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Tension Headaches: Symptoms, Causes, & Treatments

Overview

What are headaches?

Headaches are a common health problem. Almost everyone experiences one at some point in life. But they’re not all the same. Medical experts group headaches into more than 100 types.

For most people, headaches lead to minor aches or pains and happen occasionally (every once in a while). Less commonly, more severe headaches (such as migraines) can cause throbbing pain. Some headaches may make routine tasks difficult or near impossible.

Rarely, severe, sudden head pain can be a sign of a serious health problem, such as a brain tumor.

What are tension-type headaches?

Tension headaches are the most common type of headache. These headaches often cause mild-to-moderate pain around the head, face or neck. They usually don’t cause other symptoms (like nausea or vomiting). Healthcare providers generally don’t consider tension headaches to be dangerous.

Your healthcare provider may call your tension headache, “tension-type headache. This is what this headache is called by the official medical publication that classifies all headache disorders.

What are the types of tension-type headaches?

Healthcare providers break down tension headaches into two main types. They base the type on how many headaches you have and how often:

  • Episodic tension-type headaches happen less often (fewer than 15 days a month). Your provider may call them “infrequent” if you have one or fewer headaches each month.
  • Chronic tension-type describe when your headache days outnumber headache-free days. Chronic tension headaches happen 15 or more days each month for more than three months in a row.

How common are tension headaches?

People don’t always see their doctor for a tension headache, which makes exact numbers hard to predict. Researchers estimate that as many as 2 in 3 adults in the U. S. get tension headaches.

Chronic tension headaches are much less common. They affect an estimated 3% of adults. Women get tension headaches more often than men.

Symptoms and Causes

What causes tension headaches?

Researchers haven’t identified one single cause for tension headaches. This headache type is not hereditary (run in families).

Some healthcare providers believe tightened muscles in the back of your head or neck may trigger (bring on) tension headaches.

What are some triggers that may bring on tension-type headaches?

You may be more likely to have tension headaches if you have:

  • Eye strain, such as from staring at a computer screen for a long time.
  • Pain in other parts of your head and neck caused by problems such as temporomandibular disorders.
  • Problems sleeping, such as insomnia.
  • Stress related to family, work or life challenges, such as starting or losing a job or juggling too many commitments.

How does a tension-type headache feel?

People experience tension headache symptoms differently. Some people describe tension headache pain as feeling like someone (or something) is squeezing both sides of their head together or a band around their head.

You may have pain that’s:

  • Constant (but not throbbing).
  • Mild or moderate (not severe).
  • On both sides of the head.
  • Better after you take over-the-counter pain relievers.

How is a tension-type headache different from a migraine?

Migraines are another common headache type. Migraines and tension headaches tend to cause different symptoms.

A migraine is more likely to cause:

  • More severe pain.
  • Throbbing or pounding pains.
  • Symptoms focused on one side of the head.
  • Pain that gets worse when you’re near bright lights or loud sounds.
  • Nausea or vomiting.

How long does a tension-type headache last?

That depends. A tension-type headache may last for 30 minutes or (less commonly) months. In general, episodic tension headache symptoms tend to come on slowly and end sooner. They often happen in the middle of the day. Episodic headaches usually don’t last longer than a week.

People with chronic tension-type headaches can have symptoms that last for months at a time. Pain may stay at the same level of discomfort for days. While uncommon, these headaches can take a toll on your quality of life.

Is a tension-type headache dangerous?

Not according to medical experts. While chronic tension-type headaches can disrupt your life, tension headaches don’t tend cause serious health issues.

Sometimes tension-type headaches may be a sign of an underlying disorder such as thyroid disease or an underlying tumor or a primary headache disorder, such as chronic migraine or new daily persistent headache. Anyone over age 50 with a new onset headache should see their doctor for an evaluation .

Diagnosis and Tests

How are tension-type headaches diagnosed?

No test exists to definitively diagnose tension headaches. Your healthcare provider will start by reviewing your medical history. They will then examine you to evaluate your symptoms.

Your provider may ask you a lot of questions to learn more about your symptoms, such as:

  • Do your symptoms feel worse at certain times of the day?
  • Do your symptoms feel worse after eating certain foods?
  • Do over-the-counter pain relievers help you feel better?
  • How often do you have symptoms?
  • How would you describe your stress levels?

A headache specialist will use a diagnostic manual called the International Classification of Headache Disorders-3 to make sure that you fulfill criteria for tension-type headache.

In some cases, your provider may order an imaging scan, such as an MRI. Imaging tests can help rule out less common but potentially serious causes of your symptoms. Learn more about headache diagnosis and tests.

Management and Treatment

How are tension-type headaches treated?

If you get a tension headache every so often, over-the-counter pain relievers may effectively treat your pain. Your provider may recommend you first try one of these options to relieve your symptoms:

  • Acetaminophen (Tylenol®).
  • Aspirin.
  • Ibuprofen (Advil®, Motrin®).
  • Naproxen sodium (Aleve®).

Are there any other tension headache medication options?

If over-the-counter pain relievers don’t help, your provider may prescribe medication. Certain medications reduce how often your headaches happen or how much they hurt. The antidepressant amitriptyline (Elavil®) has helped some people with chronic tension headaches. Opioids should not be used.

Are there any risks to taking medication to treat tension headaches?

Over-the-counter pain relievers are generally safe. But overusing pain relievers can cause other problems. Make sure to follow the instructions on the bottle carefully. Always check in with your provider if you feel the need to use pain relievers more than twice a week.

Take these medications only when you need them. Use the smallest dose that relieves your pain.

In general, overusing pain medications may cause:

  • Headaches: Taking pain relievers too often can actually cause a headache (called rebound headaches) when you stop taking the medicine. This effect is similar to withdrawal.
  • Other side effects: All drugs have side effects. Avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, too often. Overuse may cause stomach pain, bleeding or ulcers. If you take any medication regularly, discuss the risks and benefits with your doctor.
  • Reduced benefits over time: Your body can build up a tolerance (get used to) any medication. You may notice that a medication you’ve used regularly doesn’t work as well as it once did.
  • Dependence: Some medications can become addictive. They may pose more risks than benefits. For that reason, healthcare providers usually recommend against prescribing benzodiazepines and narcotics (such as codeine and oxycodone) to treat tension headaches.

Can medication cure tension-type headaches?

No treatment (medication or otherwise) can cure tension headaches. Medicines help you manage and get relief from your symptoms so that you can enjoy more of life.

Can I treat a tension-type headache without medication?

Absolutely. While medication may be helpful, it’s not a substitute for coping with stressors that may cause your headaches.

Other tension-type headache treatment options include:

  • Home remedies, like placing a hot or cold compress where it hurts, may help you feel better.
  • Counseling can help you identify what’s causing your headaches and learn useful coping methods.
  • Relaxation training includes deep breathing exercises and listening to soothing music. These methods can relax your muscles and relieve pain.
  • Meditation.
  • Biofeedback uses sensors connected to your body to monitor and then counteract your body’s physical functions. It teaches you ways to manage stress by identifying and then reducing muscle tension. Biofeedback may relieve or prevent headaches.

Prevention

How can I prevent tension headaches?

Researchers have yet to uncover how to prevent all headaches. If you experience chronic tension-type headaches or frequent tension-type headaches certain medications may stop some headaches before they start. These are antidepressants such as amitriptyline or venlafaxine or duloxetine. These work on the pain centers in the brain.

Overall, lifestyle changes and reducing your response to stress is the best way to prevent tension headaches. The most effective stress management tool is the one that fits into your life and you feel good using. You may want to try:

  • Massage therapy.
  • Exercising regularly.
  • Staying hydrated.
  • Getting regular, restful sleep.

Outlook / Prognosis

What should I expect if I have tension-type headache?

Tension headaches can be annoying. In severe cases, they can disrupt your personal life or career in big ways. But most cases cause minor symptoms. Medication and other therapies help many people overcome their symptoms with minimal interruptions to their life.

Living With

When should I call the doctor?

Most headaches aren’t dangerous. Rarely, headache pain can be a sign of a serious medical problem. You should seek immediate medical care if you have:

  • Stiff neck.
  • Sudden, severe headache that gets worse quickly.
  • Fever that doesn’t go away.
  • Headache after concussion (head injury).
  • Confused thoughts or slurred speech or weakness.
  • New onset headache over the age of 50.
  • Sudden change in your headache pattern.
  • New onset headache in someone with cancer or autoimmune disease.

A note from Cleveland Clinic

Almost everyone experiences tension headaches. But that doesn’t mean you need to live with the pain. Over-the-counter pain relievers may be enough to relieve minor symptoms. If you have a headache more days than not, reach out to your provider for guidance. Medication and stress management help many people reduce the impact of tension headaches on their life. Massage, meditation, exercise or talking to someone you trust are just some of your options. The best stress-management therapy is the one that works for your lifestyle and feels right to you.

Chronic Tension Headache | Causes and Treatment

What is chronic tension headache and who is affected by it?

Chronic tension headache is a condition where you have a tension headache on at least 15 days every month for at least three months. This can be tiring and depressing. Tension headache (also called tension-type headache) is the common type of headache that most people have at some time.

It’s not known exactly how common chronic tension headache is, as few studies have looked at this clearly. Some studies have estimated that around 1 in 30 of all adults have chronic tension headaches – which means they have a headache on more than half of all days for three months or more. However, it is possible that a proportion of these patients actually have developed medication-overuse headaches (medication-induced headaches) as a result of their tension headaches. Therefore, it can be difficult to be certain which is their main problem.

Chronic means persistent; it does not mean severe. The severity of the headaches can vary from mild to severe. Because of the persistent nature of the headaches, however, this condition is often quite disabling and distressing, and most patients take preventative medication.

What causes chronic tension headache?

This condition tends to develop in people who start off with having tension headaches with increasing frequency, until they occur on most days. However, the cause of the tension headaches is not always clear, and may be more than one thing. They may be due to tension in the muscles at the back of the head and neck, but it is now clear that this is not always the cause. Other causes reported by patients include stress, tiredness, hunger and eye strain. Many chronic tension headaches develop for no apparent reason. Working long hours bent over a computer may trigger them.

Some people get tension headaches if they drink too much caffeine or alcohol, if they don’t drink enough water or if they go for a long time between meals and become tired and hungry. Occasionally, tension headaches can be caused by poor vision, particularly if reading in low light for long periods. Some may be triggered by environmental discomforts such as heat, cold, brightness or wind.

Some research suggests that your genetic make-up may be a factor. This means that some people may inherit a tendency to be more prone to develop tension headaches than others when stressed or anxious.

By definition, tension headaches are not caused by other conditions. So, if you have chronic tension headache, a doctor’s examination will be normal apart from the muscles around the head perhaps being fairly tender when a doctor presses on them. Any tests that may be done will be normal.

Note: medication-overuse headache can be similar to chronic tension headache.

Medication-overuse headache is caused by taking painkillers (or triptan medicines) too often for tension headaches or migraine attacks. See the separate leaflet called Medication-overuse Headache (Medication-induced Headache).

