Headache – Harvard Health

Types of headaches

Most headaches fall into four main categories: tension, migraine, cluster, and sinus.

Tension headache. Tension headaches are the most common headache, affecting about three of every four adults at some point in their lives. The typical tension headache produces a dull, squeezing pain on both sides of the head. Most episodes are mild to moderate in severity and occur infrequently, but some people can get severe tension headaches three or four times a week. The discomfort usually last 20 minutes to two hours. While physical and emotional stress often plays a role in tension headaches, other factors can contribute, like illness, lack of sleep, and missed meals. Problems involving the neck or jaw muscles and joints can also cause tension headaches.

 
Migraine headache. Migraines are typically less common than tension headaches but are usually much more severe. They affect more women than men. Genetics also play a role. In fact approximately 70% of migraine sufferers have at least one close relative with the condition. Neurologists believe migraines are caused by changes in blood flow and nerve cell activity in the brain . Migraines cause moderate to severe throbbing pain, often accompanied by nausea and sensitivity to light and sound. Episodes usually last four to 24 hours or even longer. Migraines often begin in the evening or during sleep. In some people, the attacks are preceded by several hours of fatigue, depression, and sluggishness or by irritability and restlessness.

 
Cluster headache. Cluster headaches are uncommon, yet severe. The pain always strikes one side of the head, starting abruptly and lasting for about 30 minutes to three hours. They occur five times more often in men than women. As the name suggests, these headaches tend to come in clusters. About 90% of cluster attacks follow a pattern of one or two headaches a day over two to eight weeks, alternating with headache-free stretches. Usually, the remission time between episodes lasts six months to a year, but can be as short as a few weeks or as long as several years. It’s unclear what causes cluster headaches, although certain triggers are associated with outbreaks, such as alcohol, foods high in nitrites like processed meat and green leafy vegetables (spinach, lettuce), tobacco products, bright lights, and hot weather.

 
Sinus headache. The sinuses are air-filled spaces above, between, and beneath your eyes, on either side of your nose. Both the nose and sinuses are lined with a thin membrane. Sinus headaches can occur when this inner membrane becomes inflamed, when fluid builds up in the sinuses and can’t drain out through the nose, or when pressure in the sinuses is lower than environmental air pressure. Sinus headache pain is most often felt in the center of the face, the bridge of the nose, and the cheeks, but may also occur behind the eyes or in the center of the forehead.

 

Other headache types include:

 
Thunderclap. As the name suggests, a thunderclap headache strikes suddenly with excruciating pain. It is a serious situation that requires immediate medical attention because it could indicate bleeding in or around the brain.

 
COVID-19. Headaches are one of the most common symptoms of COVID-19, and the severity and duration vary from person to person.

 
Cervicogenic. With this type of headache, pain begins in the neck and travels to the head and face. Cervicogenic headaches are sometimes confused with migraines and tension headaches, which can also cause neck pain. They result from structural problems at the top of the spine involving thecervical vertebrae. Injuries like whiplash, arthritis, and infections are thought to be common causes.

 

Other situations can trigger occasional or recurring headaches. For instance, many drugs list headaches among their side effects. (Check with your doctor if you have frequent headaches and use medication, over-the-counter, prescription,or both, for more than 10 to 15 days a month. ) Sudden, strenuous exercise and sexual intercourse can also cause headaches, as can high blood pressure (hypertension).

What are common headache symptoms?

Headache symptoms can vary depending on the type, although there is some overlap. Here are the trademark symptoms for the most common headaches.

 
Tension headache symptoms. The typical tension headache produces a dull, squeezing pain and pressure on both sides of the head. People with severe tension headaches may feel like their head is trapped in a vise. The shoulders and neck can also ache.

