Headaches are a daily fact of life for many people in the U.S. Identifying the causes of headache is crucial to designing a proper treatment. If you suffer from headaches of any kind, here’s what you need to know.
What are headaches?
Simply put, headaches are pain or discomfort that can be generalized or local affecting any part of your head. They are one of the most common reasons that people visit their doctor.
Headaches can be classified as either primary or secondary.
Primary headaches are their own separate condition and are not caused by an underlying condition or disease. They can be further divided as cluster, tension, and migraine headaches.
Secondary headaches are associated with another condition that leads to the pain. Secondary headaches may be challenging to diagnose, as there are many conditions that cause them. Life-threatening causes that require immediate treatment include:
- Intracranial hemorrhages or hematomas
- Meningeal infections (viral, bacterial, fungal)
- Malignant hypertension
- Malignant tumors (primary or malignant)
- Diseases relating to the eyes such as glaucoma of cataracts
Primary headaches are the more common of the two types of headaches and can be broken down into three categories: cluster, tension, and migraine headaches.
What are the different types of headaches?
Knowing which type of primary headache you have is key to treatment. The three subcategories of primary headaches are:
- Cluster headaches
- Tension headaches
- Migraine headaches
These headaches are named because they occur in “clusters,” meaning they affect the same location of the head, around the same time of day, during the same time of year. The pain occurs in bursts of 20 minutes to three hours with excruciating and pulsating types of pain.
Typically, cluster headaches present on just one side of the head, usually behind the eye, and they may occur several times throughout the days and weeks of an attack. These attacks are referred to as cluster periods. After the attack subsides, sufferers may experience a period of remission that can last weeks or months.
Those suffering from cluster headaches may also experience tearing from the eye on the same side of the head as the pain, as well as nasal discharge or neurological complications (Horner’s syndrome and ptosis).
Cluster headaches more commonly affect men and are most prevalent in people in their mid-twenties. Other risk factors for cluster headaches include:
- Vasodilating medications
- Alcohol use
- Illicit drug use
Patients describe the pain associated with cluster headache as far more severe than that experienced in tension or migraine headaches.
Tension headaches are the most common headache diagnosed in adults. These typically occur towards the end of the day. You’ll usually feel them in the upper neck and occipital (back of head) region. Unlike cluster and migraines, tension headaches are not associated with any neurological disturbances.
People describe the pain as a restrictive, band-like pain wrapped around their head. Most experience pain as a slow onset that can be sped up by bright lights, noise, and stress. In some people, the pressure can be accompanied by stabbing or throbbing pain.
Other symptoms of tension headaches include:
- Sleep disturbance
- Poor concentration
Tension headaches are generally episodic and last between 15 minutes to an hour with treatment.
Migraines are more common in women and affect a significant portion of the population – approximately 36 million adults in the U.S. Although more common in adults, migraine headaches also affect children and adolescents, varying significantly with each person.
Migraine pain can be felt on either just one side of the head or in both sides of the head. This type of headache typically lasts for at least one hour but not longer than 72 hours. Nausea and vomiting are also common among patients who suffer from migraine headaches.
Migraines are further classified as classical or common.
A classical migraine features unilateral pain that is preceded by visual effects (auras and wavy lines) or other disturbances. Some patients describe these disturbances as:
- Flashes of light
- A particular smell
- Spots of vision loss
- Numbness of one or both sides of the face
- An altered level of consciousness
Common migraines are usually bilateral and have no visual disturbances.
Migraine headaches of both kinds typically have four stages.
- Prodromal: The prodromal stage is often the warning sign of a migraine and may feature fatigue, anxiety, or mood swings
- Aura: Aura only occurs in classical migraines
- Attack: The attack phase is generally when pain and other physical symptoms occur
- Postdromal: This stage occurs after the attack has ended and may leave a person feeling drained (and sometimes mildly euphoric)
Note that not all migraine sufferers will experience all stages.
Why do I get headaches?
There are some common risk factors for all types of headaches. These include:
- Poor sleep
- Poor nutrition
You can think of these three factors as contributing to the onset but not the exact cause of headaches. For example, it stands to reason that a person who is sleep deprived and lacks proper food and water may experience other health issues, but each type of headache also has specific potential causes. Let’s look at those in more detail.
Cluster headache causes
Cluster headaches are challenging not only due to the pain but also because it’s tricky to pinpoint their causes (and therefore treat them).
One potential cause of cluster headaches may be vasodilatation (opening) of the blood vessels in the brain. This causes acute and severe pain by compressing and irritating the cranial nerve (trigeminal), which innervates the sensory and some motor functions of the face.