What are the symptoms of each tension headache?

  • Tension headaches are usually felt as a band or across the forehead. They can be uncomfortable and tiring, but they do not usually disturb sleep. Some people feel a squeezing or pressure on their head.
  • It usually occurs on both sides, and often spreads down your neck, or seems to come from your neck. Sometimes it is just on one side.
  • The pain is usually moderate or mild. Tension headaches can interrupt concentration but are usually not bad enough to send you to bed. Most people can work through a tension headache if they really need to.
  • A tension headache can last from 30 minutes to seven days. Most last a few hours.
  • Tension headaches tend to become worse as the day goes on and are often mildest in the morning. They are not usually made worse by physical activity.
  • An exception to this would be a headache caused by sleeping in an awkward position, causing a sore neck, or an ache in the face and jaw due to tooth grinding.
  • There are usually no other symptoms.

Sometimes migraines are mistaken for chronic tension headaches. Some people don’t like bright lights or loud noises, and don’t feel like eating much when they have a tension headache. However, marked dislike of light or loud noise, and visual disturbances, like zigzag lines, are more suggestive of migraine. A mild feeling of sickness (nausea) can occur, especially if you are using a lot of painkillers. However, marked nausea is, again, more a feature of migraine.

The headaches you have with chronic tension headache occur frequently. In some cases, the headache can seem to be permanent, and hardly ever goes, or only eases off but never goes completely.

Many people with chronic tension headache put up with their headaches without seeing a doctor. In one study, two thirds of people diagnosed with chronic tension headache had had daily or near daily headache for an average of seven years before consulting a doctor. Most continued to function at work or school, but their performance was often not as good as it could be. Almost half had anxiety or depression, possibly as a result of coping with their frequent headaches.

If you think you have chronic tension headache, it is best to see a doctor, as treatment can often help.

How can I be sure it is not a more serious type of headache?

With tension headaches, you are normally well between headaches, and have no other ongoing symptoms. A doctor diagnoses tension headaches by their description. In addition, there is nothing abnormal to find if a doctor examines you (apart from some tenderness of muscles around the head when a headache is present). Tests are not needed unless you have unusual symptoms, or something other than chronic tension headache is suspected. Of particular note, medication-overuse headache (medication-induced headache) should be ruled out (described earlier) as this can often be mistaken for chronic tension headache.

Compared to migraine, a tension headache is usually less severe, and is constant rather than throbbing. Also, migraine attacks usually cause a one-sided headache, and many people with a migraine attack feel sick (nausea) or are sick (vomit). Some people have both migraine attacks and tension headaches at different times. In addition, some people find that one of the types of headaches is followed by another, perhaps because the pain and tiredness due to the first headache cause the second.

What are the treatments for chronic tension headache?

Painkillers

You may well be used to taking painkillers such as paracetamol, aspirin, ibuprofen, etc. Importantly though, you should not take painkillers for headache for more than a couple of days at a time. Also, on average, do not take them for more than two days in any week for headaches. If you take them more often, you may develop medication-overuse headache (medication-induced headache). Do not take painkillers to prevent headaches. Take each day as it comes. Perhaps reserve painkillers for days which are particularly bad.

Opiate painkillers such as codeine, dihydrocodeine and morphine are not normally recommended for tension headaches. This includes combination tablets that contain paracetamol and codeine, such as co-codamol. The reason is because opiate painkillers can make you drowsy. They are also the most likely type of painkiller to cause medication-overuse headache if used regularly.

Treating the cause: diary

It may help to keep a diary if you have frequent headaches. Note when, where, and how bad each headache is, and how long each headache lasts. Also note anything that may have caused it. A pattern may emerge and you may find a trigger to avoid. For example, hunger, eye strain, bad posture, stress, anger, etc.

Some doctors suggest reviewing your diet. The list of foods which can be triggers in some people includes caffeinated drinks, chocolate, cheese and alcohol. Other doctors suggest focusing on a healthy balanced diet, with a good mixture of slow-release energy foods (taken in small regularly spaced meals) and a low intake of refined sugars.

Stress and depression

Stress is a trigger for some people who develop tension headaches. Avoid stressful situations whenever possible. Sometimes a stressful job or situation cannot be avoided. Learning to cope with stress and to relax may help. Breathing and relaxation exercises, or coping strategies, may ease anxiety in stressful situations and prevent a possible headache. There are books and apps which can teach you how to relax. Sometimes a referral to a counsellor or psychologist may be advised.

Regular exercise

Many people with frequent headaches say that they have fewer headaches if they exercise regularly. If you do not do much exercise, it may be worth trying some regular activities like brisk walking, jogging, cycling, swimming, etc. (This will have other health benefits too.) It is not clear how exercise may help. It may be that exercise helps to ease stress and tension, which can have a knock-on effect of reducing tension headaches. It also may be that it strengthens your core and upper back muscles and improves posture. This means you are less likely to ‘droop’ when you sit and increase tension in the upper back and neck. It could also be an effect of getting the heart rate, breathing and blood flow increasing around the upper body, improving the supply of oxygen to muscles generally.

Physiotherapy

Physiotherapy may help chronic tension headaches through teaching relaxation techniques and breathing exercises. It may also help through detecting and changing physical habits which may be contributing to the headaches. This might include poor posture. Patients must take an active part in this kind of therapy, and do their exercises regularly, in order to see an improvement.

Acupuncture

There is some evidence that acupuncture, particularly when combined with medical therapy, can be helpful in the treatment of chronic daily headaches.

Cognitive behavioural therapy (CBT)

CBT can be a helpful add-on in the treatment of chronic daily headache. Behavioural therapies work towards reducing or eliminating the stress which may contribute to the development of chronic tension headaches. Some patients dislike the idea of talking therapies, as they feel this suggests that the doctor thinks their headache is actually depression. However, there is good evidence that these therapies do help. This might be because chronic pain is in itself stressful and CBT and other talking therapies help to break the stress-headache-stress cycle.

Preventative medication

Amitriptyline is the medicine most commonly used to treat chronic tension headaches. This medicine is not a painkiller and so does not take away a headache if a headache develops. It is an antidepressant medicine and you have to take it every day with the aim of preventing headaches. (One effect of some antidepressants is to ease pain and prevent headaches even in people who are not depressed. So, although amitriptyline is classed as an antidepressant, it is not used here to treat depression.)

A low dose is started at first and may need to be increased over time. It is slow to take effect – the low starting dose is to allow you to tolerate the medicine more easily. If higher doses are started immediately they can make you tired and sleepy. It can therefore take a couple of months of gradual dose increases before the medicine really works.

Once the headaches have been reduced for 4-6 months, the amitriptyline can be stopped. Treatment can be resumed if headaches return (recur). Other medicines are sometimes tried if amitriptyline is not suitable or does not help. These include topiramate (more often used to prevent migraine), gabapentin (more usually treatment for pain due to inflamed nerves) and tizanidine (more often used as treatment for muscle spasm). Modern selective serotonin reuptake inhibitor (SSRI) antidepressants such as fluoxetine (Prozac®) are not generally felt to be as helpful in treating chronic tension headaches.

The aims of preventative treatment are to reduce the number of headaches, or reduce their severity, or both. So, with treatment, the headaches may not go completely, but they will often develop less often and be less severe. Any headache that does occur whilst taking preventative medication may also be eased better than previously by a painkiller.

It is often difficult in retrospect to say how well a preventative treatment has worked. Therefore, it is best to keep a headache diary for a couple of weeks or so before starting preventative medication. This is to record when and how severe each headache was, and also how well it was eased by a painkiller. Then, keep the diary going as you take the preventative medicine to see how well things improve. The headaches are unlikely to go completely, but the diary may show a marked improvement.

How long do migraines last?

If you have ever experienced the pain of migraine, you’re familiar with the signs of an attack coming on: intense pain, sensitivity to light or sound, and maybe a little nausea is the cherry on top. These warning signs let you know it’s coming, but you wonder, how long can a migraine last? When will you be able to resume your normal life?

What is migraine?

Migraine is a type of headache that brings on moderate to severe pain. Migraine attacks unfold through a cascade of events. Migraines often cause episodic pain, located on one side of the head that feels like throbbing or pulsing pain. 

Although migraine has a genetic cause (90% of people with migraine have a family history of migraine), some triggers can cause migraine attacks. Common triggers include:

  • Stress or anxiety
  • Fluctuation of hormones, menstrual period
  • Bright lights, loud noises, powerful smells
  • Certain medications
  • Too little or too much sleep
  • Sudden weather or environmental changes
  • Excess physical activity
  • Certain foods, such as alcohol, chocolate, aged cheeses, food additives like MSG (monosodium glutamate), fermented or pickled foods, yeast, cured or processed meats
  • Skipped meals
  • Aspartame, nitrites, alcohol, caffeine, or other substances that make your blood vessels contract then dilate

How common is migraine?

Migraine is the third most prevalent illness in the world, according to the Migraine Research Foundation. Almost 1 in 4 households in the U.S. includes someone with migraine. 

Migraine is much more common in women, affecting three times as many adult women as men. Migraine is poorly understood and often undiagnosed and undertreated. The condition has a tremendous economic impact: People who live with migraine may have high medical costs, limited support, or poor access to quality care. In fact, migraines are a common cause of disability and ranked second (after low back pain) with respect to life lived with disability.

Migraine symptoms

Migraine symptoms vary, but you may experience some of the following symptoms:

  • Moderate to severe headache pain, usually unilateral, but not always—which can be  either side of the head or in the front or back
  • Head pain that can feel like throbbing, pounding, or pulsating and worsens with movement
  • Nausea and vomiting
  • Sensitivity to light, noise, smells

A migraine attack can be so severe as to lead to missed work or school days. 

One way to remember migraine symptoms is with the acronym POUND. 

P: Pulsating pain

O: One-day duration of severe untreated attacks

U: Unilateral pain (pain on one side)

N: Nausea/vomiting

D: Disabling intensity

How long do migraines last?

A typical migraine attack can last from four hours to 72 hours—but can vary widely. Migraine attacks occur in phases. It can be helpful to recognize the first stage—when migraine attack is coming on—so you can take medication as recommended by your healthcare provider. 

Not every phase occurs during every attack. Keeping a migraine journal (on paper or with an app) and taking detailed notes of symptoms and times can help you and your physician find patterns and establish an effective treatment plan. 

The phases of migraine are:

Phases of migraine
Prodrome

(occurs in up to 77% of migraineurs)

The beginning of a migraine Irritability; euphoria, sensitivity to light or  sound; fatigue; nausea; difficulty with concentration, reading, or speaking; yawning; food cravings; frequent urination  24 to 48 hours
Aura (potentially) A symptom for 25% to 30% of people with migraine that often involves changes in vision Vision disturbance: seeing sparks, dots, or zig-zags or vision loss

Sensory disturbance:  numbness or tingling

Motor disturbance: jerking

5 minutes to 1 hour
Headache Pain is the main symptom, can lead to absence from work or school Throbbing pain; pain and stiffness in the neck; nausea; vomiting; sensitivity to light and sound 4 hours to 72 hours
Postdrome Known as the “hangover,” the period when pain ends, but the migraine is still occurring Mood changes; fatigue; difficulty concentrating, sudden head movements transiently cause pain in the location of the previous headache 24 to 48 hours

 

RELATED: How to survive a migraine hangover

How can I make a migraine go away?