 
Migraine headache symptoms. In typical cases, migraine pain occurs on one side of the head, often beginning around the eye and temple before spreading to the back of the head. The throbbing or pulsating may be severe. Nausea is common, and many migraine sufferers also have watery eyes, a running nose, or congestion. One way to remember the symptoms of migraine is the acronym POUND:

 

• P: Pulsating pain
• O: One-day duration of severe untreated attacks
• U: Unilateral (one-sided) pain
• N: Nausea and vomiting
• D: Disabling intensity

 

About 20% of migraine sufferers also experience auras, a sequence of visual or sensory disturbances, such as temporary loss of vision, halos, sparkles or flashing lights, wavy lines, and numbness or tingling on one side of the body, especially in the face or hand. The aura can occur before and during an attack.

Although a migraine can come on without warning, there is often a trigger. Specific trigger(s) can vary, but a migraine sufferer usually remains sensitive to the same ones. Some common triggers include:

 

• changing weather, like rising humidity and heat
• lack of sleep or oversleeping
• fatigue
• emotional stress
• sensory triggers, such as bright or flickering lights, loud noises, and strong smells
• missing a meal
• alcohol, especially red wine
• chocolate
• nitrates in cured meats and fish
• aged cheese
• an increase or decrease in caffeine
• monosodium glutamate or MSG (often present in Asian and prepared foods)

 
Sinus headache symptoms. Sinus headaches can trigger pain over the forehead, around the nose and eyes, over the cheeks, or in the upper teeth and gums.

 
Cluster headache symptoms. The deep and explosive pain of cluster headaches always strikes one side of the head, often near the temple. The eye on the painful side becomes red and watery, the eyelid may droop, and the nose runs or is blocked. The attack starts abruptly and lasts for approximately 30 minutes to three hours. Nausea and sensitivity to light and sound also may accompany the pain.

What are the best headache treatments?

For the occasional, mild to moderately painful headache, an over-the-counter (OTC) pain medication is often sufficient treatment. These include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, naproxen (Aleve), and ibuprofen (Motrin, Advil). Always follow the label’s instructions and take these medications only as directed. Consult your doctor if you use OTC drugs more than a couple of times a week to manage headaches.

Non-drug remedies include eating a snack and drinking water or a caffeinated beverage like coffee. Some people find relief from placing a cold compress on their head and/or a heating pad or warm towel around their neck and shoulders. Taking a warm shower or a nap may also help. Relaxation techniques, such as deep breathing, meditation, and visualization can ease headache pain by relaxing muscles and reducing tension.  

      

Certain types of headaches may require stronger treatments. For example:

• Tension headache. People who suffer from severe tension headaches are more likely to benefit from a doctor-prescribed pain medication or a muscle relaxant.
• Migraine headache. Migraine sufferers may be able to control their headaches with OTC pain relievers if taken early in the attack. For more severe episodes, prescription drugs are needed.

Most doctors recommend triptan drugs, which are available as tablets, nasal sprays, or injections. Examples include sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt). Triptans act on specific serotonin receptors to constrict dilated blood vessels throughout the body. Most people feel the effects after 20 to 30 minutes and complete relief within one to two hours. Still, the sooner you take them once symptoms appear, the better. Some people require a second dose within 12 to 24 hours.

Other prescription drugs used to treat migraines are ditans and calcitonin gene-related peptide (CGRP) inhibitors. Ditans act on different serotonin receptors found mainly within the brain. However, they don’t constrict blood vessels like triptans, which makes them a safer alternative for people with heart disease or high blood pressure. Lasmiditan (Reyvow) currently is the only FDA-approved ditan.

CGRP inhibitors (known informally as “gepants”) block the CGRP chemical that inflames nerve endings and causes blood vessels to dilate. Currently three gepants have been approved for migraines: ubrogepant (Ubrelvy), rimegepant (Nurtec ODT), and atogepant (Qulipta).

Cluster headache. For cluster headaches, sumatriptan (also used to treat migraines) is often effective, particularly when given by injection. Another option is inhaling oxygen, administered in an emergency room or at home from a portable tank, which can be prescribed by a doctor. If there’s no improvement after 15 minutes of inhaling, further oxygen therapy may not help.

