Seven out of 10 people in the U.S. have at least one headache per year, according to the American College of Physicians (ACP). And it is estimated that 45 million Americans suffer from chronic headaches. Headaches are an important cause of days missed from work, costing billions of dollars in lost productivity annually. (ACP)
Most headaches are not life threatening, and can be managed with medication and lifestyle changes.
The three types of headaches are: tension headaches, cluster headaches, and migraines.
The most common types of headache include migraine, cluster, sinus and tension. In most cases, lifestyle changes, such as stress management and relaxation techniques, and medication can help relieve pain.
Cluster headaches are a type of non-throbbing vascular headache. The pain is described as severe, burning and and penetrating and the headaches can last for long periods of time, known as the cluster period. The cluster period can be as long as six weeks at a time. The headaches occur every day and often more than once a day. Symptoms occur on one side of the head, behind the eye, and can be associated with tearing. It is estimated that 1 million Americans have cluster headaches. Men are most often affected.
Migraines are considered a neurological disease caused by the activity of nerve pathways and brain chemicals. They are a type of throbbing vascular headache that typically involves one half of the head (the word “migraine” is derived from the Greek word for “half-head”). This type of headache is often the most severe and complex.
The Migraine Research Foundation (MRF) reports that nearly one out of every four households in the United States has a migraine sufferer. They are one of the top 20 most disabling diseases in the world. (MRF)
Migraines have a genetic tendency: having a family member with migraines increases your risk. In adults, they occur more frequently in women (18 percent) than in men (six percent). Prior to puberty, however, migraines are more common in boys than in girls. (MRF)
There are two basic types of migraine headaches: with aura and without auras. Auras are types of visual disturbances of bright spots, flashing lights, zig-zagging lines, or temporary loss of vision. These visual disturbances occur about 30 minutes before the headache and can last for 15 minutes. However, 80 percent of people with migraines do not have auras.
Another kind of migraine is hemiplegic migraines. They are migraine headaches accompanied by stroke-like symptoms. Speech can be slurred, and there can be numbness and weakness of the face, arm, or leg. Hemiplegic migraines can resolve without any permanent deficits. Women with migraines who take birth control pills have an increased risk of hemiplegic migraines and strokes.
Migraines have three phases: prodrome, peak headache, and postdrome. Prodrome is the period leading up to the migraine. This is the time when auras occur. The prodrome phase may affect concentration, mood, appetite and frequent yawning may occur. Postdrome is the 24-hour period after the migraine. During this time, drowsiness can occur, and mood can vary from depression to feelings of joyfulness.
Migraines can occur before, during, or after menstrual periods. The most common food trigger for migraines is alcohol. There is uncertainty, however, as to whether chocolate is a migraine trigger. Keeping a personal food diary is a good way to track what foods may be associated with your migraines. Obesity and a sedentary lifestyle are known to increase frequency of migraines in adults and children. Maintaining optimal weight and getting proper amounts of exercise are two lifestyle changes that can help to decrease migraines.
Most headaches are not signals of a life threatening illness. You should contact your doctor immediately if headache occurs after head trauma, or is associated with drowsiness, fever, vomiting, facial numbness, slurred speech, or weakness in an arm or a leg, convulsions or confusion. Seek medical attention if you have sudden onset of a severe headache, or neck stiffness. Pressure around the eyes with a yellowish-green nasal discharge and sore throat also should be evaluated by your physician.
A headache can be a symptom of many different disease processes. The cause of a headache is determined by a complete history and physical exam. This examination should include a look at the head and neck and include a complete neurological evaluation. Medication history is important, because the sudden absence of medication and foods can cause rebound headaches. For example, heavy coffee drinkers who suddenly stop drinking coffee can experience headaches.
Tests that can evaluate headaches include:
- CBC (complete blood count to look for infection)
- sinus X-rays (if sinusitis is suspected)
- skull X-rays (if trauma is present)
- computed tomography (CT) scan or magnetic resonance imaging (MRI) of the head (in cases where stroke, trauma, or blood clots on the brain are suspected)
Treatment varies according to the cause. Most tension headaches are successfully treated with over-the-counter medications, such as aspirin, acetaminophen (Tylenol), or ibuprofen (Advil). Stress reduction, biofeedback, elimination of food triggers, exercise, and medication are common treatments for migraines and other vascular headaches.
Preventive treatment is used when headaches occur three or more times per month. Sumatriptan, a drug that acts to decrease the vascular inflammation in migraines, is commonly used for the control of migraine headaches. Other medications that can be used to prevent migraines are:
- beta blockers (propranolol, atenolol)
- verapamil (calcium channel blocker)
- methysergide maleate (helps to reduce blood vessel constriction)
- amitriptyline (antidepressant)
- valproic acid (anti-seizure medication)
Written by: Verneda Lights and Matthew Solan
Medically reviewed by Brenda B. Spriggs, MD, MPH, FACP