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

HEADACHE – Hadassah Medical Moscow

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

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

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

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

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

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

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

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

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

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

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Large molecules in the form of monoclonal antibodies directed against the CGRP receptor or ligand are injected to prevent migraine. The US Food and Drug Administration (FDA) approved the CGRP antagonist monoclonal antibodies erenumab, fremanezumab, and galcanezumab in 2018 and eptinezumab in 2020 for the preventive treatment of migraine. In 2020, two drugs (erenumab, fremanezumab) were registered in the Russian Federation.

Pain in the temple area – the causes of occurrence, in what diseases it occurs, diagnosis and methods of treatment

Arthritis

Migraine

Meningitis

Neuralgia

Hypertension

Vasculitis

Otitis

Mountain sickness

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28 of October

Pain in the temple area: causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Definitions e

Pain in the temple area is one of the most common complaints that brings patients to the doctor.

In the bone structures of the skull and brain tissues, pain sensitivity is negligible, so the main sources of pain are blood vessels, meninges and cranial nerves.

Varieties of pain in the temple area

According to the International Headache Classification 3 (2013), all headaches are subdivided into:

• for primary pain not associated with diseases of the brain and other structures of the head and neck;
• secondary pain associated with other diseases;
• painful cranial neuropathies, other facial and headaches.

Possible causes of pain in the temple area

Arterial hypertension is one of the common causes of headache in the neck and temples. With an increase in pressure, headache attacks occur, which may be accompanied by nausea, vomiting, “flies” before the eyes.

Tension headache is one of the most common reasons for visiting a neurologist and therapist. Patients characterize it as compressive, pressing.

Tension headache impairs the quality of life and performance, despite the fact that it is considered benign and does not carry serious consequences.

Migraine is the most common form of paroxysmal headache.

Migraine is characterized by localization of pain in the temporo-fronto-orbital region and the paroxysmal nature of the course.

If the pain is not paroxysmal, then it is not a migraine. Attacks can be both on one side of the head, and on both, and also change their localization (right-left).

An attack of headache can occur at any time of the day, more often during a night’s sleep in the morning or after waking up. The pain is pulsating, bursting in nature, with a gradual increase in intensity over several hours. Before the onset of an attack, the so-called aura is possible (harbingers of pain, they are individual, but are often described as impaired vision, speech, dizziness). The pain is aggravated by bright light, from loud noises and other stimuli, up to a change in the position of the head. The attack can last up to several days.

Garris’ periodic migraine neuralgia – characterized by sudden onset of pain in the eye area on one side and spreading to the temporal, frontal and zygomatic regions, and sometimes even to the neck.

Unlike migraine, there are no signs of pain.

The pain is burning, cutting, bursting, accompanied by redness of the eye and tearing from the painful side. Some patients experience a sensation of “eye bulging out of the orbit”. All these attacks are characterized by a certain seasonality or periodicity. The duration of the attack is from 6-8 weeks to 3 months.

Pain in the temple area may occur immediately after drinking cold water or ice cream due to spasm of the arteries. In this case, the pain is bursting, squeezing, sometimes throbbing.

Cold pain occurs in individuals with increased sensitivity to cold stimuli and with high reactivity of the body.

“Sausage” headache (in English-speaking authors – hot dogs headache ) occurs when eating foods containing food additives such as sodium nitrate. During a chemical reaction in the body, nitrate is converted to nitrite, which has a vasomotor effect (controlling the contraction and relaxation of the muscle membrane of the walls of blood vessels, and therefore the lumen of blood vessels), and sensitive people may feel pain in the frontotemporal region.

A similar effect is sometimes seen in Chinese cuisine (“Chinese restaurant headache”), where monosodium glutamate is often used.

Giant cell arteritis is the world’s most common systemic vasculitis affecting large vessels. The favorite localization of this disease is the temporal artery. Most often, the pain is intense, accompanied by a limitation of the function of the corresponding temporomandibular joint, visual impairment with a gradual decrease in it, a thickened artery in the temple area is determined.

Without treatment, it can lead to permanent blindness of the eye on the side of the lesion.

In inflammatory diseases of the ear pain in the temporal and parotid region is possible, which is accompanied by fever, redness, swelling in the ear, purulent discharge from the ear.
Meningitis develops when an infectious agent enters the membranes of the brain, followed by an inflammatory process.

Headache is sudden, sharp, diffuse, predominates in the fronto-temporal areas, sometimes accompanied by vomiting.

Neuralgia of the auricular-temporal nerve often occurs after an inflammatory process or traumatic lesion of the parotid gland. It is characterized by burning, throbbing pain in the external auditory canal, temple, temporomandibular joint, radiating to the lower jaw. The pain is accompanied by increased salivation, redness of the skin over the affected area. Seizures are provoked by food and smoking.

