What headaches are and how to cope with them

We've all had to endure the pain of a headache at one time or another. The intensity of these attacks varies, as do their causes. But there are almost always strategies for preventing or minimizing them—no matter the type.

With 150 different diagnostic categories of headache established, trying to determine the specific flogging in your noggin is enough to give you...well, a headache.

With the encyclopedic-like possibilities, what should you do? "If your headache impacts your everyday activities, interferes with work or causes you significant sensitivity to light, noise or nausea, you should seek medical attention," says headache expert Nabih Ramadan, M.D., co-editor of the book The Headaches. "Also see a doctor if your headache is accompanied by weakness on one side, difficulty speaking, double-vision or any other unusual neurological symptoms."

Though there are many types of headaches, it may help to remember that most fall into the following categories:

Tension Headaches

The "common headache" is usually the type doctors know as tension headache. Tension headaches are most common, affecting most people at some point. Almost 80 percent of us will experience this mild-to-moderate headache at one time or another, with pain pressing in at the temples, forehead or back of the head. There's no nausea, but we might feel sensitive to light or sound.

Usually characterized by a dull, non-pulsating pain or tightening on both sides of the head, they usually result from stress or bad posture (which causes a tightening in muscles of the neck) and may worsen with noise or in hot and stuffy environments. Taking an over-the-counter pain reliever such as ibuprofen is usually effective, says Dr. Ramadan. In a pinch, drinking a cup of coffee or other caffeinated beverage may also help. But if you get 15 or more tension headaches a month, preventative prescription medications may be necessary.

Triggers. Doctors suspect tension headaches are related to muscles tightening near the neck, triggered by stress. Regular exercise can help prevent tension headaches. Stretching your neck and shoulders, especially if you spend a lot of time typing or at a computer, might help prevent these headaches.

Treatment. Analgesics such as aspirin are usually enough to treat a tension headache. Caffeine can help pain relievers work 40 percent better—just don’t overdo it or you'll risk rebound headaches from the caffeine. "The day-in-day-out nature of this headache can be physically and emotionally draining," says Dawn A. Marcus, M.D., neurologist, associate professor at the University of Pittsburgh Medical Center, and author of 10 Simple Solutions to Migraine. If you're under stress, try to remove yourself from stressful situations and rest until you're feeling better.

Migraines

Nearly 25 million American suffer from migraines annually—severe throbbing headaches with all-over pain, nausea and vomiting. Migraines are intense and throbbing, typically affecting one side of the head and accompanied by nausea or vomiting, sensitivity to light or sound, and visual disturbances.

They can last for days and recur frequently. Migraines can cause sensitivity to light or lines in your vision, called aura. Women are two to three times more likely to experience migraine than men. "The World Health Organization has identified migraine among the top 20 causes of disability worldwide," says Dr. Marcus.

"If migraines occur 1 to 2 times a month and don’t interfere with your activities, ibuprofen may be helpful," says Dr. Ramadan, "but prescription medication is usually recommended when migraines are more common and severe."

Triggers. Troubled sleep, stress, infrequent meals, exposure to bright lights, and even weather changes can lead to migraine. Some get them after eating certain foods. Cheeses, dried fruits, alcohol, nuts and chocolate are known culprits. Learn to recognize early symptoms and treat for it as soon as possible. If you don't know your triggers, keep a headache diary—including foods and other exposures—and share it with your doctor.

Treatment. Over-the-counter and prescription pain relievers can help, and some people respond well to caffeine in conjunction with medication. "Many people find that aggressive treatment in the very early stages prevents the headache from becoming problematic,” says Dr. Marcus. Gentle techniques can work as well. "When you first sense a headache starting, treat the attack with a variety of distracting, non-medication techniques: go for a walk, practice relaxation techniques, do stretching exercises, etcetera," she says.

If your headaches are particularly frequent or don't respond well to traditional treatment, you can try preventive medicines to help avoid migraines. These are given over a longer period of time. They can also help alleviate migraine symptoms if you happen to develop a headache while taking the medication.

Cluster Headaches

Cluster headaches cause a short, non-throbbing, but intense burst of pain to recur on one side of the face or behind an eye. They may occur one to four times a day—especially in the spring and fall, says Dr. Ramadan. Cluster headaches can occur for months and then go into remission.

Men get them five times as often as women. Cluster headaches might emerge once a day for months, then go into remission. Luckily, cluster headaches are the rarest of the three major headaches, affecting only three in every 1,000 people—some 1 million people a year. Cluster headaches often triggered by alcohol or erectile dysfunction medications. OTCs may work, but prescription medications are sometimes needed.

Triggers. Alcohol may be an inconsistent trigger of this type of headache, and cigarette smoking is even more strongly linked.

Treatment. Because cluster headaches can come and go so quickly, fast treatment is best. Breathing 100 percent oxygen through a mask is one of the most effective of these treatments, providing relief in as little as 15 minutes. Prescription medications that stop inflammation can help prevent headaches from returning. Try to maintain a regular sleep schedule; and avoid alcohol, tobacco products, bright lights and high altitudes.

Sinus Headaches

Sinus headaches are characterized by a deep, dully ache that worsens with head movements, along with tenderness over the sinuses, nasal discharge, facial swelling and pain or fullness of the ears. They are managed by treating the root problem—sinus infection.

Headache Warnings

If your headache is accompanied by any of the following symptoms, seek immediate medical attention. It could be that your headache is rooted in something more serious.

  • stiff neck
  • recent head injury
  • weak or tingling limbs
  • severe and persistent head pain

Ancient Headache Remedy

Acupuncture is a Chinese remedy for pain involving the placement of thin needles into key points on the body. Research published in the journal Headache shows that migraine sufferers exposed to traditional acupuncture experienced significantly more migraine relief than those in fake acupuncture or control groups—even though all were given migraine medication. "Acupuncture is substantially free from side effects," says lead study author Enrico Facco, M.D., professor of anesthesiology at the University of Padua, Italy. "It is indicated when patients have more than two attacks a month, or when the drug treatment is not well tolerated or is not effective."

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 26 May 2010

Last Modified: 27 Mar 2014