They can range from mild and nagging to fierce and nauseating. There’s no telling when one will strike, or how severe it will be. We’re talking about headaches – and they’re a real pain. Here's how to identify and treat specific headache types.
With some headaches, you’re still able to function, although the throbbing in your head may distract you a little. With others, you’re in agony: nauseated, dizzy, feeling like you can’t possibly carry on your normal activities. There are different types of headache, each with different characteristics, and they need to be treated accordingly or you won’t find much relief. So how do you know what type of headache is plaguing you – and what can you do to soothe it?
Types of Headaches
When trying to describe such a pain, “I have a headache” is a pretty broad statement. There are many different kinds, each a nuisance in its own right. Each is brought on by something different, and therefore require different methods of treatment.
Cluster Headaches
Cluster headaches are aptly named, because the attacks come in groups – a.k.a. “clusters.” This type of headache can hit you like a Mack truck, seemingly coming out of nowhere with no advanced warning. This has been described as the worst type of headache pain, more severe than any others. During a cluster period, a sufferer may have up to four headaches per day, each episode lasting anywhere from thirty to forty-five minutes.
Cluster headaches affect far more men than women – about five to one. They usually begin between the ages of 20 and 45. They occur most often during the spring and fall, which makes people tend to associate them with allergies (but this is a misconception – they aren’t caused by allergens). Unfortunately, about ten percent of cluster headache sufferers have headaches year-round.
They come on most commonly in the morning or late at night. Sufferers can have this sort of headache for days, even weeks on end; this is called a cluster cycle. When a cluster cycle is over, a person may not get this type of headache again for months or even years.
Clusters are normally unilateral, only occurring on one side of the head, and the side doesn’t vary from cluster to cluster; if you get one on the right side, it will most likely be on the same side again next time. The pain may begin in or around one eye, and that eye may be bloodshot or watery.
The nostril on the side of the headache may also begin to run. The pain usually radiates from the eye to the forehead, temple, and cheek. It’s so excruciating, sufferers say, that they can’t even sit still and sometimes are even compelled to bang their heads against something.
Experts know very little about the exact causes and factors influencing cluster headaches. Unlike migraine headaches, which we’ll discuss later, clusters aren’t the product of heredity. Sufferers of clusters do tend to have a couple of things in common: a history of chronic smoking, and the use of alcohol.
There may be a link between histamines, which dilate or expand the blood vessels, and cluster headaches; the levels of histamine in the blood and urine increase during an attack. But histamines aren’t thought to be the leading cause of the headaches, just an influence. Antihistamines aren’t an effective treatment.
There are two types of treatment for any type of headache: preventative – which, as the name implies, helps to stop headaches before they begin – and abortive, which helps stop a headache in progress. Preventative care includes taking prescribed medications according to direction, avoiding the known causes of headaches, and learning self-help measures. Abortive care just involves getting rid of the headache you already have.
For cluster headaches, the following medications are prescribed:
Preventative treatments:
Verapamil
Prednisone
Ergotamine tartrate
Lithium carbonate
Divalproex Sodium
Histamine acid phosphate
Abortive treatments:
Oxygen
Dihydroergotamine
Sumatriptan
Lidocaine
Now for a bit of good news: less than one percent of the population gets cluster headaches.
Tension Headaches
Tension Headaches are the most common form, with an estimated two-thirds of all people experiencing this type of headache at some point in their lives. They’re usually responsive to over-the-counter analgesics. The bad thing is that since they’re so common, many people don’t seek medical attention because they think tension is the source of their headache – when really it’s caused by something entirely different.
There are two types of tension headaches: episodic and chronic. The main distinguishing difference between episodic and chronic tension headaches is the frequency and severity with which they occur.
Episodic headaches:
Occur randomly, and are usually brought on by temporary stressors such as fatigue, anxiety, or anger.
Are generally felt either in the temples and forehead, or the back of the head and the neck.
May include a “vice-like” tightening sensation around your head, and feelings of pulling or pressure (this is why they’re also referred to as “muscle contraction headaches”).
