Headache

Headaches are extremely common - nearly everyone experiences them at some point. They can range from a mild annoyance to debilitating pain that interferes with daily activities. While most headaches are not serious and can be managed with self-care, some types require medical evaluation.

Understanding the type of headache you're experiencing helps determine the best treatment approach. Headaches are generally classified as primary (the headache itself is the condition) or secondary (caused by another condition).

Primary Headaches:

1. Tension Headaches:

   • Most common type
   • Mild to moderate pain
   • Feels like pressure or tightness
   • Both sides of head
   • Usually not disabling

2. Migraines:

   • Moderate to severe pain
   • Often one side of head
   • Throbbing or pulsing
   • May have nausea, sensitivity to light/sound
   • Can last hours to days

3. Cluster Headaches:

   • Severe, excruciating pain
   • One side of head, around eye
   • Occur in clusters (periods)
   • Less common

Secondary Headaches (caused by other conditions):

• Sinus headaches
• Medication overuse headaches
• Headaches from illness or injury
• Headaches from dehydration

Headache symptoms vary by type:

Tension Headache:

• Dull, aching pain
• Pressure or tightness
• Both sides of head
• Neck and shoulder tension
• Not worsened by activity

Migraine:

• Throbbing or pulsing pain
• Often one side
• Nausea, sometimes vomiting
• Sensitivity to light and sound
• Aura (visual disturbances) in some
• Worsened by activity

Cluster Headache:

• Severe, sharp pain
• Around one eye
• Red, watery eye
• Stuffy or runny nose
• Restlessness

Seek emergency medical care if headache is:

• Sudden and severe ("thunderclap" headache)
• Accompanied by fever, stiff neck, confusion
• After head injury
• With vision changes, difficulty speaking, weakness
• Different from usual headaches
• Worsens with coughing or movement

For Most Headaches:

1. Rest in a Dark, Quiet Room:

   • Especially for migraines
   • Reduce sensory stimulation

2. Apply Cold or Warm Compress:

   • Cold for migraines
   • Warm for tension headaches
   • Try both to see what helps

3. Stay Hydrated:

   • Dehydration can cause headaches
   • Drink water throughout the day

4. Over-the-Counter Medications:

   • Acetaminophen
   • Ibuprofen or naproxen
   • Use as directed
   • Don't overuse (can cause rebound headaches)

5. Relaxation Techniques:

   • Deep breathing
   • Meditation
   • Progressive muscle relaxation

6. Caffeine (in moderation):

   • Small amount may help
   • Don't overdo it
   • Withdrawal can cause headaches

• Sudden, severe headache ("worst headache of your life")
• Headache with fever, stiff neck, confusion
• Headache after head injury
• Headache with vision changes, weakness, difficulty speaking
• Headache different from your usual pattern

• Frequent headaches (more than 2 per week)
• Headaches requiring medication more than twice weekly
• Headaches interfering with daily life
• Headaches that have changed in pattern
• New headaches in someone over 50
• Headaches that don't respond to treatment

• Occasional tension headaches
• Headaches responding to self-care
• Known triggers that can be avoided
• Following treatment plan for chronic headaches

Evaluation may include:

1. Medical History:

   • Description of headaches
   • Frequency, duration, triggers
   • Family history
   • Medications

2. Physical and Neurological Exam:

   • Check for signs of underlying conditions
   • Neurological function

3. Imaging (if indicated):

   • CT scan or MRI
   • Usually not needed for typical headaches
   • May be ordered if:
     • Sudden onset
     • Abnormal neurological exam
     • Headaches have changed

4. Other Tests:

   • Blood tests
   • Lumbar puncture (rare)

Treatment depends on headache type:

Tension Headaches:

• Over-the-counter pain relievers
• Stress management
• Physical therapy if neck-related

Migraines:

• Acute medications (triptans, NSAIDs)
• Preventive medications (if frequent)
• Lifestyle modifications
• Biofeedback, relaxation

Cluster Headaches:

• Oxygen therapy
• Triptans
• Preventive medications

Important: Medication overuse can cause rebound headaches. Use medications as directed and discuss frequent use with your doctor.

Identify and Avoid Triggers:

• Keep a headache diary
• Common triggers:
  • Stress
  • Certain foods
  • Dehydration
  • Lack of sleep
  • Hormonal changes
  • Weather changes

Lifestyle Modifications:

• Regular sleep schedule
• Regular meals
• Stay hydrated
• Regular exercise
• Stress management
• Limit alcohol and caffeine

Tension Headaches:

• Muscle tension in head and neck
• May involve chemical changes in brain
• Often stress-related

Migraines:

• Complex neurological condition
• Involves blood vessels and nerves
• Genetic component
• Triggers cause cascade of events

Cluster Headaches:

• Related to hypothalamus
• Trigeminal nerve involvement
• Vascular changes

• Headaches can occur at any age
• May have difficulty describing symptoms
• School-related stress common trigger
• Most are tension-type

• Peak age for migraines (20s-40s)
• Stress and lifestyle factors important
• Hormonal changes (women)

• New headaches need evaluation
• Higher risk of secondary causes
• Medication interactions possible

Warning signs include: sudden severe onset, "worst headache ever," accompanying fever/stiff neck, neurological symptoms, or headache after injury. When in doubt, seek medical care.

Many headaches can be prevented by identifying and avoiding triggers, maintaining regular sleep and meals, staying hydrated, managing stress, and following treatment plans for chronic headaches.

If you have headaches more than twice weekly, they interfere with daily life, or you need medication frequently, see a healthcare provider. They can help identify the cause and develop a treatment plan.

Yes. Common triggers include aged cheeses, processed meats, alcohol (especially red wine), chocolate, caffeine (or withdrawal), and artificial sweeteners. Keep a diary to identify your triggers.

No. Daily headaches are not normal and should be evaluated by a healthcare provider. They may indicate medication overuse, an underlying condition, or need for preventive treatment.