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We all have headaches every now and then. Most of us usually tend to ignore them until they start interfering with our daily activities. Although, headache is a symptom itself, the other symptoms of headache are not just restricted to dull or sharp pain in the forehead region, but differ depending on the type of headache. There can be a lot of reasons you might be having a headache such as sinus infections, colds, stress, dehydration, vision problems, hormonal issues, migraine, head injury, and central nervous system (CNS) infections.
The actual cause of headache can be diagnosed with methods like CT scan, MRI, or certain blood tests. Your doctor will start the medication depending on the cause, type, and severity of your headaches. However, it is also important to bring some lifestyle changes such as proper diet, sleep, and relaxation techniques, if you suffer from recurrent headaches.
- Adults between 20 to 40 years of age
- Both men and women
- Blood vessels
- Worldwide: 50% (2016)
- Acute sinusitis
- Otitis media or externa
- Temporomandibular joint syndrome
- Wisdom tooth impaction
- Dental cavities
- Cervical and paraspinal radiculopathies
- Medication overuse headache
- Brain malignancy
- Viral infection
- Vascular malformations
- Pituitary tumors
- Oral analgesics: Ibuprofen & Paracetamol
- Antiemetics: Domperidone
- Combination analgesics
- Triptans: Sumatriptan
- Ditans: Lasmiditan
- Single pulse transcranial magnetic stimulation (STMS)
- Vagal nerve stimulation (VNS)
- Behavioral therapy
- Physical therapy
- ENT specialist
Symptoms Of Headache
The symptoms of headache are not just restricted to dull or sharp pain in the forehead region but differ depending on the type of headache. Some of the common symptoms associated with different headaches are:
Dull pain around the forehead, neck, and back region. These symptoms are more common in tension-type headaches.
Severe and throbbing pain usually on one or both sides of the head, along with pain in the eye, temple, or back of the head. Sensitivity to light, sound, and aura is common in migraine types of headaches.
Constant pain that occurs in the sinus regions such as the bridge of the nose or the cheeks along with the feeling of fullness in the sinus is common in sinus headaches.
Types of headaches
There are more than 150 types of headaches. Headaches can be broadly classified as primary and secondary.
A. Primary headaches
A primary headache means the headache itself is the main medical problem, and not a symptom of an underlying illness. A primary headache is thought to be caused by overactivity of or problems with pain-sensitive structures in your head. The most common types by a very long way are tension headaches and migraines. Here is a rundown on some of the primary headaches:
1. Tension headaches
It is the most common type of headache.This headache presents as mild to moderate pressure or tightness on both sides of the head, where the patient complains as if a tight band or rope has been tied on the head. Sometimes, the pain might feel spreading into or from the neck. Pain is not throbbing in nature.
Some tension headaches are triggered by exhaustion, stress, or disorders involving the muscles or joints of the neck or jaw. They can be troublesome and tiring, but they usually do not disturb sleep. Most people can continue working with a tension headache. However, the headache might worsen during activities like climbing up stairs or bending over.
Migraine pain is an intense pulsing from deep within the head. This pain can last for days. The headache significantly limits the ability to carry out daily chores. Migraine is throbbing and is usually one-sided.
Although a migraine can start without any warning, it is often set off by a trigger. The triggers may vary from person to person. The most common ones are fatigue, stress, lack of sleep, bright flickering lights, loud noises and dietary triggers like red wine, chocolate, aged cheese or an increase or decrease in caffeine. Nausea and vomiting also usually occur along with headache. Migraine is often life-long, and characterized by recurring attacks.
3. Cluster headaches
Cluster headaches are relatively uncommon but a severe type of primary headache. It presents like a brief but severe burning, throbbing or constant headache. This headache gets its name because the pain tends to come in clusters, with one to eight headaches a day for one to three months every year or two, often at the same time of year. They disappear completely or go into remission in between for months to years, only to reoccur later.
Patients often describe them as unbearable which greatly interferes with their normal routine. Cluster headaches occur around or behind one eye or on one side of the face at a time. Sometimes, swelling, redness, flushing, sweating, nasal congestion, and eye tearing can also occur on the side that is affected by the headache.