Neuralgia of the ear node is manifested by bouts of burning pain in the temporal region lasting from several minutes to an hour. May be accompanied by ear congestion and increased salivation.

Altitude sickness changes the tone of the arteries due to reduced oxygen pressure and changes in barometric pressure. Headache is accompanied by shortness of breath, palpitations, blurred vision.

The severity of symptoms depends on the rate of ascent to altitude.

The pain is relieved by applying cold to the temples and drinking cool water.

Traumatic injury to the temporal region can cause pain. This includes a wide group of pathologies: fracture of the temporal bone, dislocation of the temporomandibular joint, soft tissue contusion.

Subarachnoid hemorrhage occurs for various reasons, for example, as a result of a rupture of an aneurysm of cerebral vessels, a person feels like a strong blow to the head, hot liquid spills in the head, strong constriction, and then bursting. The pain may initially be localized in the corresponding section of the head – in the temporal region when an aneurysm of the internal carotid artery ruptures.

Damage to the temporomandibular joint (both inflammatory – arthritis, and non-inflammatory – arthrosis, malocclusion) may be accompanied by pain in the parotid and temporal region. When moving the lower jaw, a crunch and clicking in the joint may occur, the pain intensifies when chewing and during a conversation.

Which doctors should I contact if I have pain in my temples?

With the appearance of intense and recurring pain in the temples, you should seek the advice of a specialist.

If pain persists after taking painkillers or other symptomatic treatment previously prescribed by a doctor (for example, to lower blood pressure), and there are no signs of injury, then you should contact
therapist or
pediatrician. Depending on the accompanying symptoms, you may need to consult a neurologist, rheumatologist, otolaryngologist, ophthalmologist. In case of a previous injury, it is necessary to consult a traumatologist or
surgeon to rule out severe injury.

Diagnostics and examinations for pain in the temples

The list of examinations is prescribed by the doctor depending on the indications. An approximate list of studies that can be assigned:

• computed tomography of the head;

CT scan of the brain and skull

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

RUB 4,890

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MRI of the brain and cervical spine

Magnetic resonance imaging of the cervical spine and brain for diagnosis and selection of the optimal treatment option.

RUB 10,890

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X-ray of the temporomandibular joints

An X-ray examination to assess the structure of the temporomandibular joint and identify comorbidities.

RUB 2,290

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Electroencephalography (EEG)

EEG is a safe and painless method for studying the functional state of the brain.

RUB 3,090

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C-reactive protein (CRP)

C-reactive protein – acute phase protein, a sensitive indicator of tissue damage during inflammation, necrosis, trauma.
Synonyms: Blood test for CRP; C-jet …

Up to 1 business day

Available with house call

665 RUB

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

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

Up to 1 business day

Available with house call

RUB 810

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Hemostasiogram (coagulogram), screening

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

Up to 1 business day

Available with house call

RUB 1,620

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What to do with pain in the temples?

First of all, it is necessary to provide the patient with peace and fresh air, dim bright lighting, turn off loud music.

As a first aid, you can apply a cold compress to the temporal region – a towel soaked in cold water or ice previously wrapped in a cloth.

If you have had similar pains before and the doctor prescribed drugs, you should take them.

Treatment of pain in the temple area

The choice of treatment depends on the cause of the pain.

Of the medical methods of therapy, anti-inflammatory non-steroidal drugs are used, however, independent long-term treatment with them without medical supervision is not recommended.

Depending on the pathology, specific types of treatment are used for this disease. So, with arterial hypertension, the doctor will prescribe drugs that reduce blood pressure. In giant cell arteritis, glucocorticosteroids and immunosuppressive therapy are used. In inflammatory diseases of the ear, antibiotic therapy is carried out. Injuries often require surgery and treatment in a hospital setting.

Sources:

1. Healy P. M., Jacobson E.J. Differential diagnosis of internal diseases: Algorithmic approach. Per from English. – M.: Binom, 2014. 280 p.
2. www.ihs-headache.org
3. Clinical guidelines “Migraine”. Developed by: All-Russian Society of Neurologists, Russian Society for the Study of Headache. – 2021.
4. Headache. – 2nd ed., revised. and additional – M.: Medical Information Agency, 2007. 472 p.
5. International recommendations. Clinical pharmacology and therapy. Recommendations for the treatment of giant cell arteritis of the French group for the study of vasculitis of large vessels / I.O. Smitienko, P.I. Novikov, A.D. Meshkov, S.V. Moiseev. – Moscow, 2017, 26 (5). pp. 57–64.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.