Cluster headaches also seem to be seasonal in nature, possibly linked to changes in barometric pressure that lead to changes in the hypothalamus. The hypothalamus controls the body’s circadian rhythm and the increase in light during the summer may trigger these headaches.
Tension headache causes
Tension headaches seem to be directly correlated with stress. Many people who experience tension headaches find that they gradually worsen as their day goes on. This could be related to stress or eyestrain associated with extreme focus on a task.
Another theory is that continued musculoskeletal (myofascial) irritations may cause tension headaches. Examples of continued myofascial irritation or stimulation includes jaw clenching as well as poor posture of the back or neck.
Migraine headache causes
Migraine headaches may be the most researched type of headache. This could be due to the fact that tension headaches typically respond well to simple treatments and cluster headaches are often mistaken for migraines.
Regardless, research recognizes that there is a neurological component to migraine headaches. Migraine headaches are thought to be vascular in origin, similar to cluster headaches, but may also be associated with imbalances in the neurotransmitter serotonin.
Migraines are also more common among people who have a first-degree relative (parent or sibling) who suffers from them as well. This indicates a genetic link in patients with a family history of migraines have a gene that predisposes them to migraines.
Whatever the root causes, it is commonly acknowledged that migraines are triggered by certain things due to changes in brain activity. Pain sensors in the brain become extra sensitive.
Sensitizing desensitization is a development involving both the peripheral nervous system (PNS) and the central nervous system (CNS). Local tissue injury and inflammation activate the PNS, which sends signals through the spinal cord to the brain.
Central sensitization is where there is an increase in the excitability of neurons within the CNS (brain and spinal cord), so that normal inputs from the PNS begin to produce abnormal responses.
When this occurs, low-threshold sensory fibers activated by very light touch of the skin activate neurons in the spinal cord that normally only respond to noxious, or more severe, stimuli. As a result, things that would normally produce a harmless sensation now produce significant pain. These triggers can be any type of sensory input, including touch, taste, sound, sight, and smell.
Some of the most commonly associated migraine triggers include:
- Loud noise
- Bright lights
- Certain foods (chocolate, peanut butter, avocado, banana, citrus, dairy products, fermented and pickled foods, and MSG, are particularly common)
- Certain medications (birth control pills, for example)
- Menstrual cycle fluctuations
- Strenuous activities
- Emotional or mood disorders (e.g., depression or anxiety)
Everyone’s migraine triggers are different, however. Tracking your own symptoms over time can give you some idea of what may be causing your migraines.
Which headache treatments work?
Treatment for all types of headaches starts with making sure you have adequate food, rest, and hydration. After that, there are two things to focus on: managing pain and other symptoms during your headache and preventing future headache occurrences.
Some potential pain management treatments during a headache include:
- Oxygen (most commonly used acutely in cluster headache)
- NSAIDs (for tension headaches)
- Anti-emetics (for nausea and vomiting)
- Butalbital with aspirin or acetaminophen
Although these may provide relief from the headache, they do not decrease the frequency or intensity or prevent the attack from recurring. They also are not equally effective each time, and efficacy varies from person to person.
Although many patients may experience relief with these headache treatments, there is also a concern of overuse and dependence that may develop. In some cases, overuse of these medications can become a cause of all types of headaches (including cluster and migraine headaches). It is crucial for patients to talk with their doctors about the use of medications for managing pain and other symptoms of headaches.
How to prevent headaches
Preventive therapy works to stop headaches before they start. Medications and techniques that are considered preventive therapies are directed at reducing the frequency and severity of the attacks.
Most of these treatments are not able to terminate an acute episode on their own, so they are typically used in conjunction with other therapies during an attack.
Headache prevention medications
Some of the more common preventive medications include:
- Antiseizure medications
- Cardiovascular drugs (beta blockers or calcium channel blockers)
The relationship between depression and anxiety disorders in people with migraines is strong. People who are experiencing migraines or migraine-like symptoms, therefore, should also be screened for depression or anxiety disorders.
By treating both the physical and mental aspects of headache, a person’s quality of life and symptom management may improve. Treatment for these disorders can be done through medication or behavioral therapy.
Behavioral interventions can also be helpful in treating headaches. Some of the more common behavioral modifications include:
- Biofeedback training
- Mind and body relaxation (yoga, acupuncture, and massage)
- Cognitive behavior therapy
Let’s look at each of these in more detail.