4. New daily persistent headaches
New daily persistent headaches usually start suddenly in a person who does not have a past history of headaches. They persist on a daily basis and can last for more than three months. The pain is moderate to severe and can mimic chronic tension-type headache or chronic migraine.
5. Exertional headaches
Exertion headaches happen soon after periods of intense physical activity. Weight lifting, running, rowing, tennis, swimming, and sexual intercourse are common triggers for an exertion headache. It is thought that these activities cause increased blood flow to the head, which can lead to a throbbing headache on both sides of your head. This type of headache usually resolves within a few minutes or several hours.
B. Secondary headaches
Secondary headaches are caused by an underlying medical condition. Examples of secondary headache causes include:
1. Sinus headaches
Sinus headaches are the result of sinusitis or sinus infection, which causes congestion and inflammation in the sinuses which are air-filled spaces in the skull. The pain from these headaches is deep and constant in nature and often focused around the cheekbones, the bridge of the nose or forehead.
2. Hormone headaches
Women commonly experience headaches that are linked to hormonal fluctuations. Menstruation, birth control pills, hormone replacement therapies, and pregnancy can affect the estrogen levels, which can cause a headache. When headache occurs two days before periods or in the first 3 days after it starts, they are known as menstrual migraines.
3. Hypertension headaches
High blood pressure can cause you to have a headache. This kind of headache signals an emergency. This occurs when your blood pressure becomes dangerously high. You may also experience changes in vision, numbness or tingling, nosebleeds, chest pain, or shortness of breath.
4. Post-traumatic headaches
Post-traumatic headaches can develop after any type of head injury. These headaches feel like migraine or tension-type headaches, and usually, last up to 6 to 12 months after your injury occurs. They can become chronic in some cases.
5. Medication overuse headaches
Medication overuse headache (medication induced headache) or rebound headache is caused by long term and regular intake of painkillers usually taken to get relief from headache. This headache usually occurs every day and early morning and improves with painkillers but returns as the effect of medication wears off. Medication overuse headaches usually stop on cessation of painkillers. It is difficult in the short term, but doctors can help recover from medication overuse headaches for a long term relief.
Some secondary headaches are not very common but their recognition is extremely important as timely treatment can be life-saving and can help avoid serious repercussions. They may occur due to one or more of the following reasons:
Idiopathic intracranial hypertension
Cerebral venous thrombosis
Infections such as meningitis or encephalitis
Causes Of Headache
Headache usually occurs when the muscles of the head and neck region tighten. This may occur in different types of headaches such as tension headaches and migraines.
There are various causes and triggers of different types of headaches:
1. Tension headache
A tension headache can be caused by overuse of alcohol, caffeine, or caffeine withdrawal. It can also occur due to fluctuating hormones in women, straining of the eyes, or any injury to the head or neck. Poor posture can also trigger tension-type headaches.
2. Cluster headache
The exact cause of cluster headaches is unknown. However, genetic and environmental factors can cause cluster headaches in some individuals. A cluster headache can be triggered by factors such as overuse of alcohol, smoking, high altitude, and overexertion.
3. Migraine headache
Migraine refers to a neurological condition where headache may be associated with other symptoms such as aura. The exact cause of migraine is not known, but some studies show that migraine is caused by serotonin along with pathways that cause narrowing of blood vessels and reduced blood flow, followed by widening of these arteries. Migraines can be triggered by certain environmental conditions like cold weather, processed foods, bright light, and sound.
4. Sinus headache
Sinus headaches are caused by sinusitis, which is the infection or inflammation of the sinus cavities. This can be triggered by change in weather or allergies.
5. Other causes
Apart from the above mentioned causes, some other causes of headache can be serious and potentially life-threatening such as:
Head or brain injury
Hypoglycemia (low blood sugar)
Intracranial bleeding (bleeding inside the skull)
Risk Factors Of Headaches
You are at risk of headaches, if you:
Are under a lot of stress
Uncorrected nearsightedness or farsightedness (also known as visual aberrations/disorders)
Are sleeping irregularly or are lacking proper sleep
Have hormonal changes (estrogen levels for women)
Take some prescription medications such as nitroglycerin & estrogen
Have suddenly stopped taking caffeinated beverages
Diagnosis Of Headache
Headache is not a disease in itself but is a condition arising due to various underlying pathologies. Evaluation of a headache usually begins with taking your medical history and performing some basic tests such as:
Complete blood count (CBC): CBC test is carried out to look out for an infection that could be causing your headaches.
