transforms into a chronic one. While the mechanisms behind this change are poorly understood, some risk factors for the transition from episodic to chronic headache include:

• overuse of pain medication
• obesity
• disrupted sleep
• high caffeine intake
• persistently high stress levels

There are many possible treatments for constant headaches. A doctor will work with you to determine which treatment will be best for you. Your treatment will depend on the type of headache you’re experiencing.

Treatments for constant headache include:

Medications

Medications can be used to prevent or treat constant headaches. If overuse of OTC or prescription pain medication is contributing to constant headache, your doctor will likely recommend that you discontinue this medication to help break the headache cycle.

Often, the treatment of constant headaches aims to prevent headaches from happening. This can decrease the need for the use of pain medications. Some examples of medications that may help to prevent constant headaches include:

• antidepressants called tricyclics, such as amitriptyline and nortriptyline, which can prevent headaches and may also help manage the anxiety or depression that can occur with constant headaches
• antiseizure medications like gabapentin (Neurontin) and topiramate (Topamax)
• beta-blockers like propranolol (Inderal) and metoprolol (Lopressor)
• monoclonal antibodies to calcitonin gene-related peptide like erenumab (Aimovig), fremanezumab (Ajovy), eptinezumab (Vyepti), atogepant (Qulipta), and rimegepant (Nurtec), which work to prevent migraine attacks, and galcanezumab (Emgality), which can prevent migraine attacks and cluster headaches
• medications like the calcium channel blocker verapamil (Verelan) or the mood stabilizer lithium, which can help prevent cluster headache
• Botox injection, which is an injection of a neurotoxin made from the bacteria that causes botulism (Botox can also be an option for people who aren’t tolerating daily medication)

When headaches do happen, you may treat them with medications like:

• nonsteroidal anti-inflammatory drugs like ibuprofen (Motrin, Advil) and naproxen (Aleve)
• triptans like sumatriptan (Imitrex) and rizatriptan (Maxalt)
• ergot derivatives like dihydroergotamine

Generally, however, use pain medications sparingly where possible. This is because they can lead to medication overuse or rebound headaches.

Non-medication therapies

Your doctor may recommend other therapies as well, possibly in combination with medications. Non-medication therapies include:

• Therapy. You can receive therapy from a mental health professional either alone or in a group. Therapy can help you understand the mental effects of your headaches and discuss ways to cope.
• Biofeedback. Biofeedback uses monitoring devices to help you understand and learn to control body functions such as blood pressure, heart rate, and muscle tension.
• Nerve stimulation. This approach involves delivering electrical impulses to stimulate certain nerves. Occipital nerve stimulation may help with migraine, while vagus nerve stimulation can help to treat cluster headache.
• Acupuncture. This treatment involves inserting tiny hair-thin needles into specific places on the body.
• Massage. Massage may help with relaxation and reduce tension in muscles.
• Supplements. Options such as butterbur or feverfew may help to lower the frequency of migraine attacks.

Lifestyle changes

A doctor may suggest making some lifestyle changes in order to help manage your headaches. These can include things like:

• avoiding things that can trigger your headaches
• making sure that you get enough sleep
• trying to eat meals more regularly
• managing weight if you have overweight or obesity
• exploring ways to lower your stress levels
• getting regular exercise
• limiting or avoiding caffeine or alcohol use
• quitting smoking

You can visit a primary care doctor to discuss your constant headaches. They may also refer you to a neurologist, which is a type of doctor who specializes in conditions that affect the nervous system.

To reach a diagnosis, a doctor will first take your medical history. They may ask questions like:

• How often do you get headaches?
• How long do your headaches last?
• Where is the pain located and what does it feel like?
• Do your headaches occur at a certain time or after a specific activity?
• Do you have any additional symptoms with your headaches?
• Do you have a family history of some types of headache, such as migraine?
• What medications are you taking?

A doctor will then perform a physical examination. Laboratory testing typically isn’t necessary unless you have symptoms of an infection or other illness.

During an examination, a doctor will work to rule out any possible secondary causes of headache, which can include:

• infections, such as meningitis or encephalitis
• obstructive sleep apnea
• seizures
• traumatic brain injury
• brain tumor
• exposure to toxic chemicals or substances

A doctor may also use imaging tests, such as a CT scan or MRI, to help diagnose the cause of your headache.

In order to receive the most effective treatment for your constant headaches, visit a doctor to receive a diagnosis. The Healthline FindCare tool can provide options in your area if you don’t already have a doctor.