What type of headache do you have?

Headaches are familiar to nearly everyone: in any given year, almost 90% of men and 95% of women have at least one. In the vast majority of cases, however, the pain isn’t an omen of some terrible disease. The three most common types of headaches are tension, sinus, and migraine. The most common headache triggers are stress, fatigue, lack of sleep, hunger, and caffeine withdrawal.

Mixed headaches

As understanding of the different types of headaches has evolved, researchers have altered some of their beliefs about migraine and tension headaches and the relationship between the two. This is largely because of the realization that some headaches don’t neatly fit either category. “Mixed” headaches have characteristics of both types, and because they’re hard to classify, treatment can be challenging.

For instance, the more intense a tension headache gets, the more it resembles the sharp, throbbing pain of a migraine headache. Likewise, when a migraine headache becomes more frequent, its pain begins to feel like that of a tension headache. Symptoms of headaches fall along a continuum ordered by their characteristics: the occasional tension headache is at one end and the classic migraine headache is at the other. In between are chronic daily headaches, which can start with features typical of either tension or migraine headache.

Headache caused by a medication or illness

Some headaches are actually symptoms of another health problem. Many non-life-threatening medical conditions, such as a head cold, the flu, or a sinus infection, can cause headache. Some less common but serious causes include bleeding, infection, or a tumor. A headache can also be the only warning signal of high blood pressure (hypertension). In addition, certain medications, such as nitroglycerin and female hormones (prescribed for a contraception or menopausal symptoms) are notorious causes of headache.

Because the following symptoms could indicate a significant medical problem, seek medical care promptly if you experience:

• a sudden headache that feels like a blow to the head (with or without a stiff neck)
• headache with fever
• convulsions
• persistent headache following a blow to the head
• confusion or loss of consciousness
• headache along with pain in the eye or ear
• relentless headache when you were previously headache-free
• headache that interferes with routine activities.

Always take children who have recurring headaches to the doctor, especially when the pain occurs at night or is present when the child wakes in the morning.

Image: m-imagephotography/Getty Images

how they differ and what they talk about

Headache can become chronic and significantly spoil life, affecting a person’s performance and normal functioning in society. Few people know, but there are different types of headaches , which differ from each other both in causes and methods of treatment. What are the types of headaches and their causes , as well as signs of a headache we tell in the article.

Headache – causes, symptoms and types of headaches

Headache is a very common condition that most people experience many times in their lives. In simple words, it is pain or discomfort in the head or face. Headaches vary greatly in location and intensity of pain, as well as in frequency of occurrence. Brain tissue does not have nerve fibers sensitive to pain and does not feel pain. If you have a headache, they are responsible for it:

• A network of nerves that extends to the scalp.
• Certain nerves of the face, mouth and throat.
• Muscles of the head, neck and shoulders.
• Blood vessels on the surface and base of the brain.

Although most headaches are not dangerous, some types may be a sign of a more serious condition.

Headache symptoms

Headache symptoms depend on the type of headache. The frequency of headaches and the intensity of symptoms can also vary. Typical headache symptoms include:

• sharp, throbbing or dull pain;
• constrictive pain;
• pain on one or both sides of the head;
• gradual or sudden onset of headache;
• duration from less than an hour to several days;
• covers the back of the head or neck;
• less commonly – nausea, vomiting, or sensitivity to light (photophobia).

Headache symptoms may be similar to other health conditions or problems. Always contact your healthcare provider for a diagnosis.

Why is headache so dangerous?

Almost all types of headaches activate the same pain receptors. This can make it difficult to know if your headache is a sign of a serious condition or not. The most serious causes of headache include:

• hemorrhagic (bleeding) stroke. A hemorrhagic stroke happens when a blood vessel in your brain ruptures and bleeds;
• aneurysm. Bulging or swelling of a blood vessel in the brain;
• meningitis. A bacterial or viral infection that causes swelling of the protective lining of the brain;
• brain tumor. A “primary” brain tumor starts in the brain and can be malignant or benign.