Can be eased with over the counter medications and self-managed fairly well.
Chronic headaches:
Occur just about every day, possibly for months on end.
Do not respond as well to over the counter medications.
Require a doctor’s care.
There are many physical factors that contribute to a tension headache, including …
Poor posture
Holding the head or neck in an abnormal position for a long period of time
Arthritis
Eyestrain
Misalignment of jaws or teeth
Lighting or noise levels
Abnormalities in the bones, muscles, or discs of the neck and back
There are also emotional factors, things which cause excess stress on the body, such as grief, depression, and job or relationship conflicts. The undue stress can manifest itself in the form of a headache.
Treatments of tension headaches range from drugs to alternative therapies such as relaxation techniques.
Preventative treatments:
NSAIDS (nonsteroidal anti-inflammatory agents):
Fenoprofen
Flurbiprofen
Ketoprofen
Naproxen
Nabumetone
Oxaprozine
Antidepressants:
Protryptaline
Desipramine
Amitriptyline
Doxepin
Nortriptyline
Imipramine
Fluoxetine
Sertraline
Paroxetine
Nefazodone
Venlafazine
Citalopram
Escitalopram
Trazodone
Bupropion
Phenelzine
Abortive treatments:
NSAIDS:
Ibuprofen
Diclofenac
Ketorolac
Flurbiprofen
Meclofenate
Muscle relaxants/analgesics:
Carisoprodol
Orphenadrine citrate
Chlorzoxazone
Methocarbamol
Cyclobenzaprine HCL
Metaxalone
Baclofen
Migraine Headaches
Migraine headaches affect approximately twenty-eight million people in the United States alone; they’re the kind of headache that can bring your daily activities to a screeching halt. Since four out of five sufferers report a family history of this type of headache, there is a theory that the predisposition toward migraines may be genetic. Women tend to experience migraines three times more frequently than men, which is most likely due to hormonal factors. Some experts even posit that there is a type of “migraine personality” – a person who, according to certain traits, is more likely to get migraines. People with so-called “migraine personality” are perfectionists, critical, orderly, analytical, and high-strung. The generally high anxiety and tension level that these types experience may contribute to the headache.
For seventy percent of sufferers, migraines occur on only one side of the head (unilateral pain). Migraines happen when there are biochemical changes in the brain. Such changes prompt the trigeminal nerve to trigger other changes: the rate of blood flow shifts, distending the blood vessels. This distention causes the nerves around the blood vessels to release chemicals that cause a slight inflammation, prompting the brain to produce pain signals.
There are many different types of migraine (unfortunately, they’re all equally painful). They all share a few basic symptoms, but each type has its own differentiating characteristics. Generally, all migraines begin the same way: a dull ache that, over a period of a few minutes, turns into a throbbing or pulsating pain that’s located in the temples and the back or front of one side of the head. The two most prevalent types of migraine are the common migraine and the classic migraine.
Common migraines (also known as migraine without aura): These are “regular” migraines. They’re caused by changes in the size of the arteries in the brain. These headaches last for three to four hours (or longer, depending on the severity; some can actually last for a week!). There’s no real pattern to when they occur; they can happen at any time of day.
Classic migraines (also known as migraine with aura): The only feature that distinguishes this from a common migraine is that sufferers see an aura before the headache begins. The aura – or visual disturbance – is caused by neurological symptoms, and begin anywhere from five to thirty minutes before the onset of a migraine. They can manifest as wavy lines, dots, flashing lights, tunnel vision, or blind spots. In more severe cases, a person’s neurological disruption can be really frightening – there may be a tingling or “pins and needles” feeling in the head, visual or auditory (sound) hallucinations, even trouble remembering words. These symptoms can last for up to an hour, but normally fade away when the actual headache begins.
Opthalmoplegic migraines: With this relatively rare type of migraine, the pain is centered in the eye. It surrounds the eye socket and may even cause temporary paralysis in the muscles around the eye. These symptoms can be caused by pressure on the nerves located in the back of the eye, so medical attention should always be sought if this type of migraine occurs.