Make an appointment with a doctor to discuss your symptoms if:

• You’re experiencing two or more headaches in a week.
• Your headaches get worse or don’t improve when you use OTC pain medication.
• You use an OTC pain medication almost every day to control your headaches.
• You notice that things like physical exertion or strenuous activities trigger your headaches.
• Your headaches begin to interfere with your day-to-day activities, such as sleep, work, or school.

Medical emergency

Sometimes a headache may be a symptom of a more serious problem, such as a stroke or meningitis. Go to the nearest emergency room if you experience:

• a severe headache that comes on suddenly
• a headache that includes symptoms of infection, such as high fever, stiff neck, nausea, or vomiting
• a headache that includes other neurological symptoms, such as confusion, numbness, or problems with coordination, walking, or speaking
• a headache that occurs after a head injury

Was this helpful?

It’s possible that you may have a few additional questions about headaches. We’ll address some of these below.

What kind of headaches does COVID-19 cause?

Headache is a potential symptom of COVID-19, the illness caused by SARS-CoV-2. Early estimates from the World Health Organization placed the prevalence of headache in COVID-19 at 13.6 percent.

However, these estimates vary greatly based on the group that’s being observed. For example, some studies have reported headache in 13 percent of participants, while others have reported this symptom in almost 75 percent of participants.

An October 2020 study surveyed 262 people with confirmed COVID-19 that included headache as a symptom. The survey respondents reported experiencing headaches that:

• typically affected both sides of the head
• could be felt as a variety of different sensations, including pulsing, pressing, or stabbing
• lasted a long time, sometimes over 72 hours
• were more resistant to pain relieving medications
• often occurred along with other COVID-19 symptoms like loss of taste and smell or digestive symptoms
• felt different from their typical headaches (in those with a history of headaches)

Headache can also be a symptom of post COVID-19 condition, or long COVID. An August 2021 paper reviewed 28 studies and 7 pre-print studies. It found that the prevalence of persistent headache in the 6 months after COVID-19 illness was between 8 and 15 percent.

Is it common to have headaches every day?

Chronic daily headaches aren’t that common. According to a 2017 review, the estimated worldwide prevalence ranges between 3 and 5 percent. It’s believed that most of these people have chronic migraine.

When should you be concerned about a headache?

There are some red flags that indicate that you should be concerned about a headache. These include a headache that:

• happens two or more times per week
• recurs or is persistent
• gradually worsens over several days
• is different from your typical headache patterns or symptoms
• is very severe and comes on suddenly
• develops after you’ve had a head injury

You might also be concerned about a headache that happens with any of the following symptoms:

• nausea and vomiting not related to another known illness
• high fever
• stiff neck
• weakness
• numbness
• shortness of breath
• blurry vision
• confusion
• seizures
• loss of consciousness

Headaches are also concerning when they’re new and happen in:

• older people
• those who are living with HIV
• people with a history of cancer or a weakened immune system

If you have a headache that falls into any of these categories, it’s important to visit a doctor promptly. They can help to evaluate your condition and determine what may be causing your headache.

Constant or chronic daily headaches happen when you have a headache for 15 days or more out of a month. Many types of headaches can become constant, including tension headaches and migraine.

A variety of treatment options are available for managing constant headaches. Speak with a doctor about your symptoms to receive a proper diagnosis and the most effective treatment for you.

Headache in the back of the head – treatment and causes

In this article:

Headache in the back of the head is a common complaint.

Any pain, including a headache in the back of the head, always has vascular and so-called vegetative components.

The fact is that the brain itself does not hurt! Headache is pain emanating from the vessels and membranes of the brain. They have the highest concentration of pain receptors. Activation (irritation) of these receptors generates pain impulses. They enter the brain through the nerves and conductors of the predominantly autonomic part of the nervous system, causing the so-called minimal brain dysfunction.

Read more about cerebral and dysfunction and how it relates to the autonomic nervous system.

Sufficient and correct diagnosis of the state of blood vessels and the autonomic part of the nervous system allows us to understand the causes and mechanisms of headache. This provides a unique opportunity to eliminate the cause of the headache as well as manage the pain. Especially for chronic headaches. Pain can always be reduced or completely blocked.