Prevention is one of the best tools for stopping migraine symptoms. “One of the most effective ways to treat migraine is simply not to have one,” says Alex Feoktistov, MD, the founder and the president of the Synergy Integrative Headache Center in Chicago, Illinois. Identifying and avoiding the things that trigger your migraine onset is key. “Trigger avoidance is a very important treatment strategy that allows us to reduce migraine attack frequency naturally,” Dr. Feoktistov says. 

Migraine can be challenging to diagnose and treat, but there are many helpful medications and strategies. Seek advice from a headache specialist if you experience moderate or severe headaches that are difficult to control. A headache specialist can help to establish a treatment plan that includes preventive and acute treatment for migraine pain. 

Preventive treatment 

Preventive treatment aims to reduce the frequency of migraine attacks and may take several weeks to start working. Preventive treatment can be considered if you have at least three or four episodes per month, and/or experience significant disability from the attacks. 

Preventive treatment options may include one or a combination of the following:

Lifestyle changes to avoid triggers can help decrease the number of attacks as well. 

Acute treatment

While the goal of preventive treatment is to reduce the frequency of attacks, the goal of acute or abortive treatment is to stop an ongoing migraine attack. It should work quickly, within one or two hours, Dr. Feoktistov explains. Abortive treatments work best when given early in the course of a headache and in a single large dose (instead of repeated small doses). 

Medication

Acute treatment for migraine can include one or a combination of the following medicines:

  • Over-the-counter medications (OTC) pain relief such as acetaminophen, ibuprofen, naproxen, or combination medications containing aspirin, acetaminophen, and caffeine 
  • Triptans such as Imitrex, Relpax, or Zomig, which come in a variety of formulations (a non-oral route of administration may be needed for patients with significant nausea or vomiting)
  • Anti-nausea medications may be needed to be given intravenously: metoclopramide or prochlorperazine 
  • Medications such as Fioricet (butalbital, acetaminophen, and caffeine) and opioid pain relievers may be prescribed if all other treatments fail

With any acute treatment, there is a possibility of medication overuse headache or rebound headache. There is also the potential for side effects. For example, triptans come with a risk for serotonin syndrome, especially when combined with other medications that increase serotonin levels. Keep an open line of communication with your healthcare provider to ensure you are getting the proper treatment with minimal side effects and no drug interactions. 

Medical devices

You can also talk with your headache specialist about noninvasive neuromodulation devices. Limited data from small randomized controlled trials suggest the use of electrical current or magnets to prevent or treat migraine: gammaCore, Nerivio, Cefaly, or Relivion. “These devices have demonstrated good efficacy and an excellent side effect profile,” Dr. Feoktistov says. 

Everyone has a different medical history and takes different medications. Talk to your healthcare provider about all of the health conditions you have, all of the medications you take (including prescription, OTC, and vitamins), and your unique treatment needs. 

How long is too long for a migraine?

Every 10 seconds, someone in the U.S. goes to the emergency room for head pain. So when should you go to the ER for migraine? According to the American Migraine Foundation, “the best reason for an ER visit is for unusual symptoms that are new to you.” 

Not sure when you should go to an emergency department? You should go if you have:

  1. A severe headache that comes on within seconds
  2. A new or unusual symptom like fever, numbness, weakness, vision problems, or confusion
  3. A new unusual headache while pregnant
  4. A headache with an immunocompromised immune system
  5. A headache with other serious medical conditions
  6. A migraine attack that lasts longer than 72 hours (this is called status migrainosus)
  7. Taken headache medication and it is not working or your pain is debilitating
  8. Persistent aura with the aura symptoms lasting for one week or more, as this may require neuroimaging
  9. Neurologic changes, such as stiff neck, visual changes, personality change, or disorganized thinking

The American Migraine Foundation reminds patients that there is not one universal protocol for treating headache or migraine in the ER. Different ER doctors may approach treatment in different ways. For the long-run you should follow up with your headache specialist to establish or tweak your treatment plan.

Don’t give up

If one treatment hasn’t worked, there are always other options to try. “There are many effective ways to treat migraine headaches and that may include lifestyle changes, diet, and supplements, pharmacological therapy, noninvasive neuromodulation, as well as interventional treatment including a variety of nerve blocks and other interventions that might be very helpful,” says Dr. Feoktistov. When you find the combination that works for you, migraine should not stop you from living a normal, uncompromised life.

Turtle Headache – StatPearls – NCBI Bookshelf

Continuing Education Activity

Turtle headache is a subtype of the broader category of hypnic headache. This condition is a rare, episodic headache syndrome first described in late 1980. Hypnic headaches can occur as either a primary headache disorder or potentially secondary to a malignant process. This type of headache has also been referred to as “clock-wise” headaches or an “alarm clock” headaches due to its clinical features. It characteristically demonstrates a strictly sleep-associated headache with a repetitive pattern in the sense that it occurs at the same time every night. According to the ICHD-3 criteria, attacks have to occur on at least 10 days a month for greater than 3 months and last for 15 minutes up to 4 hours after waking. This activity outlines the evaluation and management of turtle headaches and highlights the role of the interprofessional health care team in evaluating, managing, and treating patients with this condition.

Objectives:

  • Identify the etiology of turtle headache.

  • Outline the appropriate history, physical, and evaluation of turtle headaches.

  • Explain the treatment and management options available for turtle headaches.

  • Review inter-professional team strategies for improving care coordination and communication to advance turtle headaches and improve outcomes.

Access free multiple choice questions on this topic.

Introduction

Turtle headache is a subtype of the broader category of hypnic headache. This condition is a rare, episodic headache syndrome first described in late 1980. Hypnic headaches can occur as either a primary headache disorder or potentially secondary to a malignant process. It also has the names “clock-wise” headache or an “alarm clock” headache due to its clinical features. It characteristically presents as a strictly sleep-associated headache with a repetitive pattern in the sense that it occurs at the same time every night.[1] According to the ICHD-3 criteria, attacks have to occur on at least 10 days a month for greater than 3 months and last for 15 minutes up to 4 hours after waking. Many patients report some motor activity during headache attacks such as reading or eating. Restlessness or autonomic symptoms, which are characteristic of cluster headaches, are not observed with hypnic headaches.[2] Most patients report moderate pain that can be either bilateral or unilateral. There may be some underlying association between migraines and hypnic headaches, but most individuals had their last migraine attack years before the presentation of the hypnic headache.[3] As mentioned previously, the turtle headache is a small subtype of hypnic headaches. Not much is known regarding this type of headache, but it typically occurs in the morning after awakening and after going back to sleep. It is usually bilateral and occurs when an individual retracts his/her head under the blankets, like a turtle retreating into its shell.

Etiology

The etiology of turtle headache is unknown but is suspected to be due to gray matter volume changes in the posterior hypothalamus, which is the biological clock of the human body. There have been some studies about the volume of the hypothalamus as a diagnostic biomarker of chronic migraine. While not specific to turtle or hypnic headaches, this can play an important role in solidifying the etiology of these headaches. A recent study examined this relationship and found evidence of functional connectivity and structural plasticity within the hypothalamus in concordance with the pathogenesis of migraines.[4] Another study compared hypnic headaches and cluster headaches, which showed decreased and increased gray matter volume, respectively, in the posterior hypothalamus.[5] In terms of turtle headache, There is not much known about the pathophysiology. While changes in the hypothalamus are one of the suspected theories, so is the role of hypoxia. Studies have demonstrated a possible link between hypoxia, migraine, and cluster headache, but the exact mechanism of this is not yet known.[6]

Epidemiology

In terms of hypnic headaches in general, they typically appear after the age of 50 years old, but there have been rare reports in patients as young as 8 years old. There is a slight female predominance in terms of these headaches with a ratio of about 3 to 2. The actual incidence and prevalence of hypnic headaches are not known because it is likely underdiagnosed. The same goes for turtle headaches because there is so little information about them that patients are likely not getting diagnosed with them in the first place.[7] There have been no reported familial cases nor is the frequency of the condition known. The majority of why all of this information is so obscure and unknown is because of the lack of knowledge in terms of diagnosis. Many patients who may suffer from turtle headaches or other forms of hypnic headaches never get the exact diagnosis, and thus, the statistics behind the condition remain a mystery. 

Pathophysiology

As mentioned already, there is not much data regarding hypnic headaches in general, and there is even less available about the pathophysiology of turtle headaches. There are theories that hypoxia is a cause of the headache based on the premise that the headache occurs when individuals pull the blanket over their heads into an environment with less oxygen. There are several reasons why this may play an essential role in determining the exact pathophysiology behind turtle headaches. High-altitude headache has been well studied and reportedly occurs in almost 80% of individuals who ascend to heights above 3000 meters. Hypoxia has been found to cause cerebral vasodilation, which results in increased capillary pressure and edema, leading towards the symptoms of a headache.[8] Cortical spreading depression is known to play a role in the pathogenesis of migraines. There have been studies demonstrating that this phenomenon is inducible by hypoxia.[9] Finally, there are suspicions that metabolic failure in the setting of deficient mitochondrial energy metabolism might have a role in the pathogenesis of headaches. This failure is present in the setting of hypoxia in between migraine attacks and may sensitize migraine patients to hypoxia.[10]

History and Physical

When obtaining a history from these patients, they will typically endorse recurrent episodes of throbbing or sometimes dull head pain that occurs only during sleep and awakens them from sleep. They will state that they frequently occur, sometimes more than ten times per month, and will last upwards of fifteen minutes when they awaken the patient. Some patients will endorse migraine-like symptoms, including nausea and vomiting, as well as photophobia and phonophobia. Others will suffer from autonomic features such as rhinorrhea or lacrimation.[11] The physical exam is generally benign in these patients. It merits noting that any abnormal examination should have a workup and further investigation to rule out brain tumors, which can cause individuals to awaken early due to headaches.[12]

Evaluation

Diagnosis of this headache is almost entirely dependent on history, taking revealing a headache that occurs during sleep and causes awakening, typically in a middle-aged adult. It is important to rule out other primary or secondary headaches causing nocturnal attacks. Regarding turtle headaches specifically, individuals will have a pattern where the headache occurs after awakening and then attempting to go back to sleep by pulling the blanket over his/her head. Furthermore, neuroimaging (either in the form of a CT scan of the brain or MRI of the brain) should be obtained in individuals with a new or nocturnal headache to rule out an intracranial mass as the cause. No lab work can assist in the evaluation of these headaches. 

