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There are several different types of headaches. Migraines and tension headaches are the most common. Other types are cluster headaches and rebound headaches.
Tension headaches often are brought on by stress. They frequently start in the middle of the day. They may be mild or severe, and get worse over time.
A cluster headache is a rare type of headache. Cluster headaches typically start all of a sudden and occur once or more each day for a period of time. Often, they occur at the same time(s) each day. The period can last 4 to 8 weeks, or up to 12 weeks.
On average, each headache lasts about 45 to 90 minutes. The most common times for cluster headaches to occur are between 1 and 2 a.m. and 1 and 3 p.m., and around 9 p.m. Cluster headaches are more common in men than women.
People who have problems with medicine or substance abuse get rebound headaches. These headaches occur most days early in the morning.
Symptoms of headaches
The main symptom of headaches is head pain. Other symptoms vary, based on the type.
Migraines are defined by pounding or pulsing head pain. The pain may begin in your forehead, the side of your head, or around your eyes. Migraines often get worse and are hard to get rid of. Movement, bright lights, and loud noises can make the pain worse. Nausea and vomiting are common. You also may have blurry vision or be lightheaded.
The pain from tension headaches is constant and dull. You may feel it on both sides of your head or around your head, like a band. In addition to pain, you may feel tightness or pressure. The headaches can cause aches in your jaw or neck.
The pain from cluster headaches often is severe. It may occur behind or around one or both eyes. The headaches can cause your eyes or nose to become red and swollen. They also can make you feel restless.
The pain and symptoms from rebound headaches can vary. Nausea and vomiting are common. You may be anxious, irritable, or depressed, or have trouble sleeping.
What causes headaches?
The exact cause of headaches varies and is not always known.
Migraines may be caused by:
- change in body chemicals
- environmental factors.
A lot of factors can cause tension headaches. These include:
- sleep problems
- sinus and allergy problems
- stiff or sore muscles, which can be brought on by jaw clenching or poor posture
- hormonal changes in women
- certain medicines
- certain foods and beverages.
Cluster headaches do not appear to be related to health conditions or diseases of the brain. Some of the triggers of cluster headaches include:
- taking certain medicines, such as nitroglycerin
- heavy smoking
- drinking alcohol
- a change in your normal sleep pattern
- abnormal levels of certain hormones
- problems with your hypothalamus, which is the part of your brain that controls your body’s “biological clock.”
Overuse of medicine is the main cause of rebound headaches. Be careful taking too much of certain medicines. These include:
- pain medicines
- over-the-counter medicines
- ergotamine medicines.
If you get rebound headaches, these medicines should not be taken more than 2 days per week. Talk with your doctor to find out if you should stop taking these medicines altogether.
How are headaches diagnosed?
Your doctor often can tell what kind of headache you have. They do this by examining you and reviewing your symptoms. It may help if you keep track of the time and pattern of your headaches, as well as how they feel. This can help determine what the causes, or triggers, are and how to treat them. It also helps to rate your level of pain on a scale.
In rare cases, the doctor may perform tests to aid in a diagnosis. These could include lab tests to check your blood or chemical levels. They also could include imaging tests, such as X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) scans.
Can headaches be prevented or avoided?
If you know what triggers your headaches, you should avoid these things.
The most common treatments for headaches are rest and over-the-counter pain relievers. These include aspirin, acetaminophen, ibuprofen, and naproxen. Always check the label when choosing an over-the-counter pain reliever. You want to look for side effects or possible drug interactions with other medicines you take. Make sure you read and follow the directions on the label carefully. If you have any questions, ask your doctor or pharmacist.
Keep in mind that children should not take aspirin. It can cause a serious illness called Reye’s syndrome in children younger than 18 years of age.
It is best to treat headaches when they begin or when they are still mild. It is harder to treat and get rid of headaches once the pain is worse. Talk to your doctor if these common treatments don’t work. They can suggest a different treatment option.