To understand if your headache is dangerous, it is important to understand the types of headaches, their causes, and how to get rid of the headache.

Types of headaches

Headaches are caused by signals interacting between the brain, blood vessels, and surrounding nerves. During a headache, an unknown mechanism activates certain nerves that affect the muscles and blood vessels. These nerves send pain signals to the brain.

What types of headaches are there? Headaches can be more complex than most people think. Different types of headaches may have their own set of symptoms, occur for unique reasons, and require different treatments.

Once you know what type of headache you have, your doctor will be able to suggest treatments that will help you manage and prevent them.

Types of headaches by localization

Types of headaches by localization:

• migraine – severe and throbbing pain in one side of the head.
• stress – prolonged pain “compressing” the head like a hoop.
• influenza, acute respiratory infections – pain in the superciliary arches, forehead and temples.
• osteochondrosis – a sharp pain in the back of the head and at the temples.
• hypertension – severe throbbing pain, usually in the back of the head.

Hypertension

People with hypertension or high blood pressure may experience frequent headaches. This type of headache signals an emergency when your blood pressure becomes dangerously high. A headache from hypertension usually occurs on both sides of the head, has a throbbing sensation, and tends to get worse with any activity.

About the types of headaches, about headaches by zones, we will tell further.

Tension headaches

The most common type of headache is tension headache or tension headache, which does not recur often and becomes chronic in only 3% of cases. It occurs due to injuries to the muscles of the neck and head, as well as due to severe stress. When diagnosing, most often the source of pain is not determined.

Signs: There is tightness or pressure around the top of the head, and the muscles of the eye sockets and forehead may seem very tense and impossible to relax. The intensity of the pain usually increases in the evening. The duration of such pain can be as much as half an hour, or a week.

Treatment: in case of irregular tension pain, it is better to use simple painkillers, and also try to be outdoors more often, do light physical exercises, stretch your neck and shoulders. Chronic pain should be treated with medication as prescribed by a doctor.

Attention! Self-medication can harm your health, be sure to consult your doctor before taking any medication.

Cluster pain

Cluster pain affects about 1% of the world’s population. Interestingly, in 80% of cases, cluster pain bothers men. Her reasons are unknown.

Signs: throbbing intense pain on one side of the head, usually around the eye. It lasts 15-60 minutes and is accompanied by tearing, redness of the eyes, a rush of blood to the head, and a runny nose. Sometimes it can become so acute that the person cannot even talk. Cluster pains occur with uniform time intervals at the same time of day – once a month, a week.

Treatment: Difficult to treat because it comes and goes unpredictably. For prolonged attacks, drug injections and oxygen therapy are used.

Migraine

A possible cause of migraine is brain dysfunction, but it is currently unknown which cause. There is evidence that when a migraine occurs, blood vessels expand greatly, and electrical activity of an abnormal nature occurs on the cerebral cortex.

Symptoms: Migraine is a type of headache on one side of the head that lasts from 4 hours to 3 days. A migraine is often described as a stabbing, throbbing pain. Migraine episodes tend to recur and often result in nausea, dizziness, and sensitivity to light and smells.

Treatment: There is no cure for migraines, but prescription medications can help relieve some of the symptoms.

Attention! Self-medication can harm your health, be sure to consult your doctor before taking any medication.

Intracranial bleeding

Manifests as increasing, sudden pain in any part of the head after an injury (sometimes symptoms appear after a few hours).

Signs: accompanied by impaired speech skills, vision, coordination, nausea, personality disorders. Symptoms worsen over time, after which the person may lose consciousness.

Treatment: see a doctor who will remove the accumulated blood from the skull so that the hematoma does not press on the brain, thus damaging it. In this field, it is important to find out the cause of the hemorrhage by examining the vessels of the brain.