Erthrocyte sedimentation ratio (ESR): ESR test or erythrocyte sedimentation rate is done, if giant cell arteritis (GCA), which is an inflammatory disease of large blood vessels, as well as other systemic disorders, are suspected.
Computed tomography (CT) scan: CT scan may also be chosen in some cases of headaches. However, due to the radiation, MRI is the preferred option.
Magnetic resonance imaging (MRI): MRI is often used to identify any structural abnormalities in the brain.
Cerebrospinal fluid study: Lumbar puncture (LP) and cerebrospinal fluid test may be advised in patients who have headache along with fever, meningeal signs, focal neurological deficits, or suspicion of intracranial hypertension.
Prevention Of Headache
To prevent the occurence of headaches, one must identify the triggers and try to avoid them.
1. Steer clear of stress
Stress can cause muscle tightening in the neck & shoulder region. This can lead to tension headaches. Such a headache feels like a tight band. It usually begins in the neck and back and works its way up to the head. Stress is also known to trigger a migraine headache. Therefore, it is advised to stay away from stress to prevent headaches.
2. Stay away from foods that trigger headaches
Eating certain foods often triggers a migraine headache. Migraines are usually triggered by foods such as bananas, cheese, chocolate, citrus fruits, and dairy products. Knowing which foods trigger your headache and staying away from them is the best bet to keep headaches away.
3. Limit your alcohol intake
Alcohol is a common cause of headaches such as a migraine headache or a cluster headache. Limit your alcohol intake to prevent headaches.
Headaches such as cluster headache migraine can be triggered by factors, such as smoke, humidity, bright light, intense scents, or cold weather. Thus, it is advised to protect yourself from environmental triggers that could aggravate your headache.
5. Be aware of caffeine withdrawal
If you normally consume caffeine in coffee or tea, stopping this intake abruptly can trigger a migraine. This is due to the constriction of blood vessels without caffeine, which is the main reason for the pain associated with migraines. Thus, you must not abruptly cut down your caffeine intake; if you are prone to headaches.
6. Do not cut down on your sleep
A lack of sleep is associated with migraines and tension headaches.
Specialist To Visit
You should go to a doctor if:
You get headaches too often or for a long period of time (chronic headache)
Your headaches are severe
Your headache fails to subside with home care
Your headache interferes with normal activities
You get sudden headache that worsens in no time
Your headaches are triggered by exertion, coughing, bending, or strenuous activity.
If you need to take a pain reliever every day or almost every day for your headaches.
You have headache following a head injury
Do consult a doctor, if you have other signs and symptoms along with headache such as:
Fever and stiff neck
Seizures, confusion or blackouts
Weakness or numbness
Difficulty in vision
Sudden onset headache
Vomiting that precedes a headache
Continous worsening of a headache
Headache that disturbs sleep/routine activities
The treatment of your headache depends on what is causing it. While an occasional headache does not require medical help other than over-the-counter medicines and self care, severe and recurrent headaches require medical attention. You will be advised to get a physical or other examination done to find the actual cause of your headache. There are various specialists who can treat your headaches such as:
Treatment Of Headache
There are are various treatment approaches to headache such as:
1. Oral analgesics: Analgesics such as ibuprofen and paracetamol are generally the first line treatment for headaches. Oral analgesics such as non-steroidal anti-inflammatory drugs (NSAIDS) are prescribed generally for cluster headaches and tension headaches.
2. Antiemetics: Antiemetics such as domperidone may also be prescribed in migraine, where headache is accompanied with nausea & vomiting.
3. Combination analgesics: In some cases of severe headache, analgesics are given adjuvantly with caffeine, barbiturates, and opiates. This therapy is usually short & can only be taken under medical supervision.