The practice of sitting for a period of time and focusing on the breath is one of those alternative treatments that studies have found highly effective for reducing headache days, but you might first wonder how such a simple activity could possibly help reduce the pounding in your head.
Researchers are still working to uncover exactly how meditation reduces headaches, but one key is the practice’s ability to reduce stress, one of the most common triggers of headaches ranging from tension to migraine.
Scientists at Wake Forest Baptist Medical Center studied two groups of adults, one that attended mindfulness-based stress reduction (MBSR) classes and another control group that received traditional care. Those in the MBSR group also meditated at home five days a week for 45 minutes.
The study revealed that meditators experienced on average one-and-a-half fewer migraines per month than the control group. And those migraines that did develop were shorter and less painful.
If you’d like to try meditating, simply find a quiet space and sit on a thin pillow or blanket to elevate the hips. You may also sit in a chair if sitting on the floor isn’t an option. Bring awareness to the breath and continue breathing for at least five minutes, but preferably longer, around ten or 15 minutes. Set a timer on your cell phone so you don’t have to worry how much time has passed.
Exercise is another great stress reliever, and researchers have found that working out promotes more headache-free days in a couple ways.
First, the weight-loss benefits of exercise could help. A study published in the journal Neurology uncovered a greater risk of migraines among people who are obese. Researchers said the finding was critically important because some migraine drugs can lead to weight gain, which could potentially offset any benefit from the medication.
The study found obesity was related to an 81% higher risk of migraines than people who fell into normal weight ranges. Study author Lee Peterlin says:
“These results suggest that doctors should promote healthy lifestyle choices for diet and exercise in people with episodic migraine.”
Meanwhile, earlier research from the University of Gothenburg found that exercise was equally as effective as medicine at preventing migraines. In the study, subjects were divided into groups, one that exercised three times a week for 40 minutes, a second that participated in relaxation techniques, and a third that received medication. All three groups reported a reduced number of headaches.
If you’d like to incorporate exercise into your routine, experiment and find an activity you enjoy. That could be walking, playing tennis, riding a bike, or hiking. The most important thing is to get active and have fun while doing it.
Acupuncture, the centuries-old Chinese medical treatment of using thin needles to restore health and balanced energy to patients, has been found to help migraines, according to research published in the Canadian Medical Association Journal.
A group of patients receiving treatment was compared to a control group receiving a placebo treatment, with needles inserted at random and not in specific places. Patients in both groups reported fewer migraines, with as much as a 50% drop in headache days as well as less severity in those migraines that did develop.
While patients in both group experienced an initial benefit, only patients in the group that received actual acupuncture enjoyed continued relief when surveyed three months later.
The mind/body practice of yoga has also been found to help migraine sufferers reduce pain. A study published in The International Journal of Yoga found patients with chronic migraines experienced fewer attacks with less severity after practicing five times a week for six weeks.
While patients with only occasional migraines may benefit from more vigorous exercise, some doctors say yoga may be a better option for patients experiencing more severe symptoms, reports Prevention magazine.
If you’d like to try yoga, seek out a local class at a gym or yoga studio. Practicing under the watchful eye of a trained teacher will help new students avoid injury.
Another treatment for headaches that can be both preventive and helpful during the acute stage of a headache is botulinum A toxin (Botox) injections.
Recently there has been a flood of research to determine the efficacy of Botox injections for the treatment of migraines. This treatment was suggested when people receiving Botox injections for their facial wrinkles noted improvement of their headaches. Essentially, Botox is injected in the same or similar locations as it is for the treatment of wrinkles in cosmetic practices. After years of study, the evidence is clear that Botox injections offer significant, long-term pain relief with few side effects or risks.
Botox is only FDA-approved for chronic migraines (15 or more days per month), so other uses are considered off-label, even though some anecdotal evidence shows improvement in cluster headaches as well.
In addition to Botox, the pain specialists at Arizona Pain offer an array of injections and procedures that can offer relief in treatment of both primary and secondary headache pain.
Some of the other injections and treatments we offer include:
- Occipital nerve stimulation
- Cervical facet injections
- Cervical epidural steroid injections
- Sphenopalatine nerve blocks
- Occipital nerve blocks
- Supratrochlear nerve blocks
- Supra/infraorbital nerve blocks
There have been numerous studies and publications on the effectiveness of these treatments for the relief of moderate to severe headaches. This research often suggests using these therapies when other more conservative treatments have failed to treat a patient’s facial pain and peripheral/central desensitization that is commonly associated with migraines.
