Headaches: Understanding pain in your head
Have you been experiencing headaches? If so, you’re definitely not alone. Over 90 percent of adults experience headaches in their lifetime. There are many causes, which doctors break down into two categories: Primary and secondary. There are three types of primary headaches: migraine, tension-type, and cluster headaches. Secondary headaches are those that result from some other process in the body, such as infection or trauma. It is important for you and your doctor to figure out which type of headache you have, because some headaches are symptoms of serious illness, and also because for all headaches the cause determines the appropriate treatment.
Tension-type headaches usually feel like a mild- to moderate-headache, pressing or tightening pain on both sides of the head — maybe like a belt being tightened around your head. Stress, bright lights, noise, and strenuous activity, such as intense exercise, can make tension-type headaches worse. They tend to occur later in the day and can last anywhere from 30 minutes to a whole week.
Migraine headaches are typically a moderate to severe, throbbing or pulsating pain on one side of the head — maybe like a hammer repeatedly hitting one side of your head. Migraines sometimes have triggers, such as bright lights, noise, certain foods or odors, exercise, lack of sleep, or menstruation in women. Some people may experience an “aura” — or warning sign — prior to the onset of pain. Migraine auras are varied and may include visual changes such as blurry lines or distorted images, sensory changes such as tingling, ringing in the ears. In some cases, migraine aura may mimic the symptoms of a stroke with symptoms such as confusion or weakness. In those cases, it is most important to seek emergency medical evaluation to rule out a more serious cause of the symptoms.
Migraine headaches typically have triggers. Bright lights, noise, and routine activity, such as walking or climbing stairs, can worsen migraines. Migraines usually last between 48 and 72 hours without treatment, and the pain goes away completely between episodes. Another clue that points toward migraines is nausea or vomiting during the headache.
Cluster headaches are less common than tension-type and migraine headaches. They usually last between 15 minutes and three hours and are characterized by deep, excruciating pain behind or around one eye. The pain may be associated with tearing or redness of the eye or runny nose, both on the same side as the pain.
The treatment and prevention of primary headaches depend on the type. Your doctor can help you correctly diagnose and find the appropriate prevention and treatment plan for the type of headache you are experiencing.
Any headache that occurs as a result of another process happening in the body: exposure, toxic ingestion or traumatic injury, is referred to as a secondary headache. An easy way to remember this is that in secondary headaches, the pain is a result or symptom of the problem — not the cause of the problem. Secondary headaches may have very benign causes or may be warning signs of other, serious or life-threatening illness. It’s your doctor’s job to determine the cause and provide the appropriate treatment of the cause. Some common causes of secondary headaches include sinus or other infections, tumors, glaucoma, side effects of medications such as birth control pills, steroids, antidepressants, and many more. Another very common cause of headaches that we don’t often think about is overuse of pain medications. Overuse of pain medications is defined as taking over-the-counter medications for pain (e.g. ibuprofen/Advil/Motrin, acetaminophen/Tylenol, naproxen/Aleve, etc.) more than 15 days per month, or as taking prescription pain medications (e.g. opiates, barbiturates, triptans, etc.) more than 10 days per month. If you identify with this and experience frequent headaches, you should consider stopping these medications. It seems pretty ironic that using too much pain medication can actually cause pain, but it’s true.
All of us have experienced a headache and worried about something more serious. Fortunately, headaches are usually nothing to worry about. In fact, less than five percent of headaches are the result of a serious medical problem. However, you should get to your doctor’s office in a hurry if you have any of the following “red flag” symptoms: fevers, change in weight, neck stiffness, numbness, weakness, tingling, clumsiness, confusion, personality change, change in vision, sudden onset of new or severe headache, significant increase in pain when you lie down or bend over, constant headache that never goes away, or personal history of head trauma or fall, cancer, immunodeficiency, or bleeding disorder.
If you have been experiencing headaches without any of the above red flags, the first thing you should do is keep a diary. Write down the quality, location, severity, and time course of the pain, along with any associated symptoms or things that worsen or improve your headache. This information will be very helpful for you and your doctor to figure out what is causing your headache and what is the best strategy to help improve your pain.
The most important things you can do to help treat benign headaches are to sleep between seven and nine hours each night, drink plenty of water, avoid skipping meals, and exercise daily for at least 30 to 40 minutes. These important lifestyle changes are proven to help with headaches. In addition, it is important to talk to your doctor about any problems you may have with sleep, mood, or anxiety, as these can contribute to headaches. Regular deep breathing exercises have also been shown to improve headaches. Other treatments, such as physical therapy, acupuncture, meditation, and massage, may also help. There are medications you can buy without a prescription and take to treat a headache after it comes on. These include NSAIDs (e.g. ibuprofen/Advil/Motrin, naproxen/Aleve, etc.) and acetaminophen/Tylenol. However, it is important to remember that using these medications too often can actually cause headaches! If you have frequent headaches, there are some prescription medications you can try to prevent the headaches from happening in the first place.
Talk to your doctor about which of these medications might be right for preventing your headache.
Medical Content edited by Dr. Mark Clark, Medical Director, Block Island Medical Center.