4. Triptans: Triptans such as sumatriptan give long-term relief from migraine headaches. These medicines not only treat migraine but are used as preventive therapy for migraine headaches.
5. Ditans: Lasmiditan is a newer drug used in the patients with chronic migraine. Its action is similar to triptans but the effect is more specific to the CNS.
6. Single pulse transcranial magnetic stimulation (STMS) & vagal nerve stimulation (VNS): These procedures are usually recommended for patients who are non-responsive to conventional therapy. These are newer treatment modalities approved by the FDA & used with varying success in the treatment of migraine attacks in adults. In this, electromagnetic probes are placed externally over the head which helps to regulate the neural pathways in the brain to relieve headache.
7. Behavioral therapy: Behavioral therapy such as cognitive behavioral therapy, relaxation techniques such as meditation helps in reducing the muscle tension, which is common in tension headache.
8. Physical therapy: Physical therapy for headache includes improving posture, hot and cold packs, exercise programs, and electrical stimulation.
Note: If your headache is due to migraine, then medicines to prevent migraine are recommended. These include beta-blockers like propranolol, antidepressants like amitriptyline, antiepileptics like topiramate, calcium channel blockers like flunarizine and CGRP antagonists. Here’s more about migraine and its treatment.
Home-care For Headache
Headaches can be annoying and can disrupt your daily functioning. Here are some self-care tips that can help you get relief from headaches.
Don’t forget the basics
If you are prone to headaches then you should be extra careful about taking your meals on time, taking proper sleep, and staying away from foods that aggravate your headaches.
Relaxation techniques to your rescue
Relaxation techniques such as deep breathing, yoga, and meditation can help you greatly in not only relieving your headaches but preventing them as well. Tension headaches can be relieved easily with hot or cold packs over the shoulders and neck. You can also go for some stretching exercises to get relief from headaches.
Acupressure is an ancient science that could help in relieving headaches, especially if it is tension headaches. In this type of headache, acupressure points are pressed, which helps in releasing tension and promotes the proper circulation of blood.
It has been found that certain herbs such as butterbur & peppermint oil can help in relieving headaches. Apart from the herbs, certain minerals and vitamins such as magnesium, coenzyme Q10, and Vitamin B12 can help in getting relief from your annoying headaches.
Here’s more quick fixes for migraine and ways to get rid of pain!
Complications Of Headache
Headaches are common and may occur every now and then. However, ignoring headaches can sometimes do more harm than good as it may be a result of some underlying pathology. Headaches should not be ignored for long. Not only do they start affecting normal functioning and hamper your productivity but also may lead to complications such as severe neurologic disability. Therefore, it is important that secondary causes of headaches are found out and the underlying pathology is rightly managed.
Here are some of the conditions where headaches should not be ignored. These include:
Headaches that are unusually severe in intensity
Headaches that develop after the age of 50
A drastic change in the headache pattern
Headaches that increase with movement or coughing & sneezing
Headaches that worsen with time
Headaches that are accompanied with changes in personality or functioning
Headaches that are followed by fever, confusion, stiffness in joints, decreased alertness, or memory
Headaches that are associated with neurological symptoms such as visual disturbances, slurring of speech, weakness, or seizures
Headaches that are accompanied by a painful red eye
Headaches in which there is pain and tenderness near the temple region
Headaches that start occurring after a head injury
Headaches that affect your daily functioning
Headaches in patients who have impaired immune systems such as cancer patients
Alternative Therapies For Headache
Though there are various treatment options available for headaches, they fail to be efficacious in certain patients or pose certain side effects. Thus, many patients seek complementary and alternative medication for headaches, such as:
1. Chiropractic treatment
Chiropractic treatment is considered useful for migraines. In this, spinal manipulation and interventions including massage are recommended for management of patients suffering from episodic or chronic migraine. Low-load craniocervical mobilization may be helpful in the management of patients with episodic or chronic tension-type headaches in the long run. For cervicogenic headache, spinal manipulation is the choice of chiropractic treatment.
Some homeopathic remedies may have beneficial effects in patients suffering from chronic tension type headaches.