Treatment / Management

The basis of treatment for hypnic headaches is typically based on anecdotal evidence. There are no clear-cut studies or answers, and a multitude of medications and interventions have been tried, including oxygen inhalation. Usually, the initial management of this condition begins with caffeine and indomethacin. Melatonin and flunarizine have been effective in a few patients. If those are unsuccessful, lithium has been shown to provide benefit, but it comes with lots of side effects both in the short and long term including nausea, tremor, and kidney/liver dysfunction.[13]

Differential Diagnosis

The differential diagnosis for turtle headaches is broad due to the “alarm clock” nature and presentation associated with sleep. Some of the other conditions that can potentially mimic turtle or hypnic headaches include migraine or cluster headaches, episodic paroxysmal hemicrania, medication overuse headache, nocturnal seizure with postictal headache, obstructive sleep apnea presenting with headache, nocturnal hypertension, pheochromocytoma, temporal arteritis, or intracranial mass. Exploding head syndrome is a unique but uncommon condition that can be mistaken for hypnic or turtle headaches. These patients have a sensation of an explosive noise in their head that causes them to wake up, but there is no actual pain associated with it. Attacks of this nature tend to occur during transitions from wakefulness to sleep.[14]

Prognosis

Turtle and hypnic headaches can last for years. Fortunately, a large portion of patients who suffer from this condition does well with treatment. A systematic review identified 70 plus patients with hypnic headaches who had follow-up ranging from six months to five years. This study found that 47% of patients had no remission of headaches. 43% had remission after undergoing treatment. 7% had a relapse after remission, and 3% had spontaneous remission.[15] No studies have specifically looked at turtle headaches.

Complications

There are no significant complications with turtle headaches. A majority of patients, in general, obtain relief after the treatment. The debilitating effects of the headache are limited and are addressable by treating the headache.

Deterrence and Patient Education

  • Avoid pulling the blanket over your head while in bed

  • Healthy sleep hygiene may be beneficial in terms of preventing these headaches

  • Exercise and ensure adequate oxygenation

Enhancing Healthcare Team Outcomes

Headaches are a common presentation in clinical practice and for the most part, are encountered by the nurse practitioner, pharmacist, and primary care provider. However, not only are there many different types of headaches, but in some cases, the cause may be something serious like a bleed in the brain or a tumor. Thus, headache management is best with an interprofessional team.

While the general practitioners may not be aware of all types of headaches, the key is to obtain a specialist referral when the diagnosis is unknown or is atypical. The nurse practitioner or primary care physician should not initiate complex treatments for a headache until there is confirmation that there is no serious underlying pathology.

Turtle headaches can be complicated to diagnose. They are highly underdiagnosed. For individuals who suffer from hypnic headaches, the broader, “alarm clock” style headaches that encompass turtle headaches are also challenging to diagnose. It is crucial for clinicians evaluating headache patients to take a detailed and complete history as that will be where the answer lies. It is also essential to rule out any significant secondary causes of the headaches, especially in the setting of an abnormal neurological exam. The pharmacist should provide patient education regarding the different types of headaches. Simply offering an NSAID is not always the right approach; many of these patients can benefit from a headache specialist consultation. Nursing staff can assist in evaluating treatment compliance and success, as well as reporting adverse medication events to the pharmacist or physician.

Long-term relief is attainable but requires an accurate diagnosis to attempt appropriate treatments.

Patients with headaches need long-term monitoring to ensure that the treatment is working. Headaches may be benign but can seriously affect the quality of life. Hence, a mental health professional should be consulted if there is evidence of anxiety or depression. Only with an interprofessional team approach can there be a reduction in the morbidity of headaches. [Level V]

Outcomes

If properly diagnosed, most headaches have a good outcome, but relapses are not uncommon.

References

1.
Holle D, Naegel S, Obermann M. Pathophysiology of hypnic headache. Cephalalgia. 2014 Sep;34(10):806-12. [PubMed: 24875926]
2.
Suzuki N. [New international classification of headache disorders (ICHD-II)]. Rinsho Shinkeigaku. 2004 Nov;44(11):940-3. [PubMed: 15651338]
3.
Bourgeais-Rambur L, Beynac L, Villanueva L. [Brain network dysfunctions as substrates of primary headaches]. Biol Aujourdhui. 2019;213(1-2):43-49. [PubMed: 31274102]
4.
Chen Z, Chen X, Liu M, Ma L, Yu S. Volume of Hypothalamus as a Diagnostic Biomarker of Chronic Migraine. Front Neurol. 2019;10:606. [PMC free article: PMC6563769] [PubMed: 31244765]
5.
May A, Ashburner J, Büchel C, McGonigle DJ, Friston KJ, Frackowiak RS, Goadsby PJ. Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nat Med. 1999 Jul;5(7):836-8. [PubMed: 10395332]
6.
Britze J, Arngrim N, Schytz HW, Ashina M. Hypoxic mechanisms in primary headaches. Cephalalgia. 2017 Apr;37(4):372-384. [PubMed: 27146279]
7.
Holle D, Naegel S, Obermann M. Hypnic headache. Cephalalgia. 2013 Dec;33(16):1349-57. [PubMed: 23832130]
8.
Carod-Artal FJ. High-altitude headache and acute mountain sickness. Neurologia. 2014 Nov-Dec;29(9):533-40. [PubMed: 22703629]
9.
Somjen GG, Aitken PG, Czéh GL, Herreras O, Jing J, Young JN. Mechanism of spreading depression: a review of recent findings and a hypothesis. Can J Physiol Pharmacol. 1992;70 Suppl:S248-54. [PubMed: 1295674]
10.
Paemeleire K, Schoenen J. (31) P-MRS in migraine: fallen through the cracks. Headache. 2013 Apr;53(4):676-8. [PubMed: 23557159]
11.
Lanteri-Minet M. Hypnic headache. Headache. 2014 Oct;54(9):1556-9. [PubMed: 25231430]
12.
Maheshwari PK, Pandey A. Unusual headaches. Ann Neurosci. 2012 Oct;19(4):172-6. [PMC free article: PMC4117064] [PubMed: 25205995]
13.
Schuster NM, Rapoport AM. New strategies for the treatment and prevention of primary headache disorders. Nat Rev Neurol. 2016 Oct 27;12(11):635-650. [PubMed: 27786243]
14.
Sharpless BA. Exploding head syndrome. Sleep Med Rev. 2014 Dec;18(6):489-93. [PubMed: 24703829]
15.
Liang JF, Wang SJ. Hypnic headache: a review of clinical features, therapeutic options and outcomes. Cephalalgia. 2014 Sep;34(10):795-805. [PubMed: 24942086]

How Long Can Headaches from Alcohol Withdrawal Last?

Alcohol withdrawal symptoms are some of the strongest and most dangerous withdrawal symptoms of any drug. They usually start out mild and depending on the amount and usage of alcohol consumption, can become life-threatening.

How Long Before Alcohol Withdrawal Symptoms Start?

Alcohol withdrawal comes on quickly (within hours of your last drink), has an intense peak of symptoms (peaking at about 72 hours from the last drink in many cases), and the symptoms can continue on for weeks, months or years – due to a high rate of Post-Acute Withdrawal Syndrome (PAWS).

Because PAWS symptoms from alcohol can start off so intense, and take so long to lessen or go away, many recovering alcoholics find themselves asking,

“When will I feel normal again after quitting alcohol?”

Alcohol Withdrawal Headaches

After quitting alcohol, the symptoms of withdrawal will show up quickly, and the first symptoms to show are usually anxiety and headaches. There will also be cravings, nausea and vomiting, depending on the severity of the alcohol abuse.

How Long do Alcohol Withdrawal Symptoms Last?

These headaches and other symptoms will usually increase by day 3 of alcohol withdrawal when the individual is hitting the peak of acute withdrawal and starting day 4 will usually begin to subside in intensity and continue to slowly subside over the course of the first few weeks of sobriety. Alcohol withdrawal usually lasts about 7-14 days, however, for those that experience protracted withdrawal, prolonged withdrawal, and PAWS, the anxiety and headaches could take months or even a year to fully subside.

Prolonged Alcohol Withdrawal

Prolonged Alcohol Withdrawal has an alcohol withdrawal timeline that is longer than the average withdrawal of about 72 hours to a week.

Prolonged alcohol withdrawal is fairly rare but more common in those that have been drinking steadily for long periods of time. For example, if a patient has been consuming an average of 12 drinks per day for 10+ years, the baseline for blood alcohol levels has remained fairly steady for a very long time. In cases like this, it is less surprising to see prolonged withdrawal; and in cases of prolonged alcohol withdrawal, it is also common to see the symptoms take longer to go away – including anxiety and headache.

Prolonged alcohol withdrawal is prolonged acute withdrawal, so it is important to note that the “danger zone” of the first 48-72 hours will be extended, and in cases of prolonged alcohol withdrawal, it is imperative to stay under medical detox care.

Alcohol Post-Acute Withdrawal Syndrome (PAWS)

Some recovering alcoholics will also experience PAWS after the acute withdrawal phase. The symptoms of PAWS can be almost as intense as the acute withdrawal symptoms, but are not considered life-threatening. Because PAWS symptoms can feel almost the same as acute withdrawal, many recovering alcoholics get worried that the symptoms will never go away. We can assure you that in most cases they will indeed lessen in severity and will eventually go away, but it does take time.

Related Reading:

How Long Do Alcohol Withdrawal Headaches Last?

To answer this, first, you must establish what point of withdrawal you are in. Are you in the acute withdrawal phase, or are you experiencing headaches as a result of Post-Acute Withdrawal? If you are out of the acute withdrawal phase and still having headaches, it could be recurrent symptoms of PAWS causing the headaches.

PAWS symptoms tend to wax and wane in intensity. For example, an individual who has been sober from alcohol for a month may see the intensity of the PAWS symptoms peak every 3 days or so.

If the headache is the main symptom of your PAWS, the headaches will get worse for 3 days, get better for 3 days, and so on – with the space between the changes going for every 4 days, to every 5 days, etc. These timelines are not set in stone, but you get the idea of how the ebb and flow “gets better” the more time you stay sober. The same can be said for other PAWS symptoms, like anxiety.

Headache Cycles During Alcohol Recovery

Another quirk with PAWS that keeps you on your toes, is how the symptoms can come back in recurrent cycles. Everything about recovering from alcohol abuse comes down to cycles – because that is how your body works, in cycles. Therefore, it is not uncommon to see alcohol withdrawal headaches, anxiety and other symptoms come back in weekly or monthly cycles of intensity.

These cycles make many in recovery concerned, especially when they have just seen the alcohol withdrawal headaches get better finally, only to return with a new cycle of symptoms. The worst thing you can do is worry and increase your anxiety by thinking that there is something severely wrong with you. Cycles of headaches and symptoms is normal for anywhere up to a year or more – depending on how long you were previously abusing alcohol.

Are Continued Alcohol Headaches a Sign of Another Underlying Medical Condition?

Part of a clinical treatment for alcohol detox and initial alcoholism recovery is checking your health for any underlying conditions. In the best detox and drug rehabs in Northern California, professionals will check to make sure they know all conditions that are affecting you, in addition to the alcohol abuse, and they will treat or recommend treatment for any medical conditions they find, or suspect.

If your alcohol detox program did not find any underlying conditions that could be a source of headaches during your initial alcohol detox treatment, it is unlikely that you developed a new health concern, and it is more likely you are experiencing PAWS headaches.

