FAQs on Headaches

More than 45 million Americans suffer with headaches, according to the National Headache Foundation. Of these people, 28 million have migraine headaches. Headaches are more common in women than men, and they are the most common reason for absenteeism from school and work.

Primary Headaches

Primary headaches are pain of the head that is not the result of another medical condition. These include:

  • Tension-type headaches – This is the most common type of headache. Tension headaches are usually mild to moderate, bilateral (both sides of the head), and non-throbbing. These headaches do not usually get worse with routine activities.
  • Migraine headaches – This is the second most common primary headache. Migraines are usually moderate to severe and described as throbbing. Migraine headaches can last from four hours to three days, and occur several times each month. Symptoms associated with migraines are sensitivity to noise, light, and odors, nausea, vomiting, loss of appetite, and upset stomach.
  • Cluster headaches – This is a severe headache that affects men more often than women. The pain is described as piercing, burning, and throbbing. Most patients report the pain behind one eye, on one side of the head, and occurring several times in a month in a cluster.
  • New daily persistent headaches (NDPH) – This type of headache starts abruptly and occurs daily for long periods of time. This headache is related to other diseases, and is often bilateral.

Secondary Headaches

Secondary headaches result from another neurological or medical condition. These headaches include:

  • Sinus headaches – This pain is related to sinus problems. These headaches are described as constant, deep, and pressure-related. The patient often reports a foul taste in the mouth, fever, facial swelling, and fullness of the face.
  • Medication overuse headaches – When a patient takes too much butalbital medicine or over-the-counter medicine, he/she can develop rebound headache. These headaches are often called “transformed” headaches.

Risk Factors and Triggers

Certain situations, foods, and substances increase a person’s likelihood of developing headaches. These include:

  • Genetics – Headaches tend to run in the family.
  • Smoking and second-hand smoke
  • Strong chemicals and perfumes
  • Foods, such as aged cheese, wine, ad processed foods
  • Certain allergens like pollen, dust, and pet dander
  • Pollution
  • Noise
  • Bright lights
  • Stress
  • Weather changes
  • Skipping meals
  • Depression
  • Tension
  • Alcohol use
  • Changes in sleep patterns
  • Excessive medication use

Headache Causes

Headaches are the result of signals interacting in the brain, surrounding nerves, and blood vessels. When a headache occurs, certain blood vessels and nerves are activated, sending out pain signals. This mechanism trigger release of serotonin, prostaglandins, and other substances that cause blood vessel swelling and pain.

Treatment Options

Headaches treatments include:

  • Botox – For severe migraine headaches, the doctor can inject the forehead, shoulders, and neck with botulinum toxin A. This chemical blocks nerve signals and relieves pain.
  • Cervical epidural steroid injection – For headaches occurring due to neck (cervical) pain, an epidural injection can be done. The doctor injects the epidural space with a corticosteroid agent.
  • Occipital nerve block – For occipital neuralgia and other types of head pain, the doctor performs a block. This involves injecting the back of the head with an anesthetic or neurolytic agent.

Medications

Many medications are used to prevent and treat headaches. These include:

  • Triptans – For migraine attacks, these drugs are given at the start of the headache. Examples are Imitrex, Maxalt, and Zomig.
  • Ergots – These medications contain caffeine and include Treximet and Cafergot.
  • Opioids – Strong narcotics used for severe pain.
  • Beta blockers – Used to prevent headaches. Examples include Betimol and Lopressor.
  • Calcium channel blockers – Examples include Calan and Verelan. These drugs work for preventing headaches.
  • Tricyclic antidepressants – These medicines are used to prevent migraine headaches.
  • Anti-seizure medicines – Depacon, Topamax, and Neurontin are used for prevention of headaches.

Resources

National Institute of Neurological Disorders & Stroke. Headache Information Page.

National Headache Foundation. Headache-Frequently Asked Questions.

Ropper A.H., Samuels M.A. (2009). Chapter 10. Headache and Other Craniofacial Pains. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor’s Principles of