Hemiplegic migraines: This type is also relatively rare, and very severe. Sufferers of hemiplegic migraines get an aura before the onset of the headache. Its distinguishing feature is that, in addition to the aura, it causes temporary motor paralysis or sensory disturbances on one side of the body immediately before the headache hits. This type especially seems to run in families.
Retinal migraines: This type begins with a loss of vision in one eye. It can be either complete or partial loss, but is always temporary. The pain will be a dull ache concentrated behind the eye and sometimes spreading to the rest of the head.
Basilar artery migraines: Very rare, this form of migraine tends to strike adolescent girls and women in their early twenties, since it is most likely related to hormonal influences. It’s among the most frightening type of migraine for those who aren’t accustomed to them; symptoms include dizziness, confusion, the inability to balance, the inability to speak correctly, vomiting, visual problems, ringing in the ears, and a throbbing pain centered in the back of the head. Basilar artery migraines come on very suddenly. They usually go away as the sufferer reaches adulthood, and are generally replaced by classic migraines.
Abdominal migraines: Did you know that migraines don’t always have to be centered only in the head? That’s the case with abdominal migraines – as the name implies, they’re initially felt in the abdominal area. That’s why this type is often difficult to diagnose, because its symptoms – nausea, vomiting, and diarrhea – can be easily mistaken for other problems. The symptoms show up as a forerunner to a migraine, and can last for hours at a time. This type is most prevalent in children.
Migraine sufferers can usually tell what triggers their headaches, and learn to avoid those triggers. Some of them include:
Extreme fatigue
Stress
Oversleeping
Skipping meals
Caffeine
Alcohol
Chocolate
Hormonal changes
Changes in barometric pressure
Changes in altitude
Menstruation
For many migraines – about thirty percent – food is the culprit. To avoid eating yourself into a headache, doctors recommend turning your nose up at any food containing the following:
Additives
Nitrates, found in processed meats; yellow food coloring, also known as “annatto”; and MSG, typically found in Chinese foods, canned or processed foods, soy sauce, and meat tenderizer.
Tyramine – a substance naturally found in the body that helps to support blood pressure and is also found in certain foods, such as:
Tyramine is also found in the following foods, but in lower amounts, making them safe for the migraine sufferer to eat in moderation:
Avocados
Bananas
Citrus fruit
Figs
Raisins
Red plums
Raspberries
Chocolate
Migraine headaches are treated with a huge variety of different medications. They’re available in just about any form ranging from nasal sprays to tablets to injections.
Preventative treatments:
Beta blockers (such as Propranol and Timolol)
Calcium channel blockers (such as Verapamil, Nimodipine, and Diltiazem)
Anti-epilepsy medications (such as Divalproex Sodium, Neurontin, and Topiramate)
NSAIDS (such as Ketoprofen, Flurbiprofen, Fenoprofen, and Naproxen)
Serotonin reuptake inhibitors (such as Fluoxetine and Paroxetine)
Abortive treatments:
Over-the-counter medications (such as Ibuprofen and Aspirin/Acetaminophen/Caffeine combinations)
NSAIDS
Glutocorticoids (such as Prednisone and Dexamethasone)
Rebound Headaches
Rebound headaches occur when you over-medicate. It usually goes like this: you have a headache, so you reach for an analgesic such as aspirin, acetaminophen, or ibuprofen, or even a prescription headache medicine. If the medicine helps to relieve your headache, you start to use them more frequently. Perhaps you think, “Hmm … if the dosage on the package works, then a higher dosage would work even better.” Soon you find yourself having to take higher and higher dosages of the medication in order to achieve results. You may even be somewhat addicted, taking the medicine to ward off a headache that you think might come on later. It’s safe to assume that if you’re having to use medication to relieve a headache more than twice a week, you may be overmedicating yourself and inadvertently giving yourself more headaches. The bottom line: always take over the counter medications and prescriptions as directed!