In one study, 65% of patients reported a significant decrease in pain when treated with blockade of the supraorbital and greater occipital nerves in the treatment for migraines.
Transnasal sphenopalatine ganglion (SPG) block injections are also helpful in migraines, but have also had positive results in treating medication-resistant cluster headaches. A number of surgical treatments have been attempted in cases of cluster headache resistant to treatment with medication, and SPG blockade has had the most successful results. SPG blockade is a less-invasive surgical technique that offers hope for people who suffer from cluster headaches.
The best approach to headache treatments
It’s also important to note that headache treatment and prevention is often most successful when you use a combination of therapies. These therapies will likely include:
- Adequate rest
- Proper nutrition
- Regular exercise
- Good hydration
- No smoking
- Limited or no alcohol or drug use
- Stress management practices
Knowing your migraine triggers and avoiding them is key. When you do suffer from headaches, continuing self-care as well as medication and other interventions can help reduce the length of your headache and the intensity of your pain.
Arizona Pain understand the pain of all kinds of headaches. If you are suffering from headaches that have been unresponsive to treatment, give us a call today. We can discuss the best and most beneficial options for your particular headache and help you get your life back.
- Pathophysiology of tension-type headache: potential drug targets. Ashina M. CNS Neurol Disord Drug Targets. 2007 Aug;6(4):238-9 PMID: 17691978 Headache. 2003 Jul-Aug;43(7):704-14 Yarnitsky D, Goor-Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A, Burstein R. PMID: 12890124 [/fusion_builder_column][PubMed – indexed for MEDLINE Migraine and depression. Frediani F, Villani V. Neurol Sci. 2007 May;28 Suppl 2:S161-5 PMID: 17508165
- Recent advances in understanding migraine mechanisms, molecules and therapeutics. Goadsby PJ. Trends Mol Med. 2007 Jan;13(1):39-44. Epub 2006 Dec 1 PMID: 17141570
- Chronic headaches: pharmacological and non-pharmacological treatment. Grazzi L, Usai S, Bussone G. Neurol Sci. 2007 May;28 Suppl 2:S134-7 PMID: 17508160
- Behavioral approaches to the treatment of migraine. Semin Neurol. 2006 Apr;26(2):199-207 Holroyd KA, Drew JB. PMID: 16628530 [PubMed – indexed for MEDLINE Botulinum toxin type A in chronic migraine. Expert Rev Neurother. 2007 May;7(5):463-70 Freitag FG. PMID: 17492897 [PubMed – indexed for MEDLINE]
- Botulinum toxin type A in prophylactic treatment of migraine. Am J Ther. 2006 May-Jun;13(3):183-7 Anand KS, Prasad A, Singh MM, Sharma S, Bala K. PMID: 16772757 [PubMed – indexed for MEDLINE]
- Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial. Pain Pract. 2006 Jun;6(2):89-95. PMID: 17309715 [PubMed – indexed for MEDLINE] Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tawfik OM.
- Intranasal sphenopalatine ganglion block: minimally invasive pharmacotherapy for refractory facial and headache pain. J Pain Palliat Care Pharmacother. 2006;20(3):57-9 Obah C, Fine PG. PMID: 16931483 [PubMed – indexed for MEDLINE]
- Sphenopalatine endoscopic ganglion block: a revision of a traditional technique for cluster headache. Felisati G, Arnone F, Lozza P, Leone M, Curone M, Bussone G. Laryngoscope. 2006 Aug;116(8):1447-50 PMID: 16885751
- Therapeutic blockade of greater occipital and supraorbital nerves in migraine patients. Caputi CA, Firetto V. Headache. 1997 Mar;37(3):174-9 PMID: 9100402
- Fibromyalgia Treatment Update. PMID: 17278924. Curr Opin Rheumatol. 2007 Rooks DS. Mar;19(2):111-7. Study finds acupuncture improves fibromyalgia symptoms. PMID: 17102788. Mayo Clin Womens Healthsource. 2006 Dec;10(12):3.
- Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. PMID: 16770975 Mayo Clin Proc. 2006 Jun;81(6):749-57.
- Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. PMID: 17549233 Evid Based Complement Alternat Med. 2007 Jun;4(2):165-79. Epub 2007 Feb 5 Tsao 2007
- Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. PMID: 16078356 J Rheumatol Suppl. 2005 Aug;75:6-21.
- Mease 2005 An open, pilot study to evaluate the potential benefits of coenzyme Q10 combined with Ginkgo biloba extract in fibromyalgia syndrome. J Int Med Res. 2002 Mar-Apr;30(2):195-9 Lister 2002