Headache

Headache disorders, including migraines, can have many different causes, including changing hormones, stress, hunger, lack of sleep, smoking or frequent use of commonly used pain medications.

Some people suffer migraine headaches after eating foods high in tyramine such as aged cheeses, smoked fish, cured meats and some types of beer.

Everyone gets a headache now and then. But if your headaches are frequent or severe and start to affect your life or your work, it’s time to seek help.

Types of headaches

There are 150 different types of headaches with different headache symptoms and different treatments. Headaches can be classified into two classifications: primary or secondary headaches.

Primary headaches are their own condition, such as migraines, tension or cluster headaches. Hemicrania continua is also a type of primary headache.

Primary headaches

Common primary headaches include:

Tension headaches

Tension headaches are the most common type of headache among teenagers and adults. A tension headache is typically caused by stress and may cause mild to moderate pain that:

• Feels like a band is wrapped around the forehead or back of the head and neck
• Affects the front, top or sides of the head
• Usually begins gradually
• Can last from minutes to days
• Comes and goes over time

Cluster headaches

A cluster headache is extremely painful and may cause intense burning or piercing pain that:

• Is throbbing or constant
• Is located behind one eye or in the eye region
• Lasts for minutes or hours, but may recur multiple times a day
• Occurs regularly, often at night

Cluster headaches occur more often in men than in women.

Migraine headaches

Migraine headaches are known by their intense, throbbing pain, often on one side of the head. However, migraine attacks can cause pain in the whole head or move from one side of the head to the other.

Migraines can be debilitating and can significantly impact your quality of life. A migraine headache can last for several hours to a few days and can be accompanied by symptoms such as nausea, vomiting, sensitivity to light and sound and visual disturbances known as auras.

A migraine aura happens before your headache starts and includes some sensory changes. Your hearing, speaking or vision may be affected, and you may notice weakness or tingling in your muscles at the same time.

What is the main cause of a migraine?

Migraines are believed to involve changes in the brain and the release of certain chemicals, although the exact cause is not fully understood.

While a migraine may be a symptom of another condition, it’s most often its own disorder. In many cases, certain foods tend to cause migraines in some people.

Foods that could trigger a migraine headache include:

• Caffeine
• Monosodium glutamate (MSG)
• Aged cheeses
• Artificial sweeteners
• Some fruits and nuts
• Gluten
• Chocolate
• Cured or processed meats
• Fermented foods, such as wine, kefir, yogurt and kombucha
• Alcohol
• Yeast

Migraine treatments

Migraine treatment options typically include a combination of lifestyle changes, preventive measures and medications to provide relief from migraine symptoms during an attack.

Over-the-counter pain relievers such as ibuprofen, aspirin or acetaminophen may help offer some relief when the headache is mild or moderate.

Triptans are common prescription medications used to relieve migraine pain when the pain is severe. Your doctor may also prescribe other medications to help relieve nausea and other migraine symptoms.

Your provider may prescribe medications to reduce the frequency and severity of migraine attacks. These medications may include antidepressants, anti-seizure drugs, beta-blockers, Botox injections and calcium channel blockers.

Identifying your migraine triggers can also help find migraine symptoms. Some lifestyle adjustments include stress management and creating healthy habits. Some find migraine relief through alternative therapies such as acupuncture or cognitive behavior therapy (CBT).

Secondary headaches

Secondary headaches are headaches that are a symptom of an underlying illness or condition. For example, a sinus headache is a symptom of sinusitis or a sinus infection. Other medical conditions that may cause secondary headaches include:

• AVM (arteriovenous malformation)
• Brain aneurysm
• Brain tumor
• Carbon monoxide poisoning
• Encephalitis
• Glaucoma
• Head injury
• Hydrocephalus (too much fluid around the brain)
• Hypertension (high blood pressure)
• Infections, colds, fevers
• Meningitis
• Narrowing tear, rupture or blockage of blood vessels near the brain
• Sinusitis (inflammation of sinuses)
• Sleep disorders
• Stroke
• Trigeminal neuralgia

Headache triggers

Some things that appear to trigger different kinds of headache pain are:

• Alcohol use
• Allergens
• Caffeine use
• Changes in weather
• Changing sleep patterns
• Depression
• Loud noises
• Neck or back strain
• Perfumes
• Pollution
• Skipping meals
• Some kinds of lighting
• Stress
• Strong smells
• Tobacco and tobacco smoke
• Too much physical activity

Headache emergencies

Go to the emergency room or call 911 if you notice any of these things about your headache:

• Feels like the “worst ever” even if you get headaches regularly
• Starts right after activities like weightlifting, jogging, aerobics or sex
• Gets worse over 24 hours
• Happens after a head injury
• Brings severe pain in one eye along with redness in that eye
• You have a history of cancer and notice a new headache

Other serious things to consider are slurred speech, changes in vision, balance problems, confusion, memory loss, fever, stiff neck, vomiting, nausea, pain with chewing or a headache that starts suddenly.

Headache diagnosis

To help your doctor with a headache diagnosis and develop a treatment plan for the type of headaches you are having, keep a headache calendar or diary.

Write down when you get a headache, how bad it is on a scale of 1 to 10 and what you took to help the pain.

Your doctor will use the information you provide, along with other testing, to diagnose whether you have a migraine headache or any other kind. Some of the tests they may run include:

• Testing blood or urine to identify infections, indicate blood vessel damage or find toxins that affect the nervous system
• Testing the cerebrospinal fluid (fluid that surrounds the brain and spinal cord) to detect infections or bleeding in the skull or measure excess pressure in the skull
• Imaging, like CT or MRI, to check if there are physical abnormalities that may be contributing to your headache

Headache treatment options

Depending on your diagnosis, your doctor may prescribe medication or recommend lifestyle changes for your headache care.

Medications for headaches

Preventive medications are used to reduce the number and severity of headaches. Acute medications are used to stop headaches as soon as possible. Rescue medications are taken when the acute treatment doesn't work.

If a current medication is a trigger for your headaches, your doctor will help you change to a different medication.

If your doctor prescribes medication for your headaches:

• Try to keep current with refills. Having medications on hand avoids having to scramble for refills during an acute headache attack.
• Treat headaches early and aggressively.
• Don't take immediate-relief medications for more than two days per week or else rebound headaches may occur.
• Your doctor may recommend that you take your preventive medications daily.

Treat nausea aggressively. A prescription medication called Reglan is usually the best choice. Even if you do not have nausea, Reglan allows headache medications to be absorbed better, especially if taken 15 to 20 minutes before the other headache medications. Reglan should be taken at the first sign of a serious headache.

Lifestyle changes for headaches

Some of the lifestyle practices we may recommend for treating a headache include:

• Resting with eyes closed or napping in a quiet, darkened room.
• Placing a cool cloth or an ice pack on your forehead.
• Drinking enough water (particularly if you’ve been vomiting).

There are things you can do to help prevent migraines or other types of headaches, such as:

• Stick to a regular sleeping and eating schedule. Try to eat, sleep and wake up at approximately the same time each day.
• Identify your headache triggers and avoid them whenever possible.
• Learn acupressure (finger acupuncture) for headaches. It is simple and often effective for mild to moderate headaches.
• Try to reduce stress in your life. Learn and practice relaxation techniques, such as deep breathing or meditative imagery. Aromatherapy, chiropractic care and biofeedback can be very helpful for people who have headaches.
• Get enough exercise.

Discuss associated medical conditions, such as depression, anxiety, insomnia with your doctor. Successful headache treatment requires that these associated conditions be treated effectively.