3. Home remedies
While you might find it easier to pop a pill every time you get a headache, trying a few effective remedies can prove to be a winner in relieving headache without side effects of medications. Here are some simple and effective natural remedies to get rid of headache instantly:
Warm lemon water or tea
Black pepper soup or rasam
Steam inhalation with essential oils
Here’s detailed information on how to use these home remedies to relieve headache.
Acupressure is an ancient science that could help in relieving headaches, especially if it is tension headaches. In this type of headache, acupressure points are pressed, which helps in releasing tension and promotes the proper circulation of blood.
Behavioral therapy such as cognitive behavioral therapy (CBT) & relaxation techniques such as meditation help in reducing the muscle tension, which is common in tension headaches.
Living With Headache
Headache caused due to stress or tension seems to get better with lifestyle remedies and medication. However, if you suffer from migraine headaches, it is important to keep a tab on its triggers and get medical help to prevent them. To prevent a headache, it is important to know the cause and treat it. Here are a few tips for people who experience headache on a regular basis:
1. Keep a headache calendar as it helps you to keep a tab on what you ate or what you did that might have possibly triggered a headache.
2. Stick to a regular sleep schedule as sleep hygiene habits and maintaining circadian rhythm can go a long way in giving respite from headaches. Go to bed early and get up early, almost at the same time every day, including weekends. Avoid daytime napping and stimulants like tea, coffee or alcohol close to bedtime. Turn off all electronic devices at least an hour before going to bed. Try to keep the room temperature cool and include vitamins like melatonin and magnesium (after consultation with your doctor) for a better and sound sleep.
3. Try herbal drinks such as ginger tea or lemon tea which are packed with antioxidants and reduce inflammation, thereby relieving headaches.
4. Stay away from the common triggers of headache such as alcohol, caffeine, skipping meals, eating cheese, or eating too little.
5. Try relaxation techniques such as meditation, acupressure, and yoga as these can help you to manage stress and relieve headache-induced by stress.
6. Do not always pop a painkiller as the right medicine for headache depends on the type of headache, how often you get them and how severe it is.
7. Consult a doctor if you have other signs and symptoms along with a headache. These may include fever and stiff neck, seizures, confusion or blackouts, difficulty in vision, weakness, or numbness.
Headache can be due to stress or it can be due to an underlying symptom of brain tumor. It is not always possible to know the type of headache based on the symptoms you experience. This is when your doctor might advise investigations like CT-scan or imaging techniques to know the root cause of it and treat the condition. Hence, do consult your doctor, if you have frequent headaches and not self-medicate always.
Frequently Asked Questions
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- Fayyaz Ahmed.Headache disorders: differentiating and managing the common subtypes.BR J Pain. 2012 Aug; 6(3): 124–132.
- Leeran Baraness; Annalee M. Baker. Acute Headache; Treasure Island (FL): StatPearls Publishing; 2021 Jan-
- Christie Murphy; Sajid Hameed.Chronic Headaches. Treasure Island (FL): StatPearls Publishing; 2021 Jan-
- Chowdhary Debashish. Tension type headache.Ann Indian Acad Neurol. 2012 Aug; 15(Suppl 1): S83–S88.
- Harvard Health publishing. How to tame tension headaches. September, 2014
- SchmerlingRobert.H.Harvard Health publishing.If you have migraines, put down your coffee and read this. September, 2019
- Harvard Health publishing.Headache remedies to help you feel better. September,201
- Harvard Health publishing. Headache:When to worry, what to do. June,2009
- Bryans Roland, Descarreaux Martin, Duranleau Mireille et al. Evidence-based guidelines for the chiropractic treatment of adults with headache.J Manipulative Physiol Ther. 2011 Jun;34(5):274-89.
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- Andreas Straube & Anna Andreou. Primary headaches during lifespan. The Journal of Headache and Pain, 2019; 20(35)
- Madsen BK, Søgaard K, Andersen LL, Skotte J, Tornøe B, Jensen RH. Neck/shoulder function in tension-type headache patients and the effect of strength training. J Pain Res. 2018 Feb 23;11:445-454.