At the Meddiagnostics Center, headache treatment is based on identifying the cause of the headache. For this, a protocol developed by the Meddiagnostics Center is used, which has shown its effectiveness over the years:

2. Testing the condition of the vascular wall, its elasticity, assessment of hydrodynamics and cerebral circulation .
3. Deviations in the functioning of the autonomic nervous system are tested, which makes it possible to find individual approaches to its correction in each patient. Read more about the diagnosis of abnormalities of the autonomic nervous system .
4. In the presence of headache, dizziness, tinnitus and other conditions, deviations in the work of different parts of the brain are specified.

Read more about diagnostic methods and methods of treatment at the Neurology Center “ Meddiagnostics ”

Possible causes of pain in the back of the head

1. Osteochondrosis of the spine with reflected pain in the occiput
2. Neuropathy of the occipital greater and occipital lesser nerves
3. Radiculopathy (radiculopathy) C1 and C2
4. Pathology of the vertebral artery in posterior cervical sympathetic syndrome
5. Myogylosis of the muscles of the occipital region
6. Increase in blood pressure (arterial hypertension, arterial hypertension)
7. Processes occurring in the posterior cranial fossa (tumor, stroke)

Osteochondrosis of the spine with referred pain in the occiput

Spinal osteochondrosis is understood as degenerative-dystrophic changes in bone and cartilage tissues. The term “osteochondrosis” is used exclusively in the post-Soviet space and is a statement of a set of radiological signs. In relation to the spine, this is sclerosis of the closing plates due to a violation of the trophism (nutrition) of bone and cartilage tissues. Long-term studies Ukrainian Institute of Musculoskeletal Medicine and Neurology conducted since 1985 to 1995 showed that osteochondrosis has nothing to do with the occurrence of pain in the spine. Osteochondrosis is a natural degenerative process (involution of tissues of the supporting apparatus), which is asymptomatic. Changes in the disc itself are important, which are accompanied by a decrease in the height of the disc and a decrease in tension between two adjacent vertebrae. This is manifested by instability of the spinal segment, displacements and secondary trauma to the tissues of the intervertebral joints. Some of the details of these studies have just now been published for the first time:

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osteochondrosis, it should be especially noted that in the vertebral segments of the occiput (two upper cervical segments of the spine) there are no discs (!) And there can be no hernias. Pain, as at any level of the spine, occurs due to the so-called. facet syndrome. It was comprehensively studied and described by us in a series of scientific publications and named “ facet subluxation syndrome » more here.

Read more about Facet Subluxation Syndrome (article The essence of subluxation facet syndrome).

In relation to pain in the back of the head due to the so-called. osteochondrosis of the upper cervical spine, it should be noted that (NB!) there are no discs in the upper cervical spine. Accordingly, there can be no herniated discs in these segments of the spine. Therefore, it is not necessary to consider osteochondrosis as a cause of pain in the back of the head. The diagnosis of “osteochondrosis” is a large generalizing concept in relation to a large list of diseases that occur with pain in the spine.

Read about the so-called. osteochondrosis more here.

Neuropathy of the greater occipital and lesser occipital nerves

Involvement of these nerves can have several causes. The main one is the spine. Mechanical compression of the roots or spinal nerves that are related to the formation of the greater or lesser occipital nerves can cause a headache in the occipital region.

The figure shows the innervation zones of the greater and lesser occipital nerves. The lower figure shows the nerves of the head, which are related both to the head itself and to the occipital region.

Nerves pass through the muscle layers of the occipital region (picture below). The muscle mass of the occipital-cervical region is complex. It consists of several layers of muscles multidirectional in their function. These muscles provide movement to the occipital-vertebral region and can compress the nerves, causing pain in the back of the head.

Our studies have shown that muscle spasm often occurs due to subluxation facet syndrome. This process was studied in detail by us in the clinic and in the experiment in the 80s of the last century on the basis of needle electromyography in the clinic and experiment, as well as electron microscopy in the experiment:

Gongalsky V.V.

1. Electrophysiological assessment of neurological manifestations of violations of the topography of the vertebral motor segment//Orthopedics, traumatology and prosthetics.-1988.-N11.-S.43-46.
2. Clinical and electrophysiological evaluation of neurological manifestations of osteochondrosis of the spinal column//Medical business.-1988.-N11.-S. 83-85. (co-author Macheret E.L., Lysenyuk V.P.).
3. Ultrastructural characteristics of early musculotonic reactions of deep short back muscles in experimental osteochondrosis // Regional scientific-practical conference “Human health in an intensive industrial zone: Abstracts of reports. — Dnepropetrovsk, 1989.-Ch.2.-S.60 -61
4. Early segmental neurological manifestations of osteochondrosis of the thoracic spine // Abstract of the dissertation for the degree of candidate of medical sciences. Kyiv. 1990.-18s.