If you didn’t seek medical alcohol detox during the acute withdrawal period, you should consult a physician to check for any underlying conditions.

Ok, So When will my Alcohol-Related Headaches Go Away?

If you don’t have any underlying medical conditions causing the headaches, and they can be blamed solely on post-acute withdrawal syndrome, the headaches should be gone within 6 months, possibly a year or more – in the cases of severe alcoholism. There really is no set answer, it depends on many factors including how well your body is recovering, and if you have been able to completely abstain from alcohol.

One more thing to consider is that the headaches could be natural, or be caused by stress, lack of sleep, or any other stressors to the body. The first year of recovery can be challenging, and changes to diet and activity in your sober life may be causing some “growing pains” for you.

In the end, it is important to check with your doctor to see what is causing the headaches and get his or her opinion on the symptoms. However, if the doctor finds no specific cause for the headaches, and says it is likely tied to your quitting alcohol recently, don’t freak out and think that they will never go away. PAWS symptoms of headaches, anxiety, nausea and even the mental symptoms of depression, shame, or worry do lessen over time.

When to Worry About a Headache: 4 Key Signs

Posted On: September 21, 2020

When to Worry About a Headache

Are you currently suffering from headaches? You may treat headaches as a common occurrence and just grab painkillers over the counter. And you’re not alone since up to 1 in 20 adults have a headache every day. However common they may be, there are key signs indicating when you should be worried about your headache.

1. Throbbing Head

Serious headache symptoms can include a throbbing head which can actually mean a migraine instead of just a regular headache. Pay attention if you notice a pounding feeling and sensitivity to light.

Be mindful of any sharp stabbing pain around your eye. If you experience migraines, speak to your doctor.

2. Recurring Headaches

Chronic headaches, when a headache continually comes back for months, can be a cause for concern. Not only can they disrupt your daily life, but they can be unmanageable without medical help.

If you notice you’re having 2 or more headaches a week contact a neurological specialist. There could be underlying problems that can cause these headaches.

They can be serious problems with the brain or just a tension headache. You’ll also be able to figure out any headache triggers and make changes to reduce your headaches.

3. Headache That Wakes You Up

Headache signs and symptoms of concern can be when a headache hurts so bad it wakes you up at night. Or if you notice that it’s only the worst at night.

These symptoms can be a sign of a tumor or mass. You’ll need an MRI or CT scan of your blood vessels or brain to make sure all is ok.

4. Intense Pain

If you experience a headache that you’d say is so intense you can’t handle the pain, seek medical help immediately. When you experience an intense headache that comes on suddenly, you could have a life-threatening condition.

You could be experiencing bleeding in your brain or an aneurysm. Aneurysms can lead to deaths or comas. If you experience loss of consciousness, seizures, or blurred vision along with your intense headache, don’t delay.

When Should You Worry About Headaches?

Some headaches can go away with self-care such as taking a pain-reliever or prescribed medicine from your doctor.

Potential headache warning signs can include:

  • A headache from a blow to your head
  • Decreased memory or alertness
  • Fever
  • Stiff neck
  • Confusion
  • Slurred speech

For some headaches, you’ll want to seek immediate medical attention and not delay.

Tension Headache vs. Migraines

Migraines and tension headaches are considered the main form of headaches. These headaches are the primary problem and aren’t caused by other problems such as dehydration.

Migraines normally stay on one side of the head, usually near the temple or in the front. They can, unfortunately, last for days. The pain is caused by brain blood vessels, so migraines can cause a pounding feeling.

Sensitivity to light is common with migraines, along with certain triggers from smells and food.

Tension headaches can feel like a tightness or pressure. You don’t have to worry about a smell intolerance with tension headaches. The feeling is often found on both sides of the head.

They can be caused by musculoskeletal pain spreading into the head from the jaw and neck.

Cluster Headaches

These types of headaches come in clusters since they occur at different times. The headache happens fast but normally doesn’t last longer than an hour. They can last up to 3 hours.

The pain is often intense and normally on one side of the head. Your eye on the side that hurts can become watery and red, along with a runny nose and your eyelid can be drooping.

You can also experience nausea and sensitivity to light. Over-the-counter drugs normally don’t offer much help in regards to cluster headaches. Certain medications can help decrease how long an attack lasts.

Speak to your neurological specialist about taking oxygen therapy for pain relief.

Other Types of Headaches

Sometimes migraines are misdiagnosed as sinus headaches. If you experience seasonal allergies you’re more likely to develop sinus headaches.

Treatment options include thinning out the mucus that causes sinus pressure. You can use decongestants, nasal steroid sprays, and antihistamines.

If you’re experiencing a sinus headache, it could be a sinus infection. Your doctor might prescribe you an antibiotic for your sinus infection.

Women can experience what’s known as hormone headaches. These are caused by varying estrogen levels. Your estrogen levels can change if you’re pregnant, menstruating, or taking birth control pills.

How Are Serious Headaches Treated?

If you have headache symptoms to worry about, your doctor may order different tests and have you see a neurologist. A neurologist is a nervous system and brain specialist.

Some common tests are:

  • EEG
  • MRI
  • CT scan
  • Blood test
  • Ear exam
  • Medical history
  • Physical exam
  • Spinal fluid test

If you’re suffering from heatstroke or dehydration, your doctor might need to give you treatment through an IV.

Prevention

If you experience migraines, your doctor might prescribe pain medications or medications that help prevent them from occurring.

If you have high blood pressure, make sure you do everything the doctor tells you to and take your medications. Headaches can be caused by high blood pressure.

When to Worry About a Headache?

After reading this guide you should have a better understanding of when to worry about a headache, and obtaining the treatment you need.

Are you tired of your headaches affecting daily life? You shouldn’t have to suffer anymore. Contact us today so you can finally get the care you need and deserve.

Know Your Headache | pfpfizeruscom

This article originally published on Get Healthy Stay Healthy.

For some people, a headache is a minor or occasional nuisance prompting the use of headache medicine to stop the pain and get back to life as usual. For others, however, headaches can be painful and disabling. In fact, every 10 seconds, someone goes to an emergency room in the US with a migraine headache. But, did you know, not all headaches are created equal. There are several different headaches, some of which include migraine, tension, sinus, cluster, and medication overuse headaches. Do you know the difference?

Migraines

More than just a simple headache, migraine is a collection of neurological symptoms that can be debilitating. The hallmark of a migraine is moderate-to-severe throbbing or pulsing pain on one side of the head, with one-third of attacks affecting the entire head. One or more of the following symptoms may also accompany migraine episodes: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. Migraines can last from 4 to 72 hours. Some people experience them with aura—a strange light, unpleasant smell, or confusing thought—which can act as a warning sign that a migraine headache is coming.

Migraines are three times more common in women than men, and usually occur in people with a family history of it. There are medications to help people with migraines, and certain lifestyle changes may help.

Tension Headaches

Tension headaches, also called “stress” headaches, are the most common type of headache. The pain in a tension headache may range from mild to severe, and occurs on both sides of the head as a band of pain around the head, or as a tight feeling in the jaw or neck. Some people describe the pain as a feeling similar to having their head in a vice or an intense pressure. The pain may start slowly and gradually become more severe. Tension headaches are thought to be caused by tight muscles in your shoulders, neck, scalp and jaw, and are often triggered by stress, depression, or anxiety.

Though some may have tension headaches on occasion, some people suffer from chronic tension headaches, meaning they occur 15 or more days per month for at least 3 months. It may be hard to tell the difference between tension and migraine headaches. But it can help to know that people with tension headaches do not usually experience nausea, vomiting, or sensitivity to light, sound or smell, the way some people do with migraines.

Sinus Headaches

Sinus headaches are actually rare. They cause a dull, throbbing pain across the face and front of the head where the sinuses are located. Associated symptoms typically include nasal congestion, runny nose, and facial and forehead pressure. The pain worsens with head movements and when bending or lying down—and they are usually worse in the morning. 

Some people who experience these symptoms and think they have a “sinus headache” might actually have migraines or tension headaches. In fact, many people who were diagnosed with migraine initially may have thought that they had a “sinus” headache. True sinus headaches (called rhinosinusitis) almost always occur when a person has a bacterial or viral sinus infection and may experience symptoms such as thick nasal discharge, the inability to smell, and facial pain or pressure with a fever. The headache subsides when the sinus infection resolves or is properly treated in the case of bacterial infections.

Cluster Headaches

As the name suggests, cluster headaches recur over a period of time—meaning headaches occur in a group or “cluster” of attacks. They cause short, severe burning pain on one side of the head and may include eye-redness and a stuffy nose on the same side of the head as the pain. Cluster headaches can cause recurrent and throbbing pain on one side of the head. However, unlike migraines, cluster headaches characteristically arrive in a cyclical pattern, such as at the same time every day or every season. They can come on suddenly, without warning as a severe pain, can last for a week, a month, or a year, (hence the name “cluster”) and then go away for a certain period of time. People with cluster headaches may become restless due to the excruciating pain, and usually are seen pacing or sitting up through the attack, because lying down tends to increase the pain.

Cluster headaches are more common in men more than in women, in smokers, and in those with a family history of these headaches. Alcohol is a known trigger of intense headaches during a “cluster period.”

Medication Overuse Headaches

A medication overuse headache (also known as rebound headache) is a major cause of chronic daily headaches due to the overuse of certain headache medicines, including over-the-counter pain medications, or certain prescription medicines. Depending on the type of medicine taken, overuse is defined as taking headache medication frequently for at least 10 days per month for 3 months or longer. The headache may either develop or worsen despite the use of medication. People who suffer from medication overuse headaches often develop chronic daily headaches which can cause them to take more medication to help treat their headache, and consequently get stuck in a vicious ‘medication-headache’ cycle. Unfortunately for headache sufferers, the overuse of headache pain medication actually causes more frequent headaches.

Medication overuse headaches generally cease or go back to their original pattern within 2 months after the medication is stopped. Some people require inpatient detoxification, or an outpatient gradual withdrawal from pain-relieving medicines supervised by a doctor. Withdrawal symptoms during detoxification, may include severe headache, nausea, vomiting, sleep problems, agitation.

What You Can Do

If you experience headaches that are not well controlled by your current treatment regimen, or have any recurrent head pain, be sure to speak to your healthcare provider to find a treatment that is right for you.

Margaret L. Frazer, MD is Senior Director within the Cardiovascular and Metabolic team at Pfizer.

Visit Get Healthy Stay Healthy for more information on Your Health.

