Headaches

What are headaches?

A headache is a pain that occurs in your head, upper neck or even your face. There are several different types of headaches. Migraines and tension headaches are the most common. Other types are cluster headaches and rebound headaches.

Migraines

A migraine is an intense, pounding headache. You can get them once or often, and they can last for hours or days. Migraines are more common in women than men.

Tension 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.

Sinus headaches

Sinus headaches are caused by sinus pressure. Your sinuses are small, air-filled spaces located behind your nose, cheekbones, and forehead. When your sinuses get irritated by an infection or allergies, these spaces become swollen. This irritation also triggers your sinuses to begin overproducing mucus. Both of these contribute to sinus pressure.

Cluster headaches

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 may last days 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.

Rebound headaches

People who have problems with medicine or substance abuse get rebound headaches. These headaches occur most days early in the morning. They also are sometimes referred to as medication-overuse headaches.

Symptoms of headaches

The main symptom of headaches is head pain. Other symptoms vary, based on the type.

Migraines

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.

Tension headaches

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. If you regularly use a computer for work, adjusting your work station so that your head is looking forward instead of downward will also help.

Sinus headaches

Sinus pressure results in headache-like pain in your forehead, around your eyes, or around your nose and cheeks. Straining or sudden movement makes the pain even worse. You may have other symptoms, as well. These include a runny nose, swollen face, and sometimes fever. Your ears may also feel stopped up or like they have pressure, too.

Cluster headaches

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.

Rebound headaches

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
• Genetics
• Environmental factors

A lot of factors can cause tension headaches. These include:

• Stress
• Sleep problems
• Sinus and allergy problems
• Stiff or sore muscles, brought on by jaw clenching or poor posture
• Depression
• Anxiety
• 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
• Sedatives
• Tranquilizers
• Ergotamine medicines
• Other prescriptions

If you get rebound headaches, these medicines should not be taken more than 2 days a 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 can 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. A good way to do this is the keep a headache journal.

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?

You cannot completely prevent headaches. You may be able to lower how many headaches you have by identifying what causes your headaches.

Migraines

Medicine to prevent migraines may be helpful if your headaches happen more than 2 times a month. Preventive medicines for migraines can include prescription drugs often used to treat other ailments. Anti-seizure medicines, antidepressants, medicines to lower blood pressure, and even Botox injections are some of the preventive medicines your doctor may prescribe. Calcitonin gene-related peptide (CGRP) inhibitors can also help prevent migraines. They do so by blocking a gene-related peptide in your sensory nerves. This peptide is known to increase during a migraine attack, so blocking it can help prevent migraines.

There are also a number of non-medical treatments designed to help minimize migraine pain and frequency. One is an electrical stimulation device, which has been approved by the FDA. It is a headband that you wear once a day for 20 minutes to stimulate the nerve linked to migraines. Another non-medical treatment is counseling aimed at helping you feel in more control of your migraines. This counseling works best when paired with medical prevention of migraines as well.

Tension headaches

One way to help prevent tension headaches is to improve your posture. Improved posture can help prevent your muscles from becoming tense or tight. You can practice this while you’re sitting and while you’re standing. While sitting, make sure shoulders are back and your head isn’t slumped forward or backward. This is especially important as you work at your computer and look at your phone. When standing, make sure to hold shoulders back while also tightening your stomach muscles. Straighten your neck and hold your head level.

Sinus headaches

Keeping sinuses moist and clean may help prevent sinus headaches. Consider adding a humidifier to your bedroom. This can help your nose from becoming dry and irritated. Talk to your doctor about also using a tool to flush out sinuses. Your doctor may recommend using a neti pot or bulb syringe. This will moisten sinuses and help clean out mucus, too.

Cluster headaches

Drinking alcohol and smoking or vaping can trigger cluster headaches. Avoiding triggers may help you prevent cluster headaches. Your doctor may also prescribe calcium channel blockers for prevention.

Rebound headaches

The best way to prevent rebound headaches is to limit your use of pain relievers. You should use them only when you need them and no more than twice a week. If you feel like you need to use them more often, talk to your doctor. You should also avoid caffeine when taking pain relievers. This is because many pain relievers already contain caffeine. A double dose of caffeine can cause a headache or make it worse.

Headache treatment

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.

Prescription treatments

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.

Treatment especially for cluster headaches

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 ways to help prevent headaches 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 or fasting
• Drinking plenty of water
• Getting at least 30 to 60 minutes of exercise 4 to 6 times a week.

It is important to know what triggers your headaches, especially if you have them often. Keeping a headache journal can help you figure out what these triggers may be. A journal can help you keep track of your activities, food, and even the weather leading up to your headaches.

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 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.

• Close your eyes, take deep breaths, and focus on your breath or a positive thought.
• 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.
• 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?

Resources

National Institutes of Health, MedlinePlus: Headache

National Institutes of Health, MedlinePlus: Migraine