Temporal arteritis

Temporal arteritis is common in patients over 50 years of age and can lead to blindness if left untreated. It occurs due to hypothermia, alcoholism, various injuries, uncontrolled medication, attacks of viral infections on the immune system.

Signs: severe headaches occur due to insomnia, weight loss, depression, and the neck and shoulder may also hurt.

Treatment: Steroid drugs are used to stop the inflammation of the blood vessels. With the development of related health problems, it is also necessary to contact doctors of other specialties. For example, with clouding of the lens – to an ophthalmologist.

Brain tumor

If the headache is associated with a brain tumor, which happens in about 4% of cases, it will appear in the morning and be accompanied by vomiting. Similar episodes are repeated periodically and each time they get worse and worse. “The brain does not feel pain. There are no pain receptors in the brain. They are present only in the meninges and blood vessels. For example, when a person experiences a headache, it is not the brain itself that hurts, but the tissues surrounding it,” neurosurgeon Oleksiy Eroshkin said in an interview for Doc.ua.

Signs: seizures, sudden weight loss, personality changes in such cases become an occasion to undergo a brain examination.

Treatment: Depends on size, location and type of lesion.

Hangover headache

Hangover headache is due to the fact that alcohol leads to dehydration, which is one of the causes of migraine. In addition, alcohol dilates the vessels of the brain and disrupts the functioning of serotonin (a substance through which electrical signals are transmitted from one nerve cell to another).

Symptoms: Alcohol makes people need to urinate because it suppresses the production of a hormone called vasopressin. This hormone affects the body in a variety of ways, affecting the ability of the kidneys to reabsorb water. Sweating, vomiting, and diarrhea are also hangover symptoms. All of these symptoms can lead to further dehydration.

Treatment: The best cure for a hangover headache is a painkiller tablet and sleep.

Attention! Self-medication can harm your health, be sure to consult your doctor before taking any medication.

Headache Diagnosis

If you have a very frequent headache, or if your head hurts every day, you should consult a doctor and find out the causes of headache.

Your doctor will perform a comprehensive physical examination and diagnostic testing, and ask about your medical history.

Frequently asked questions during an examination may include:

• When do headaches occur?
• What is the location of the headache?
• What do headaches look like?
• How long do headaches last?
• Do changes in position or sitting cause headaches?
• Do you have problems sleeping?
• Do you often experience stress?
• Do you have a history of head trauma?

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

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

• Blood test.
• X-ray of the sinus.
• Magnetic resonance imaging (MRI).
• Computed tomography.

Headache treatment

Rest and pain medication are the main treatments for headaches.

Options include:

• over-the-counter pain medications such as non-steroidal anti-inflammatory drugs;
• prescription pain medications;
• preventive medicines for certain conditions such as migraine;
• other treatments for underlying conditions.

It is essential that a person does not self-medicate and follow their doctor’s instructions to prevent headaches. After all, each type of headache requires a different treatment. For example, the treatment of headache associated with drug overuse includes reducing or stopping the medication. Your doctor can help you develop a plan to safely stop the medication. In extreme cases, a person may need a short hospital stay to manage withdrawal safely and effectively.

Home remedies

Certain care strategies can help prevent or relieve headaches. You can try the following:

1. Use warm or cold compresses on your head or neck.
2. Avoid stressors whenever possible and use healthy strategies to deal with inevitable stressors.
3. Eat regularly to keep your blood sugar stable.
4. Get enough sleep following your regular daily routine and keeping your bedroom cool, dark and quiet.
5. Get regular exercise to improve your overall health and reduce stress.
6. Limit alcohol intake and drink plenty of water.
7. Take breaks during work to prevent eye strain.

Help Doc.ua: you can make an appointment with a neurologist on the website.

HEADACHE – Hadassah Medical Moscow

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

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

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

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

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

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

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

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

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

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

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