References:

1. World Health Organization. Headache disorders. Accessed June 1, 2016.

2. Migraine Research Foundation. Raising money for migraine research. Accessed May 12, 2016.

3. MedlinePlus. Headache. National Institutes of Health Web site. Accessed May 12, 2016.

4. National Institute of Neurological Disorders and Stroke. NINDS migraine information page. Accessed May 12, 2016.

5. FamilyDoctor.org. Headaches. American Academy of Family Physicians Web site. Accessed May 12, 2016.

6. Mayo Clinic Staff. Tension headache. Accessed May 12, 2016.

7. Milton S. Hershey Medical Center. Sinus headache. Accessed May 12, 2016.

8. Hutchinson S. “Sinus headache” or migraine. American Headache Society Web site. Accessed May 12, 2016.

9. National Headache Foundation. Cluster headache. Accessed May 12, 2016.

10. Mayo Clinic Staff. Cluster headache. Accessed May 12, 2016.

11. The Johns Hopkins University. Rebound headaches. Accessed May 12, 2016.

12. American Headache Society. Medication overuse headache – when the remedy backfires. Accessed May 12, 2016.

13. Holland K. Can the overuse of medication cause chronic migraines? Healthline Web site. Accessed May 12, 2016.

14. Silberstein SD. Medication overuse headache. American Headache Society Web site. Accessed May 12, 2016.

Tension headache

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Among the most common disorders of the nervous system in medical practice, headaches come first. According to research by the World Health Organization, more than half of the world’s adult population experiences headaches at least once a year. Headache can be an independent disease, such as tension headache or migraine, be a symptom of diseases of various organs and systems, or be the result of excessive drug intake or side effects.

Tension headache is perhaps the most common type of primary headache. At least 70% of people from different population groups complain of episodic manifestations of this pain. If we talk about the chronic course of the disease, then 1-3% of adults are susceptible to this. Tension headache usually first occurs in adolescent patients. It has been established that women are more likely to suffer from this ailment.

Reasons

Stress, anxiety, depressive states are only a small part of the reasons why tension headache is so widespread.It is important to know that depression is not always overt. There is also a hidden type of depression. Obvious signs of a depressive state may hide behind a mask of complaints about a different range of problems. For example, a person may experience constant fatigue, be irritable, his appetite and sleep patterns may be disturbed, but he may not even suspect that depression is in an atypical form.

In addition to psycho-emotional factors leading to tension headaches, there are several other reasons. Long stay in non-physiological positions (working at a computer, driving a car, working with small parts, etc.)leads to prolonged tension of various muscle groups, which put pressure on the vessels inside them, which provokes headaches. It also leads to increased pain syndrome for a long time in the same position during sleep. This usually happens when a person is heavily intoxicated or under the influence of sleeping pills.

Symptoms

Typically, a patient with this diagnosis describes tension headache as “a ring that squeezes the circumference of the head.”Pain is usually most felt in the occipital, temporal, and frontal regions, but it can also occur in the neck. The intensity of the pain ranges from moderate to intense. Such pain can last for different times: from half an hour to several days. The most obvious tension headache can manifest itself in the evening hours, at such moments a person may feel nauseous and refuse to eat. It is important to note that vomiting is not characteristic of this disease.

The chronic course of the disease, in contrast to episodic pain, is characterized by continuous pain syndrome, which significantly worsens a person’s standard of living and does not provide an opportunity to work and rest fully.

Prevention and Treatment

To avoid exacerbations of tension headaches, it is necessary to develop stress resistance, observe the regimen, get enough sleep, create comfortable working conditions, engage in physiotherapy exercises that can help strengthen the muscular corset of the cervical spine.

If the headache is episodic and practically does not “interfere” with the daily routine and the course of affairs, then there is an opportunity to do without long-term treatment, for example, take a single pain reliever.In the event that episodic pain interferes with normal life, it is necessary to consult with a neurologist, who is likely to prescribe more serious medication.

Chronic tension headaches are more difficult to treat. Therapy implies an integrated approach: drug treatment, massage, and consultation with a psychotherapist, and other techniques may be required. It is important that there is a complete understanding between the doctor and the patient, since the success of the treatment will depend on the efforts of both parties.In the course of therapy, the doctor can try various approaches, prescribe additional courses, and change tactics. The patient will have to try to learn how to live in a new regime, change the lifestyle and working conditions, as well as be ready for physical activity.

Headache – City Clinical Hospital 7 Kazan

The main types of headaches in our time, it is probably impossible to meet a person who could boast that he has never experienced a headache – millions of people around the world suffer daily from headaches, the intensity of which can range from a mild attack to intolerable pain.A headache can occur even in absolutely healthy people, due to changes in the weather, mental or physical fatigue, as well as after the intense celebration of our native Russian holidays. Most often, this headache goes away on its own, after a few hours of rest or after taking any pain medication. In addition, headache is a symptom of many diseases, and if you ignore prolonged headaches, you run the risk of “triggering” a serious illness.

Migraine (from the Greek “hemicrania” – “pain in half of the head”)

Pain with migraine occurs strictly periodically, with minor variations in time – attacks occur weekly, once every 12-14 days or once a month, and the frequency of pain is typical for each patient. Stressful situations, malnutrition, digestive disorders, overwork, and severe concomitant illnesses can worsen the condition, causing more frequent attacks.

The attack is usually preceded by general malaise, drowsiness, increased irritability, after which the actual migraine attack develops. In some cases, an attack may begin with an “aura” – various sensory disturbances – for example, the flashing of flies before the eyes, numbness in the limbs, or a feeling of heat. The attack itself lasts up to 72 hours, often accompanied by nausea, vomiting, intolerance to bright light and loud sounds. A characteristic feature of migraine is the pulsating nature and localization of pain in one half of the head (bilateral localization of pain, as well as its permanent nature, is much less common).It is very difficult to stop the onset of an attack even with the help of medications, conventional analgesics (analgin, aspirin, etc.) do not cause relief, the intensity of pain decreases after a good rest and a deep night’s sleep.

Tension headache

The onset of the disease often coincides with puberty, and women are more likely to suffer. The tendency towards migraines is usually inherited.

Uncomfortable posture, improper posture, frequent stressful situations, depression, pathology of the cervical spine – not all factors that cause muscle-tonic tension and, as a result, headache.

With muscle tension, pain appears gradually, with emotional tension, it can occur abruptly, the duration of the pain syndrome is from half an hour to several days. In this case, the pain is bilateral, more often localized in the frontal-occipital region, both frontal lobes, or spilled, has a blunt compressive character (“.. squeezes like a hoop”), against the background of a constant feeling of compression, there are prolonged episodes of dull, non-intense pain. The pain is accompanied by unpleasant sensations when combing hair, wearing a headdress.

As a rule, the pain is not very intense and its periodicity in time is not expressed, while the pain does not stop even at night, causing sleep disturbance, difficulty concentrating.

Pain with subarachnoid hemorrhage

Pain begins acutely, like a “blow” to the head, in a previously healthy person against the background of increased blood pressure, increased physical activity. It begins most often in the occipital region, then spreads throughout the head, may be accompanied by loss of consciousness, nausea, and vomiting.

The severity of the development of pain, especially against the background of high blood pressure, determines the likelihood that the headache is due to subarachnoid hemorrhage, and emergency medical attention is needed.

Headache with increased intracranial pressure. Headache in diseases of the cervical spine.

Sharp awkward movements in the neck, overwork, osteochondrosis cause headaches more often than people think. The pain is usually one-sided, often confused with migraine.It is localized most often in the upper cervical, occipital region, spreads to the temples, eyes. It is often accompanied by nausea, dizziness, unsteadiness when walking, which must be differentiated from acute disorders of cerebral circulation (strokes).

Increased intracranial pressure can be of two types:

  • Benign intracranial hypertension – no signs of brain damage. A fairly rare disease that is more common in overweight young girls.Characterized by headache, visual disturbances, nausea, edema of the optic discs. In most cases, the cause remains unknown, although sometimes the headache can be triggered by taking antibiotics, oral contraceptives, and retinol (vitamin A). Long-term intracranial hypertension can lead to blindness.
  • against the background of an intracranial hematoma or tumor. Headache with brain tumors is often permanent, but its intensity may decrease or increase with a certain position of the head or body, often worse in the morning, accompanied by vomiting, drowsiness.Headache usually occurs in advanced brain tumors.

Cluster headache

“Male” type of headache (in men it occurs 6 times more often than in women) – unilateral paroxysmal headache (in most cases without changing sides), lasting an average of about half an hour, occurring from 1 to 8 times a day, more often in nighttime. It is characterized by the presence of periods of exacerbation, during which attacks occur daily with possible rare one-day passes.The periods of exacerbation last from 7 days to 1 year and are separated by periods of complete remission, lasting from 2 weeks to several years.
A distinctive feature is the strongest, “burning”, sharp, throbbing, excruciating pain during an attack, localized in the orbital-frontal-temporal region. Alcohol intake intensifies the manifestations. As with migraine, a hereditary predisposition is characteristic.

Absolute headache

Paradoxical headache – appears when analgesics are withdrawn after long-term regular use.The pain occurs in the morning and continues throughout the day. The pain is dull, bilateral, usually of moderate intensity.

Neuralgic headache

Pain appears suddenly, reaches a maximum very quickly, lasts from a few seconds to several tens of seconds and quickly stops. Localized in one area of ​​the face or head. The pain is very intense, one of the most intense you can imagine. After one attack, there is an interval that lasts several minutes or days, during which there is no pain.Then painful sensations arise again in the form described above. This type of pain is especially common in trigeminal neuralgia.

Studies show that about 73% of men and 81% of women suffer from recurrent headaches, while hardly half of them seek medical help. Children are especially hard to endure headaches – it affects their mood, behavior, performance, studies and further professional guidance.

A headache, like any other, is just a symptom.If you or your child are worried about prolonged and repeated headaches, do not neglect a visit to a neurologist, as well as a medical examination, as chronic headaches can be harbingers of any serious disorders in the body. Do not neglect specialists, an experienced doctor will always help clarify the causes of headaches, establish a diagnosis and provide adequate treatment.

Diagnostics of headaches in Podolsk

What kind of pain in the head is there?

The type of headache, its duration and characteristics, first of all, depend on the cause of its occurrence.Vascular pains are usually prolonged, throbbing, but migraine pain is constant and very excruciating. Pain in the head is characterized not only by the type and duration, but also by its location: in the back of the head, all over the head, in the forehead, etc. Its localization helps to determine the cause and correctly prescribe treatment.

Tension headache

The trigger mechanism for tension headaches is usually severe stress, fatigue, or emotional overload. Such pain can be caused by constant lack of sleep, overwork, and fatigue.Constant tension headache is rarely accompanied by any additional symptoms, usually concentrated in the forehead or temples.

Characteristic of tension headache:

  • pressure sensation;
  • tension of the muscles of the neck, shoulders;
  • “flies” before the eyes;
  • jerky movements do not increase pain.

Migraine

This is a disease, often of a hereditary nature, which is accompanied by a headache of moderate or increased severity.The characteristic features of such pain: monotony, photophobia, the addition of severe nausea or vomiting. The attack can last from several hours to several days. At the same time, a person almost completely loses the ability to work.

Cluster head pain

This is a pathology that manifests itself in severe attacks of periodic headache, which exhausts a person. Attacks can last for several weeks or even months, followed by “quiet”, calm periods.The disease affects middle-aged people, more often men.