Etc.

Radiculopathy (root damage) C1 and C2

Nerves of the occipital region are formed by roots. The nerve root exits through the intervertebral foramen. In these holes, the roots can be injured. The general principle of trauma to the contents of the intervertebral foramen is set out in the above publication (see here).

Such an injury can cause radicular disorders, in particular in the occipital region. The figure below shows a diagram of dermatomes with the capture of the back of the head. The occipital region is innervated by the second (C2) and third (C3) cervical roots (see figure below).

Pathology of the vertebral artery in posterior cervical sympathetic syndrome (cervical migraine, Barre-Lieu syndrome)

Cervical migraine (posterior cervical sympathetic syndrome) occurs when there is insufficient blood flow in the vertebrobasilar basin. The syndrome is often associated with narrowing of the canal of the vertebral artery, as shown in the figure below.

It is not uncommon in the literature that the cause is the so-called. “cervical osteochondrosis”. As mentioned above, osteochondrosis has nothing to do with the development of vertebral artery syndrome.

This syndrome is characterized by headache mainly in the occipital part of the head, dizziness, noise (sometimes ringing) in the ears, the appearance of a veil before the eyes. Often, pain is felt not only in the back of the head, but also in the orbit, resembling cluster pain in its pattern (see above). Cervical migraine may be accompanied by heart and respiratory rhythm disorders (bulbar disorders) and a number of other neurological disorders.

Diagnosis of pain in the back of the head

For the diagnosis of cervical migraine, MRI of the brain with MRI reconstruction of the vessels of the head, ultrasound of the arteries of the head and neck are performed, paying attention to the condition of the vertebral arteries. Informative is the x-ray of the cervical spine and joints of the head (C0\C1, C1\2 segments). In some cases, an MRI of the cervical spine may be needed (see Diagnose Migraine and Any Other Headache). Hardware diagnosis is extremely important, since the clinical picture of cervical migraine can be given, for example, by thrombosis of the vertebral artery, brain tumors or strokes (see more about the causes of headache).

Our equipment

MRI machine Toshiba Vantage Elan 1.5 tesla

Ultrasound machine Philips AFFINITY 50

X-ray complex “Radspeed” SHIMADZU

Ultrasound machine GE LOGIQ F8

Who treats headaches, dizziness and others in the Meddiagnostics Center neurological and vascular diseases

Gongalsky Vladimir Vladimirovich

Doctor of Medical Sciences, orthopedist-traumatologist, neurologist, vertebroneurologist

Kostyev Igor Kimovich

Medical director, neurologist

Maksimov Grigory Alexandrovich

Doctor of Neurology, Candidate of Medical Sciences

Mikhail Viktorovich Volkov

Neurologist

Oleg V. Mazur

Neurologist

Headache treatment review at the Center “Meddiagnostika”

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Treatment of cervical migraine

when diagnosing causes. Vascular preparations generally accepted in neurology are poorly effective.

Myogylosis of the muscles of the occipital region

The figure below shows the muscles of the suboccipital region. Myogyloses can form in the muscles of this area. Myogylosis is a local painful muscle spasm that can give reflected pain in the back of the head. Read more about myogeloses here.

Our experimental studies using electron microscopy have shown that facet subluxation syndrome is accompanied by local spasm of paravertebral muscles. The spasm can be kept for a long time, up to several months. This is explained by the fact that the deep layer of paravertebral muscles contains more tonic (red) fibers. Local spasms lead to the so-called. recontraction, when spasmodic areas of the muscle are reborn into scar tissue. Innervated vessels and the nerves themselves fall into these scars. Areas of overcontracted muscle are painful and are called myogeloses.

High blood pressure

One of the most common causes of neck pain is high blood pressure. Arterial hypertension (hypertension) is considered to be systolic pressure above 140 and diastolic – above 90 mm Hg.

An increase in blood pressure can be physiological, symptomatic and essential (hypertension).

The physiological rise in blood pressure is asymptomatic and, as a rule, does not cause pain in the back of the head. Occurs with stress, physical activity. After the cessation of the provoking factor, blood pressure quickly returns to normal.

