A Fix-It Guide to Headaches
What causes headaches?
Headaches feel like they come from deep within the head. But they brain itself has no pain receptors. It's the skin, muscles, and blood vessels that cover the skull and the nerves that run from your brain to your head and face that cause the discomfort we call a headache. Different types include tension headaches, migraines, and cluster headaches. High blood pressure, eye or sinus problems, and brain tumors or infections can also cause head pain in rare cases.
How do I know which type I have?
Each of the three major headache types has different symptoms and responds to different treatments. Here's what you need to know about each:
Why you hurt
Pain results from stress-related muscle tension in the neck, shoulders, and head. Researchers think that fluctuations in brain chemicals called neurotransmitters, which regulate the perception of pain, may also play a role.
- a dull ache frequently described as a vise-like squeezing of the head, sometimes accompanied by a stiff or sore neck
- pain usually above the eyes or in the back of the head
- usually moderate pain
- pain may fade in and out over the course of a day or several days
What to do
For occasional tension headaches, try over-the counter analgesics: aspirin, acetaminophen, or ibuprofen. But be careful not to overuse them; that can lead to so-called rebound headaches (headaches brought on by withdrawal from these medications). For chronic headaches, see your doctor. To help prevent tension headaches, stay away from activities that strain your neck muscles, such as reading while looking down. Consider acupuncture too; some tension headache sufferers say regular treatments lessen both the severity and frequency of their headaches.
Why you hurt
Researchers previously thought migraine pain was a result of the dilation and constriction of blood vessels in the head, but currently it is thought that migraines are due to a disorder in nerve pathways and brain chemicals. Other possible triggers include hormonal changes that accompany menstrual periods (most migraine sufferers are women), oral contraceptives, changes in sleep patterns, skipping meals, changes in weather, bright or flashing lights, excessive noise, stress, and some foods -- particularly chocolate, red wine, aged cheeses, and smoked meats. Your genes may also predispose you to getting migraines. Most people who get migraines are young and female.
- mild to severe pulsing or throbbing pain, usually on one side of the head, that lasts from several hours to several days
- pain usually gets worse if you move around or look at bright light or hear loud noise
- pain often interferes with daily activities; nausea or vomiting can also occur
- headaches are sometimes preceded by visual changes called auras. During an aura you may lose your vision or see shimmering, jagged, or flashing lights or colors. Some people also feel nauseated or irritable right before a migraine begins.
What to do
Over-the-counter pain relievers such as aspirin and other analgesics can be helpful for mild cases. But for frequent or severe migraines, prescription drugs are probably your best bet. Your doctor can help you choose from a wide range, including beta blockers and calcium channel blockers, which keep blood vessels from swelling, and antidepressants, which increase neurotransmitter levels. Acupuncture, relaxation exercises, yoga, biofeedback, and the herbal remedy feverfew may also be helpful. A word of warning about herbal remedies, however: Researchers at a meeting of the American Headache Society cautioned that some herbal remedies may interfere with migraine medications or even make them toxic. So be sure to check with your doctor before taking any kind of herbal supplement. Of course you should also eat regular meals, get plenty of sleep, and avoid foods that trigger migraines for you. Drugs like ergotamine and triptans (such as Imitrex) can help stop a migraine once it starts.
Why you hurt
Cluster headaches are much less common than tension headaches or migraines. Some researchers suspect that people get cluster headaches when they are not getting enough oxygen for some reason. Fluctuating neurotransmitter levels may play a role. Some think the nerve pathways become more sensitive. Others believe that inflammation plays a role. Other suspected triggers include alcohol, cold or hot wind, high altitude, stress, and smoking. Cluster headaches occur most often in spring or fall. Most sufferers are male.
- knife-like pain limited to one side of the head, often in or around one eye, that usually lasts no more than an hour
- headaches in clusters, either several times in one day or for several days in a row, with recurrences at the same time of day, usually for six to eight weeks at a time
- nighttime onset, perhaps painful enough to wake you
- tearing in the eye on the affected side, or redness or swelling around the eye, or a droopy eyelid
- a stuffy or runny nose along with the headache
What to do
To prevent cluster headaches from occurring, doctors usually prescribe migraine medications. Once you have pain, inhaling oxygen can bring relief within a few minutes. Some people benefit from certain types of triptan medicines, such as injectable Imitrex (sumatriptan). Feverfew may ease the pain of cluster headaches, but can have side effects like mouth ulcers.
When should I see a doctor about a headache?
- your headaches get stronger and more frequent
- your headaches last more than 24 hours or recur two or three times per week
- if you also have numbness, blurred vision, memory loss, or dizziness
- if you get a headache after hitting your head
- if exercise brings on the headache
- if your headaches interfere with daily life
- if your headache is accompanied by a fever over 100 degrees, you find it painful to bend your head forward, or light hurts your eyes
- if the headache is accompanied by nausea, vomiting, or drowsiness
- if you have severe pain around one eye with blurred vision
National Institute of Neurological Disorders and Stroke. NINDS Headache Information Page.
American Council for Headache Education.
National Headache Foundation. The Complete Guide to Headache.
Herbal Products May Interfere with Migraine Drugs. Reuters Health Information.
Mayo Clinic. Migraine Headache. http://www.mayoclinic.com/health/migraine-headache/DS00120
About Migraine. Migraine Research Foundation.