Features:

  • Each attack of pain begins with lightning speed, without previous symptoms and reaches its maximum strength after a few minutes.
  • Headache deep, excruciating, prolonged, sometimes throbbing in the temples or occiput.
  • Attacks sometimes appear 8 times a day, lasting from 15 minutes to 2-3 hours.
  • Pain occurs in the eyes, temples and gradually spreads over the surface of the head.
  • The pain is always one-sided.

In addition, frequent cluster headaches are often accompanied by lacrimation, runny nose, and sweating. Seizures can occur for the first time at any age; it is believed that the disease is genetically transmitted.

Chronic daily headache

This diagnosis is made when the headache occurs at least 15 times a month. In this syndrome, the pain is moderate, often of a different nature: sometimes more or less intense, it can be localized or spread over the entire surface of the head.There are no additional signs; among the reasons, experts identify abnormal anatomy of blood vessels or nerves, chronic fatigue, taking certain medications or hormonal changes. People between the ages of 30 and 50, more often women, suffer from daily headaches.

Signs of a dangerous headache

As a rule, headache attacks do not threaten a person’s life and do not cause great damage to health. But in some cases, you need to immediately seek medical help:

The headache came on suddenly, it gets worse every minute.

  • The attack is accompanied by impaired consciousness, the person becomes inadequate, cannot speak or move normally.
  • Convulsions present.
  • Headache appeared after physical or emotional stress, develops quickly, is accompanied by impaired consciousness and speech.

Which doctor should you go to with a headache?

For persistent attacks, you should consult a general practitioner or neurologist. Sometimes it is necessary to consult an endocrinologist or cardiologist.At the Dorsummed clinic in Podolsk, highly qualified specialists will determine why the head hurts and will prescribe the right treatment.

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First aid at home for pain in the head

The easiest and most affordable way to relieve pain is to take an anesthetic medication, but you cannot abuse medications without a doctor’s prescription. Contact the Dorsummed clinic and the doctors will help you find the best medicine for headaches.

In case of an attack, peace and quiet effectively help, a light head and neck massage, which can be performed with essential oils of cedar or mint. A cool forehead compress or a warm scalp compress can also help relieve headaches. Compress for pain in the temporal areas can be carried out using a damp cool cloth. A warm shower or bath works well for headaches.

Eye pains and headaches

Is eye pain always associated with eye disease?

No, other conditions can cause pain in or around the eyes.

When can the causes of eye pain be hidden in other areas of the body?

The eye is an organ richly equipped with nerves, the sensitivity of which is provided by the trigeminal nerve, which provides sensitivity in the scalp, upper eyelid, lacrimal gland, cornea and mucous membrane of the eye, in the root of the nose, frontal sinuses, as well as in part of the lining of the brain – in its outer layer and in blood vessels. One of the manifestations of the disease of this nerve can also be pain in the eyes, although the eye, as an organ, is healthy.

Trigeminal (V) nerve and its branches

One of the nuclei of the trigeminal nerve is located in the cervical region, where its sensory fibers interact with the cerebral XI or accessory nerve, as well as with nerve pathways in the upper part of the neck, thus bringing the pain that appeared in the neck region to the head, including and up to the eyes.

Nucleus of the trigeminal V-shaped nerve in the cervical region

Eye pain can also be caused by optic neuritis and occipital neuralgia or nerve disease that occurs in the region of the first and second cervical vertebrae.

Optic nerve anatomy

What diseases cause eye pain and headache?

Migraine or a disease characterized by severe headache. The manifestations of the disease can also be increased sensitivity to light and sound, nausea and vomiting, dizziness, pain in the eyes or behind the eyes, blurred vision, changes in the field of vision (floating blurred points, flashes of light), etc.

Migraine is divided into two types – migraine with or without aura.In the case of migraine with aura, symptoms are felt before the migraine attack, which indicates the approach of the attack. A migraine attack can last from several hours to several days and usually occurs in several stages. Despite this, each patient has an individual attack.

There is also an ocular migraine, when, in the event of an attack, the main complaints are associated with changes in vision, blurring.

Migraine and cluster headaches

Cluster (beam) headache – one of the most severe headaches.It usually begins suddenly, without warning symptoms, and continues as episodic pains that recur periodically. Attacks usually last 6 to 12 weeks and can be seasonal. During an attack, pain usually occurs daily, and sometimes several times a day. The duration of one attack of pain can last from 15 to 180 minutes, moreover, pain every time occurs at the same time of day, most often at night, 2-3 hours after falling asleep. The pain is usually excruciating, in most cases localized around the eyes, but can also radiate to the face, head, and even to the neck and shoulders.The pain is one-sided, it can also be accompanied by redness of the eye, watery eyes, swelling, and sometimes even drooping of the upper eyelid.

Occipital neuralgia (occipital neuralgia) is a common type of headache. These headaches are caused by damage to the greater or lesser occipital nerves that begin in the neck, near the second and third occipital vertebrae. Pain can be caused by tumors, trauma, infections, hemorrhages, or systemic diseases such as osteoarthritis, degenerative changes in the cervical spine, diabetes, and gout.Occipital neuralgia can also be triggered by prolonged head bent position. As a rule, pain begins in the neck, then spreads upward and is reflected in the eye orbits, occiput, forehead and temples. The pain is sharp, pulsating, like an electric shock.

Trochleitis – inflammation of the oblique muscle of the eye, which causes pain above the eyeball or in the inner corner. Trochleitis can be caused by autoimmune inflammatory diseases of the connective tissue, such as Behcet’s disease, granulomatosis with polyangiitis, lymphoma, Tolosa-Hunt syndrome, and rheumatic diseases – rheumatoid arthritis, systemic lupus erythematosus or sinus inflammation, tumors.In the case of trochleitis, the pain is long lasting, in intensity it can vary from dull to severe. Various studies also suggest that trochleitis can exacerbate migraine attacks in patients who already have migraines.

Trochlear nerve anatomy

LASH is a very rare type of headache that is expressed in two ways. In the first case, the manifestations of the disease are episodic, and they are characterized by short-term and frequent attacks of headache, accompanied by symptoms such as conjunctivitis, lacrimation, drooping of the upper eyelid, nasal discharge.One attack lasts 2 to 45 minutes. In the second case, LASH manifests itself as a mild to moderate, prolonged, one-sided headache, during which migraine-like attacks appear with even more severe pain syndrome. In both cases, the localization of pain can also be behind the eyeball.

Trigeminal neuralgia is a chronic condition that affects the trigeminal nerve, in which case even the slightest irritation to the face can cause an attack of acute pain.Pain can be caused by smiling, talking, touching your face, drinking cold or hot drinks, shaving your beard, brushing your teeth, etc. Seizures may initially be short and mild, gradually progressing in both duration and intensity. The pain of a cutting nature and is similar to an electrical discharge, the cause of their occurrence is completely unknown.

Optic neuritis is a demyelinating inflammation of the optic nerve, in which the optic nerve loses myelin fiber, resulting in impaired transmission of visual information to and from the brain.This inflammation is characterized by blurred vision and pain that is aggravated by eye movement. Changes in color perception are also common. Pain is often the first manifestation of optic neuritis. This inflammation is often caused by systemic diseases such as multiple sclerosis and neuromyelitis.

Postherpetic neuralgia occurs in 7% of patients with herpes zoster, in whom the course of the disease also affected the eyes. After recovery, the patient may have episodic or even persistent pain for months or even years, including the area around the eyes.The greatest chance of developing postherpetic neuralgia is found in the elderly, as well as in people whose herpes began with a prodrome – symptoms similar to the common cold.

Paranasal sinus disease is an inflammation or swelling of the sinuses that can result from exposure to various viruses, bacteria, fungi or allergens. The inflammation creates a blockage of these sinuses, which is characterized by symptoms such as nasal discharge, pain in the face and around the eyes, headache, fever, weakness, neck pain, and coughing.

Nasal sinuses

Reflective pain. Eye pain also occurs with pain in the frontal lobe, reflecting pain from the frontal lobe to the eye, with damage to the back of the brain, and cervicalgia or pain in the neck.

The well-known philosopher Socrates, who lived before our era, said: “Just as you cannot start treating the eye without thinking about the head, or treating the head without thinking about the whole body, so you cannot heal the body without healing the soul… “Although modern medicine is extremely highly specialized in different medical fields, it is always worth remembering that the human body is a holistic entity that must be looked at on a larger scale.

Treatment of tension headaches – clinic “Scandinavia”

Tension headache is a type of headache that feels like a tight band around the head. This is the most common type of headache in the world.

Risk factors
The headache can begin due to:

  • skipping meals;
  • too long or too short sleep;
  • stressful events;
  • smoking;
  • depression or anxiety;
  • drinking too much alcohol;
  • loud or sudden noises.

Symptoms
Typically, this type of headache manifests itself like this:

  • dull, aching pain;
  • a feeling of tightness or pressure in the forehead or on the sides and back of the head;
  • soreness of the scalp, neck and shoulder muscles.

There are two types of tension headaches – episodic and chronic. The first can last from 30 minutes to a week. It is considered episodic if it occurs less than 15 days out of a month for three consecutive months.
The chronic type lasts for hours and can be continuous. If headaches occur 15 days or more a month for at least three months, they are considered chronic.

Diagnostics
For diagnosis, the doctor usually asks the person about how the pain is felt, how long it lasts and where it is located. They may also do MRI and CT scans to get an image of the brain to rule out a secondary headache.

Treatment
The following types of drugs are used to treat tension headaches:

  • Pain relievers – Simple over-the-counter pain relievers are usually the first line of treatment for headache relief.These include the drugs aspirin, ibuprofen, and naproxen;
  • combination drugs – in them, aspirin or acetaminophen is combined with caffeine or a sedative in one medicine. Combination drugs may be more effective than single-dose pain relievers.

These medicines are used to relieve symptoms of pain that has already begun. There are also preventive measures that reduce the frequency and severity of attacks:

  • tricyclic antidepressants – the most commonly used drugs to prevent chronic tension headaches;
  • anticonvulsants and muscle relaxants – other medications, such as topiramate, that can prevent chronic headache.

If your symptoms remind you of tension headaches, be sure to make an appointment with a doctor who specializes in diagnosing and treating such pains. In the Scandinavia clinic, tension headaches are treated according to the standards of the European Headache Federation.

HEADACHE

09/05/2016
IF HEAD HURTS
Headache (cephalalgia) is one of the most common symptoms of various diseases. Headache is one of the most common and universal complaints in medical practice, which can reflect trouble not only in the head itself, but also in the body as a whole.
Around the world, millions of people suffer from headaches that range from mild attacks to unbearable pain, usually caused by increased intracranial pressure or migraines. Headache can occur quite often in completely healthy people due to changes in the weather or overwork. Often, these pains go away quickly without the need for medication, or after taking any pain medication. For some, still not entirely clear reasons, women suffer from headaches more often than men.
Headache can be caused by mechanical, chemical, or thermal effects on sensitive nerve endings (receptors). These receptors, located in the soft tissues of the head – skin, muscles, in the walls of the superficial arteries of the head, dura mater, in the vessels of the base of the brain – perceive various nerve impulses that a person feels as pain.
There are more than 200 forms of headaches, the causes of which are varied – from the most harmless to life-threatening.The description of pain symptoms and the results of a neurological examination allow diagnosing the cause of the headache and prescribing appropriate treatment, or indicate the need for additional examinations. [14]

Primary headaches

Primary headaches such as tension headache and migraine are the most common forms of cephalalgia. These forms of headache have specific features, for example, migraine is characterized by the pulsating nature of severe pain, often localized in one half of the head and accompanied by nausea.A migraine attack usually lasts from 3 hours to 3 days. Rarer forms of primary headaches include trigeminal neuralgia (shooting facial pain), cluster headache (consecutive bouts of severe pain), and continua hemicrania (prolonged headache localized to one part of the head).