Certain prescription medicines can prevent headaches. Examples include:
- Tricyclic antidepressants, such as amitriptyline and nortriptyline.
- Antiepileptic drugs, such as valproic acid, gabapentin, and topiramate.
- Beta blockers, such as propranolol.
These medicines can help prevent or reduce the number of headaches you get. It can take 6 weeks or more for the medicine to start working. Talk to your doctor about whether one of these medicines is right for you. It is important to follow your doctor’s instructions. Most prescriptions need to be taken each day. Always carry your medicine with you in case you get a headache.
Several treatments are available for people who have cluster headaches. Work with your doctor to discuss the pros, cons, and side effects. Select the right treatment for you and set up a schedule for prescription medicines.
Your doctor will probably prescribe two medicines. The first medicine is preventive. You take it regularly during the entire cluster period. It helps to reduce the number of headaches you get. The second medicine is reactive. You take it to relieve the pain that occurs from a cluster headache.
These medicines can be very effective. They can reduce the number of headaches you get as well as the severity. Cluster headaches often begin quickly. You may not be able to get medical help, so you should have your medicine available. Take this as soon as an attack begins. You may want to tell family or friends about your headaches and medicines. This way, they can help you when you have an attack. For some people, oral medicines (taken by mouth) do not work fast enough. For this reason, your doctor may prescribe another form of medicine. This could be a nasal spray, injection (shot), or rectal suppository. Another treatment that works for some people is a local anesthetic. This is a numbing medicine that you apply to your nose.
At the start of a cluster headache, inhaling pure oxygen through a mask can help prevent the attack. However, this is not always practical, since the headaches come on quickly.
Living with headaches
Some types of headaches can be very painful. This is especially true if you get them on a regular basis. However, most people cope well with the right treatment.
In addition to medicine, a fixed daily routine can help manage your symptoms and prevent headaches. For instance, eating meals at regular hours. Other options include:
- Putting a heat or ice pack on your head or neck.
- Taking a hot shower or bath.
- Going to bed and getting up at the same time each day.
- Getting enough rest or sleep.
- Avoiding things that cause stress and/or doing things that relieve stress.
- Never skipping a meal. Fasting is a common cause of headaches.
- Drinking plenty of water. Dehydration also can cause headaches.
- Getting regular exercise of all types. Aim to get at least 30 to 60 minutes of exercise 4 to 6 times a week.
Some patients try alternative options for headache relief. Examples include acupuncture or chiropractic treatments. Talk to your doctor about the potential risks and benefits of these treatments. Keep in mind that not all alternative treatments are proven effective. For instance, herbal medicines are not tested by the U.S. Food and Drug Administration (FDA). Ask your doctor about taking herbal medicines. They can check for drug interactions with other medicines you take.
Another alternative treatment form is mind-body therapy. This focuses on the connection between your mind and body. You can do some types of mind-body therapy on your own.
- Meditation. Close your eyes, take deep breaths, and focus on your breath or a positive thought.
- Relaxation. Allow your muscles to release tension by applying heat or cold to the area. If heat works, take a hot shower or bath. Use a heating pad on a low setting or a hot water bottle. If cold works, try a cold pack wrapped in a thin towel to protect your skin.
- Massage. Rub your head and temples or the muscles in your neck and shoulders. Massages help release tension and pressure, and relieve aches.
Other types of mind-body therapy are biofeedback and cognitive behavior. Biofeedback is a technique where you use your thoughts to control your body. Biofeedback may help with physical and mental health problems. Cognitive behavior therapy is a form of counseling called talk therapy. It may help you identify triggers so you can stop them before headaches occur. Cognitive behavior therapy can help ease stress and treat health problems.
Questions to ask your doctor
- What type of headaches do I have, and what is the cause?
- What can I do to prevent headaches? Can exercise or other lifestyle changes help?
- What is the best treatment option for me?
- Should I keep a headache journal?
- Can alternative medicines or treatments help me?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.