Symptomatic hypertension occurs more often in pathology of the kidneys or vessels related to the kidneys:

Hypertension. Most often occurs with a headache in the back of the head. See more here.

Processes occurring in the posterior cranial fossa

Processes such as tumors, insufficiency of cerebral blood flow and impaired CSF flow, impaired cerebral blood flow (stroke) can occur with a headache in the back of the head.

Diagnosis of any headache, including pain in the back of the head, except for interview and neurological examination, includes the use of:

• MRI of the brain with MRI – reconstruction of the vessels of the head
• Dopplerography of neck and head vessels with functional tests (see details)
• Neck x-ray with head joints
• Laboratory testing when clinically indicated

Treatment of pain in the back of the head

Tactics for the treatment of headache in the back of the head depends on the diagnosis.

If subluxation facet syndrome occurs, manipulation techniques are indicated. It is necessary to restore mobility to natural ratios in the joints of the spine (in the absence of contraindications).

If the joints are inflamed (arthritis), you need to look for the cause of the inflammation and eliminate it.

For neuropathies of the occipital nerves, local drug therapy is carried out. In some cases, in the absence of contraindications, physiotherapy is used. Diagnosis of the state of the intervertebral foramens as a possible cause of neuropathy is shown.

Treatment for radiculopathy depends on the cause, which is more likely to be sought in the spinal cord or spine. If there are signs of radiculo-ischemia, vascular therapy and work with radicular sleeves and intervertebral foramens of the spine are indicated.

Posterior cervical sympathetic syndrome is treated by removing the irritation from the vertebral artery, releasing it if there are signs of compression. There are many methods of treatment, the tactics depend on the presence and nature of the neurological deficit in the vertebrobasilar basin and the cause of compression of the vertebral artery.

Myogylosis of the muscles of the occipital region. First of all, they find out the cause of the appearance of myogylosis, determine its localization and eliminate it. The second stage is work with myogelosis itself and the muscle (local drug therapy, massage, muscle mobilization, etc. )

High blood pressure (hypertension, arterial hypertension) – causes of high blood pressure are investigated. To do this, it is advisable to undergo a vascular examination, which is described and similar to the examination performed for migraine (see here). Practice shows that the normalization of cerebral blood flow often stabilizes blood pressure. How to treat arterial hypertension – a doctor of any specialty should be guided.

Pain in the posterior fossa due to tumor processes and stroke – treatment of the underlying disease.

Treatment can only be effective if the diagnosis is correct. Diagnosis and treatment of pain in the back of the head is carried out at the Center “Meddiagnostics”.

Gongalsky Vladimir Vladimirovich

Doctor of Medical Sciences in Neurology, the highest category in Traumatology and Orthopedics

Identification of the causes of headaches – MRI in Balashikha

Headaches or migraine is a functional disorder resulting from functionality and structures of the vessels of the head. These deviations are not distinguished into a separate category of the disease. They are considered either precursors to more complex diseases or the result of minor disorders. However, identifying the cause of headaches often helps prevent the occurrence and development of dangerous diseases and pathologies.

Indications for MRI

Patients presenting to the doctor with acute headaches that are not relieved by analgesics are first referred to a neurologist. He, in turn, must find out the nature of the pain and write out a referral for an MRI.

According to the nature of the pain, they are divided into 4 types:

• Basilar migraine,
• Migraine-like sensations,
• Retinal disorders of the vestibular apparatus,
• Pain with or without aura.

MRI is mandatory in all cases. With its help, the doctor can identify the cause of headaches. It is worth adding that before the advent of magnetic resonance imaging, it was believed that migraine pains were based in one half of the head. However, MRI made it possible to understand that migraines can have anomalies in which pains spread throughout the head.

Referral for MRI is also given in the following cases:

• Head injuries,
• Acute circulatory disorders,
• Postoperative recovery,
• Frequent pains in one half of the brain,
• Risk of cerebral infarction.

MRI images for migraine

An image of the brain for migraine can show several types of causes of pain:

1. Ischemic genesis. This factor is manifested by the presence of white matter in the frontal part of the head. There can be many such foci, and they are associated with the etiology of a neurological disorder. You can find them in two steps:
   • Before the attack – cerebral vessels increase in diameter,
   • After an attack, the vessels decrease in diameter.
2. Neoplasms in the brain. These are not always tumor formations. There may be aneurysms and a cyst, due to which intracranial pressure increases.