Sinus Headaches
Sinus headaches are caused by – you guessed it! – inflamed sinuses. Sinuses can become inflamed as the result of allergies, infections, or tumors. That inflammation will cause a pain where the sinuses are located: in your forehead, cheek bones, and behind the bridge of your nose. If you have a headache that is caused by blockage of the sinuses, such as from an infection, you’ll probably also be running a fever. But be careful: taking decongestants when your headache isn’t actually a sinus headache can worsen your pain.
Organic Headaches
Organic headaches are extremely rare. They’re caused by abnormalities in the skull or the brain: aneurisms, tumors (both benign and malignant), brain infections, abscesses, meningitis, cerebral hemorrhages. Not all people with these abnormalities experience headaches. Tumors, for example, will only cause a headache if it increases the pressure inside the cranium or intrudes upon the space of the arteries. Headaches caused by tumors will most likely come on quickly, and with breathtaking intensity. It may be aggravated by physical activity or coughing and will get progressively worse.
See your doctor immediately if you experience any of these “red-flag” symptoms:
Sudden, sharp headaches, especially if you get headaches very rarely
Confusion
Seizures
Difficulty in speaking
A sudden lack of balance
Inappropriate and uncharacteristic behavior
Treatment
Counseling/Psychotherapy: Chronic headaches can be caused by depression or stress. Counseling can help a person to identify and eliminate the problem that may be contributing to their headache pain.
Biofeedback: Biofeedback equipment is designed to measure the involuntary physical responses of the body – breathing, heart rate, muscle tension, temperature, and brain activity. It makes you aware of your physical responses and allows you to refine your relaxation techniques accordingly.
Acupuncture: This ancient Chinese procedure (5,000 years old!) is said to block pain by stimulating certain nerves. Tiny, fine needles are painlessly inserted into the skin at specific sites and left there for a period of time. Acupuncture studies indicate that it has a fifty to eighty percent relief rate for people with chronic pain.
Massage therapy: Having a massage, especially in the area of the head, neck, and shoulders, can greatly reduce tension and stress in those areas. This can lead to a reduced occurrence of tension-type headaches.
Relaxation training: There’s more to relaxation than vegging out in front of the TV or reading a book. Relaxation training involves recognizing your body’s responses to stress, and learning how to modify those responses in order to reduce your stress level. There are several types of relaxation training:
Guided imagery – With this technique, you use your “mind’s eye” to visualize yourself pain-free and in a relaxed atmosphere.
Progressive muscle relaxation – A sense of deep relaxation is achieved by first tightening, then relaxing, each muscle group.
Diaphragmatic breathing – This technique involves breathing deeply, slowly, and steadily, concentrating on the movement of the diaphragm. It can be very useful during a headache, because at the onset of pain, breathing usually becomes more rapid and shallow and can actually increase the severity of the headache. Learning to slow down and control the breath can prevent this from happening.
Put a sheet of foil into the freezer until it’s ice cold, then stick it to your forehead for a couple of minutes.
Wrap your head with paper or cloth that’s been soaked in vinegar.
Cut a lime in half and rub it on your forehead.
Put a hot, moist towel on your head.
Put a cool, moist towel on your head.
Rub the muscle between your thumb and index finger.
Lie down in a dark room.
Take a gingko biloba capsule.
Massage essential oil of peppermint, lavender, sage, or rose into your temples.
Take a willow bark capsule.
Drink a cup of coffee, caffeinated tea, or soda.
Boil peppermint leaves in water and then inhale the steam.
Folk Remedies
Modern science, modern schmience! Headaches were around long before any of the medications that we use to treat them. So what did people do before the advent of contemporary medicine? They relied on these (sometimes reasonable, sometimes outrageous) home remedies! Of course, there’s a reason these home remedies aren’t the most widely used method of pain relief any more, so be sure to consult your doctor prior to trying them.
“Do-It-Yourself” Headache Treatments
Rather than turning to drug therapy to treat headache pain, many people prefer to use alternative methods. Some sufferers swear that these treatments are as effective as medication. Sometimes, such treatments are used in conjunction with medication.