Headaches

(Tension Headache, Sinus Headache, Migraine, Cluster Headache)

The Facts

Headaches are extremely common – most people have a headache at some time in their life. Most headaches disappear on their own (with a little time) or with the help of mild pain relievers. Although most headaches are mild and temporary annoyances, some people have headaches that are so severe they need to consult a doctor for pain relief.

Children can also have headaches, some well before they reach the age of 10. Research shows that before puberty, headaches are more common in boys, but that trend is reversed after puberty. Adult women experience more headaches than adult men, and they're often linked to a woman's menstrual cycle. With advancing age, both women and men tend to have fewer, less severe headaches.

Headaches come in various forms: tension, migraine, sinus, and cluster headaches. In a small number of cases, headaches may signal a more serious condition that requires immediate medical attention.

The Causes

Headaches can be triggered by a variety of factors. The most common cause of headaches is prolonged tension or stress. These are called tension headaches or muscle-contraction headaches. Virtually everyone suffers from this at some time. Muscles in your scalp, neck, and face tighten and contract, causing spasms and pain.

Psychological factors such as anxiety, fatigue (e.g., eyestrain), and stress (e.g., long periods of concentration) as well as mechanical factors such as neck strain (e.g., working on a computer for prolonged periods) are often the culprits behind a typical tension headache.

Migraines are generally more severe and can be debilitating. The cause of migraines is not known but many trigger factors are recognized. These include hormonal changes (during a woman's menstrual cycle or triggered by oral contraceptives), certain foods (e.g., chocolate, aged cheeses), beverages (e.g., red wine, coffee), strong odours, lack of sleep, mild traumatic brain injury (e.g., concussion), and even stress. It is not uncommon to experience mixed tension-migraine headaches.

Sinus headaches are less common than people think. Many people with sinus headaches actually have migraine headaches. They can occur after a bout of upper respiratory infection, such as a cold. Along with the headache, people often have a runny or stuffy nose. Sinus headaches are caused when bacteria invade and infect the nasal sinuses.

Cluster headaches are an uncommon type of headache. They more often affect men, run in families, and tend to occur in clusters over a few days, weeks, or months separated by long headache-free periods lasting from months to years. The cause is not known.

So-called "ice pick" or primary stabbing headaches are severe headaches that occur suddenly, causing a few seconds of intense pain at a small, localized spot. The exact cause of these headaches is unknown, but they are usually not due to a serious problem.

Headaches may occur due to an underlying health condition. This type of headache is called secondary headache. Some of the conditions that may cause headache include dental infection, brain tumors, meningitis, and fever. Secondary headache can also arise from certain medications such as nitrates and proton pump inhibitors.

Symptoms And Complications

Tension headaches generally cause a constant pressure or a dull ache that affects the entire head. In most cases it begins slowly, with the ache usually focused above the eyes. There's a feeling of tightness across the forehead or at the back of the neck. The ache can last for hours or days at a time, with mild-to-moderate pain that is not worsened by activity and that typically improves when the source of tension is relieved.

Cluster headaches occur in "clusters" or groups, with pain lasting about 15 minutes to three hours at a time. The ache or pain is limited to one side of the head and can be extremely severe. They are often accompanied by other symptoms on the side of the headache such as redness and tearing of the eye, drooping eyelid, and nasal stuffiness and dripping.

Migraines range from mild to severe. They often occur as one-sided head pain but can sometimes affect both sides. The location, duration, and intensity of pain vary widely from person to person as well as from one episode to another. Migraine is usually a pulsating pain, often with other symptoms such as nausea, vomiting, visual disturbances, and hypersensitivity to light, noise, and smells. A migraine attack can last from hours to days, averaging from 4 hours to 3 days per episode. They're often so severe and incapacitating that many migraine sufferers are unable to carry out normal daily activities.

Migraine headaches are divided into 2 categories: migraine with aura and migraine without aura. Some people experience a pre-headache stage known as an aura, which can last about5 to 60 minutes. A typical aura includes visual disturbances such as blind spots, zigzag flashes, and light sparks. The aura normally clears as the headache starts, but there can be some overlap. Sometimes the aura will occur without a headache but more often no aura occurs before the headache.

It's critical that you seek emergency medical care if you experience a headache that:

gets worse over days or weeks
is accompanied by impaired neurological function (e.g., loss of balance, weakness, numbness, or speech disturbance) and double vision (could signal a stroke)
is accompanied by persistent nausea and vomiting or changes in vision
is accompanied by seizures, mental disturbances, and loss of consciousness
is associated with a fever or stiff neck (could signal meningitis)
is different than the usual pattern of headaches you have experienced
strikes suddenly with great intensity
wakes you from sleep or is worse when you lie down
has occurred for the first time ever after the age of 50

Making A Diagnosis

If you tend to have headaches that are frequent and severe, your doctor will examine you for any serious, life-threatening conditions (e.g., stroke, meningitis) and start emergency care if needed. As well, if you regularly have headaches and experience a change in the pattern of your usual headaches, you should see your doctor.

Typically, a thorough medical history and physical examination is enough for a good diagnosis. Recording headache frequency, intensity, what you think may have triggered them, as well as medications you have tried may help your doctor make the diagnosis. Since tension headaches are very common, your doctor will ask questions about your current stress level and other personal factors (e.g., work) that may be triggering your headaches. Depending on the location, duration, and any accompanying symptoms, the type of headache can be determined.

In some cases, CT scan or MRI (magnetic resonance imaging) may be used to check for serious causes of headache.

Treatment And Prevention

Since tension headaches are caused by factors such as neck strain, stress, and anxiety, treatment involves eliminating the stressful situation, if possible. Taking an over-the-counter pain reliever such as acetaminophen*, ibuprofen, naproxen, or ASA and finding ways to relax, rest, correct poor posture, and exercise regularly can all help to relieve and prevent headache pain.

Cluster headaches respond poorly to over-the-counter medications. Oxygen therapy and prescription medications can help.

Sinus headaches usually require antibiotics or other treatments to clear up the infection. Once the infection is gone, the headache will go away, too. Until the infection gets better, taking an over-the-counter pain reliever can help ease the pain.

Migraines can be treated with over-the-counter pain relievers, such as acetaminophen or ibuprofen, if the headaches are mild.

Other medications may need to be prescribed if the headaches are more severe. These can be divided into acute treatments and preventative treatments. Acute treatments are used to try to stop the headache from becoming more severe and to reduce the pain. These include NSAIDs, triptans (e.g., sumatriptan, zolmitriptan), and ergot derivatives (e.g., ergotamine). Acute treatments should be used no more than 10 to 15 days per, month depending on the medication. If used more frequently, they can actually cause headaches called medication overuse headaches.

If you are using acute treatment more than 10 to 15 days per month or you have severely debilitating headaches, your doctor may suggest preventative treatment that is used on a regular basis. The goal of this treatment is to reduce the number of headaches. Some preventative therapy options include beta blockers, anti-depressants, calcium channel blockers, angiotensin-related agents, triptans, anesthetics, monoclonal antibodies, and anti-epileptic medications.

Botulinum toxin (e.g., Botox) is sometimes used for people with chronic migraines (more than 15 days per month) to help reduce the frequency and severity of headaches.