Everything You Need to Know About Headaches

A person with a headache has discomfort or pain beneath the scalp or forehead, behind the eyes, or arising from the head or upper neck. While headaches may occur occasionally or frequently, they are still the most common nervous system disorder, afflicting half of the adult population at least once a year, according to the World Health Organization. (1)

The most common cause of headaches is muscle tension. Other common causes of headaches include fever, head injury, viral infections, sinusitis, and migraines. Headaches can be the body’s reaction to emotional stress, grief, too much or too little sleep, or depression. Some people get a headache after physical exertion, crying, eye strain, or sex.

There are several distinct types of headaches.

Tension Headaches

Most people experience the occasional tension headache. Some people, however, have tension headaches just about every day, and these are considered to be chronic. Symptoms for tension headaches usually include pressure or muscle tension on both sides of the head or the back of the neck. The pain is usually constant, not sharp or throbbing. Many people describe tension headaches as having a band squeezed around their head.

Hormone Headaches

Hormones play a role in the pain response to headaches in both men and women. However, women can suffer from hormone headaches, also known as menstrual migraines. These migraines may start before a woman’s period or during menstruation. Symptoms include sharp, throbbing pain on one side of the head, nausea, vomiting, and sensitivity to light, sound, and even touch.

Cluster Headaches

Cluster headaches affect men more often than women. They are extremely intense, very severe headaches that last between 30 and 45 minutes; a person can have several in one day. They usually come on with no warning, catching people by surprise. The pain is piercing and usually located on one side of the head, often around the eye. People also report teary eyes on the affected side and sinus congestion. The headaches will recur over a period of time, almost always on the same side, and are followed by a headache-free period of varying length.

Migraines are a type of headache often put in a class by themselves because of the intensity of the pain and the overall effect they have on the body. (4)

For some people, migraine symptoms include auras, which are symptoms that occur before the pain hits. The auras can be visual (seeing lines or spots), or they can cause motor or verbal disturbances. It’s estimated that 36 million people in the United States have migraines. However, most do not have migraines with auras.

Migraine pain, usually throbbing and piercing, is generally one-sided, but it can affect both sides. People often report sensitivity to light and loud noises as well as nausea during migraine attacks.

A migraine attack will typically last from 4 to 72 hours. However, migraines can last for several days. (4)

Learn More About Migraines

Headaches may be primary or secondary.

A primary headache is caused by pain or a disorder that originates from the head itself — for example, a migraine or tension headache.

A secondary headache originates outside the head, such as a headache related to nausea from the flu or as a side effect of hormonal fluctuations in the body.

Neurologists have identified 17 discrete types of headaches, each with their own causes and treatments: (5)

1. Primary tension headaches that are episodic
2. Primary tension headaches that are chronic
3. Primary muscle contraction headaches
4. Primary migraine headaches with aura
5. Primary migraine headaches without aura
6. Primary cluster headaches
7. Primary paroxysmal hemicranias (a type of cluster headache)
8. Primary cough headaches
9. Primary stabbing headaches
10. Primary headaches associated with sexual intercourse
11. Primary thunderclap headaches
12. Hypnic headaches (headaches that awaken a person from sleep)
13. Hemicranias continua (headaches that are persistently on one side only, right or left)
14. New daily-persistent headaches (a type of chronic headache)
15. Headaches from exertion
16. Trigeminal neuralgia and other cranial nerve inflammation (causing facial pain)
17. Secondary headaches due to trauma; disorders; infection; structural problems with the bones of the face, teeth, eyes, ears, nose, sinuses, or other structures; substance abuse or withdrawal; or systemic poisoning (toxic headache)

The key to getting treatment for a headache is identifying the underlying cause. (6)

Headaches can be caused by inflammation or irritation of structures that surround the brain or affect its function. They can also be caused by colds or the flu, fever, muscle stiffness in the head or neck area, dental or jaw pain, trauma to the head or neck, sinus infections, bleeding in the brain, or infections like encephalitis or meningitis.

Headaches can also be brought on by toxins, such as too much alcohol, smoking, or the consumption of allergenic or spoiled foods. Headaches can be the first sign of carbon monoxide or other environmental poisons, and they may be triggered by substance abuse or withdrawal.

General treatment for a minor headache includes rest, stress reduction, cold compresses, massage to the temples and head area, acetaminophen (Tylenol), and nonsteroidal anti-inflammatory medications (NSAIDs).

Headache prevention includes good habits such as eating healthy foods and avoiding alcohol and cigarettes. Eliminate external stressors as much as possible, and try to practice regular sleep habits. Additional treatment for headaches may include medications for migraine headaches and narcotic pain medications.

Head pain can be frightening because people often think that it could be the sign of something serious.

“A person with headaches should always discuss this issue with their physician,” says Steven P. Herzog, MD, an attending neurologist at Baylor University Medical Center in Dallas. "In turn, their physician can make a correct diagnosis of the type of headaches the patient is suffering with and whether or not they should see a headache specialist.”

Call your doctor if the quality or type of headache symptoms change or if you feel that you are having migraines, which may need prescription-strength treatment.

Other reasons to contact your doctor include these events:

• Any changes in the type of headaches you usually get
• Headaches that don’t go away or that get worse as each day passes
• Headaches that occur with physical activity (including sex)
• Headaches that happen after injury or illness
• Headaches accompanied by a fever, a stiff neck, signs of a stroke (such as difficulty speaking, numbness, or weakness), seizures, or changes in your vision
• Worsening of your headache if you have to strain, as when having a bowel movement, sneezing, or coughing
• New headaches if you’re over 40
• The headache is the worst in your life
• Headaches associated with very high blood pressure (if you are checking it at home)

People living with headaches or migraines can benefit from reliable resources offering information and support. Many organizations provide educational materials and can assist in finding doctors specializing in migraine care. There are also online communities that offer support as well as practical advice and tips.

Learn More About Headache and Migraine Resources

Additional reporting by Marijke Vroomen-Durning, RN