Secondary headaches

Headache can occur due to pathology in any area of ​​the head or neck. Some forms of secondary headaches are not dangerous (for example, cervicogenic headache – pain associated with a disorder in the muscles of the neck).Abuse headache can be caused by overuse of pain relievers for the headache, which paradoxically leads to an even greater increase in headaches.
The presence of other symptoms, along with cephalalgia, may indicate a dangerous pathological process that causes a headache. Moreover, a number of such pathologies can lead to serious damage and even death. The presence of “alarming” accompanying symptoms indicates the need for a thorough medical examination.The appearance of concomitant symptoms in people over 50 years old indicates new forms of headache: headache lasting no more than a minute (thunderous headache), temporary paralysis of the limbs, neuralgic disorders identified during the examination, sleep disturbance, pain that increases with a change in body position, during physical exertion or a Valsalva test (with coughing and tension of the body), loss or impairment of vision, chronic dislocation of the lower jaw (passing pain in the jaw when chewing), stiff neck, fever, as well as headaches in HIV-infected, cancer patients and patients at risk of thrombosis.
Thunderous headache may be the only symptom suggestive of subarachnoid hemorrhage (a form of stroke usually caused by a ruptured arterial aneurysm). A headache combined with a fever may be due to meningitis, especially if there is a meningeal syndrome (stiff neck). Confusion of consciousness can be a symptom of encephalitis (inflammation of the brain, most often of a viral etiology). Increased intracranial pressure may be the cause of a headache that is aggravated by a muscle strain or change in body position.Typically, these pains become worse in the morning, and are also accompanied by vomiting. Increased intracranial pressure can be caused by a brain tumor, idiopathic intracranial hypertension (more often young girls with overweight are susceptible to it) and, in rare cases, by sinus thrombosis of the dura mater. A headache accompanied by general weakness may indicate a stroke (in particular, intracranial hemorrhage or subdural hematoma) or the presence of a brain tumor. Headache in the elderly, especially when accompanied by visual impairment and chronic dislocation of the lower jaw, may be a sign of giant cell arteritis (inflammation of the vascular wall, and as a result, obstructed blood flow).Carbon monoxide poisoning can lead to headaches, as well as nausea, vomiting, dizziness, muscle weakness, and blurred vision. Angle-closure glaucoma (a sharp increase in intraocular pressure) can cause headaches, in particular pain localized in the eye area, and other symptoms: blurred vision, nausea, vomiting, redness of the eye and dilated pupil.

One of the typical mechanisms for the development of chronic headaches is associated with impaired vascular regulation.The cause of violations can be, for example, changes in the composition of the internal environment of the body – internal intoxication. At the same time, sensitive conductors (chemoreceptors) transmit alarm signals to the brain, which we perceive as a headache (a well-known example is a headache due to alcohol intoxication).

There are the following main causes of pain in the head:

Migraine.

Migraine is a throbbing headache that occurs intermittently, most often upon waking.During sleep, pain is usually not felt. Migraines can be mild to unbearable in severity. Usually, this pain affects one side of the head. Migraines can last up to 72 hours, often accompanied by nausea, vomiting, heavy tolerance to light, loud sounds. Doctors still have not determined what causes migraines. Hormonal fluctuations are only one explanation for migraine headaches. Also, the causes of migraines can be stress, hunger, insomnia, odors, bright lights, spicy foods, food preservatives, changes in the weather, etc.The tendency towards migraines is usually inherited.

Headaches due to increased or decreased intracranial pressure.

Most often, such pain occurs due to brain tumors and intracranial hematomas. Such pains are characterized by vomiting, drowsiness, dizziness, usually occurring at night or early in the morning. For an accurate diagnosis of such headaches, computed tomography is prescribed, they are usually treated with the help of surgical intervention.
There is also another form of headache that occurs due to increased intracranial pressure, but without any formations in the brain. Such pains can be found in young girls or women with overweight. Along with headaches, there may also be visual impairments. Symptoms for these pains are pain in the forehead, temples, back of the head, or the entire head. It can be provoked due to changes in the weather, overwork, stress.

“Horton’s” headache.

This type of headache is common in men. The pain is characterized by seizures, is very strong and boring, usually spreads around the eye, to the temple and forehead. The attacks usually occur at the same time. During such attacks, you should not drink alcohol.

Tension headache.

The most common. This type of headache is usually triggered by exertion. You sit at the computer, desk, in the car all day, or, for example, stand at the counter in one position, are constantly nervous, and at home you sleep on an uncomfortable bed and pillow.The result is a spasm of the vessels of the brain and neck. There are emotional (stress, anxiety) and muscle tension (neck muscle tension). People with headaches of this type are prescribed computed tomography, as well as a visit to a neurologist or even a psychiatrist, since tension headache can occur due to latent depression.

Headache due to concussion (traumatic brain injury).

Such headaches, as a rule, can last for many years after an injury and are accompanied by anxiety, irritability, decreased concentration, and dizziness.The patient usually worries that his condition is getting worse, begins to suffer from depression. For headaches caused by concussion, as a rule, spa treatment and pain relievers are required.

Neck headache.

Pain in the head with osteochondrosis of the cervical spine, as a rule, has one-sided localization in the cervico-occipital region and spreads to the temporo-orbital region. Pain in the head can be episodic or lingering, chronic.A cervical headache can be moderate or severe. This pain can be accompanied by nausea, staggering, dizziness. Often, patients with this pathology complain of limited movement in the cervical spine, stiffness in the muscles of the neck and back, a significant decrease in the volume of voluntary movements in them. Pain can occur for no apparent reason, however, it is much more often provoked by mechanical factors. As a rule, the occurrence of such headaches is preceded by episodes of overexertion – sleeping in an uncomfortable position, prolonged physical activity associated with tilting or hyperextension of the head, unusual physical activity.

Pain in the head caused by extra-cerebral causes.

– pain in the head with arterial hypertension – do not occur as often as it is commonly believed. However, a common symptom when blood pressure rises is severe, pressing, throbbing pain that usually affects the neck and back of the head.
– pain in the head with extracerebral infectious diseases. Infections of any origin and location (very different, including flu, tonsillitis and many others) can be the cause of up to 40% of acute headache attacks.Any viral or bacterial infections can begin with a headache attack, and later other symptoms of the disease, such as fever, drowsiness, lack of appetite and other manifestations of the disease, can join.
– action of drugs / chemicals. Of the drugs, oral contraceptives, nitrates (for example, nitroglycerin), and caffeine most often cause headaches (both when taking drugs and when they are canceled). Chemicals include alcohol, benzene, carbon monoxide, insecticides, and lead.
– headaches associated with metabolic disorders (headaches during hypoxia, hypercapnia, dialysis, etc.).
– pain in the head with pathology of the skull, neck, eyes, ears, nose, paranasal sinuses, teeth, mouth, other structures of the face and skull (pain in the head with glaucoma, sinusitis, etc.).

There are many treatments for headaches. Most often, we use patented pain relievers that reliably relieve headaches, and this is quite enough.But it must be remembered that if you are worried about prolonged and repeated headaches, you should not neglect a visit to a neuropathologist, as well as a medical examination, since chronic headaches can be harbingers of any serious disorders in the body.
Remember that any pain is a kind of signal about any disorder or damage in the body. A headache, like, in principle, any other, is just a symptom. If you prefer to self-medicate, keep in mind that drug abuse can lead to serious diseases of the liver, kidneys, stomach, intestines, and allergies.
Do not neglect specialists, an experienced doctor will always help clarify the causes of headaches, establish a diagnosis and provide adequate treatment. We have one health, and we need to take care of it!

Headache treatment specialists in Stavropol

Headache is one of the most common complaints. There are more than 200 forms of headaches, the causes of which are varied – from the most harmless to life-threatening.The description of the pain symptoms and the results of the neurological examination make it possible to diagnose the cause of the headache and prescribe the appropriate treatment, or indicate the need for additional examinations. If your head hurts more than ever before, you urgently need the help of a doctor.

Primary headaches such as tension headache and migraine are among the most common forms of cephalalgia. These forms of headache have specific features, for example, migraine is characterized by the pulsating nature of severe pain, often localized in one half of the head and accompanied by nausea.A migraine attack usually lasts from 3 hours to 3 days.

Rarer forms of primary headaches include trigeminal neuralgia (shooting facial pain), cluster headache (consecutive bouts of severe pain), and continua hemicrania (prolonged headache localized to one part of the head).

Secondary headaches can occur due to pathology in any area of ​​the head or neck.

Secondary headaches associated with:

  • with head and / or neck trauma;
  • with lesions of the vessels of the brain and neck;
  • with non-vascular intracranial lesions;
  • with various substances or their withdrawal;
  • with infections;
  • with impaired homeostasis;
  • with pathology of the skull, neck, eyes, ears, nasal cavity, sinuses, teeth, oral cavity or other structures of the skull and face;
  • with mental illness;
  • with cranial neuralgia and central causes of facial pain.

According to statistics, in most cases, headaches are primary (they proceed without complications and pass quickly), however, some forms of secondary headaches can be a sign of a dangerous disease for which specific treatment is required.

For any type of headache, it is recommended to keep a special diary. This will help determine the most common causes of headaches. In the diary, you need to enter information about meals, sleep patterns, physical activity, work and household chores.Women also need to record their menstrual flow. changes in hormonal levels can also affect headaches.

To prevent headaches, avoid any triggers that you can identify with your journal. Do specific relaxation exercises. Try to relax, rest, or sleep in a dark, quiet room with your head elevated. Take a cool shower. Massage your neck and shoulder muscles.

Frequent or very intense headaches require medical attention.Only a doctor will be able to accurately determine the cause of headaches, if necessary, conducting additional examinations. The doctor will prescribe the appropriate treatment, and in some cases will offer hospitalization for a detailed examination and selection of therapy.

Selection of pharmacotherapy
Treatment of abusal (drug-dependent) headache
Selection of pharmacotherapy
Botulinum therapy for migraine
Biofeedback
Psychologist
TCMP, BAK
Standard electroencephalographic examination (EEG) Duplex ultrasound scanning of the brachiocephalic arteries (USDSACA)
Electroneuromyography Holter electrocardiogram monitoring (Holter ECG monitoring)

You can make an appointment with a specialist for the treatment of headache, tension, cluster pain by filling out the form below.