Headaches: Overview

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KEY POINTS

• There are many different kinds of headaches and each kind has different causes and symptoms.
• To help diagnose and treat your headache, it helps if you keep track of your symptoms. Treatment depends on the kind of headache you have.

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What is a headache?

A headache is a feeling of pain, usually sharp or aching, or a feeling of pressure or fullness in or on your head, including your face and sometimes one or both ears. Many different things may cause a headache. Some causes are serious and some are not, so information about your symptoms is very important.

What is the cause?

There are several kinds of headaches:

• A sinus headache is pain or pressure caused by your sinuses being swollen, congested with mucus, or infected. The sinuses are hollow spaces in the bones of your face and front of your skull. They connect with the nose through small openings. Like the nose, they are lined with tissue that makes mucus. Mucus drains through the small openings to the nose. Sinus headaches are due to blocked sinuses that are swollen and irritated (inflamed). This may be caused by:
  • Severe or untreated seasonal or year-round allergies
  • Injury to the bones in your nose or face
  • A deformity inside the nose that causes the sinuses not to drain properly
  • Small growths called polyps in the sinuses that partially block the sinus openings
• A tension headache is a headache caused by tense muscles in your neck, shoulders, or scalp. Tension headaches are very common. Tension headaches may be caused by:
  • Stress from family, work, finances, or health problems
  • Anxiety or depression
  • Sitting or standing in one position for a long time
• A migraine headache is a type of headache that can last for hours to days. It can cause intense pain, changes in your vision just before or during the headache, or nausea during the headache. You may be sensitive to light. You may have warning symptoms called an aura, which is usually a special feeling or vision change before or during the migraine. Migraines may tend to run in families. The exact cause of migraines is not known. They may be related to a problem with the blood flow in the brain or nerve excitement, or they may happen with changes in brain chemicals and hormones such as estrogen. You may find that your migraine headaches seem related to things such as:
  • Missing a meal
  • Changes in the weather
  • Not enough sleep
  • Eating foods such as cheese, chocolate, or foods that contain MSG or preservatives such as nitrates
• A medicine overuse headache (MOH) is a headache that happens daily or almost daily, and causes you to take pain medicines for more than 10 to 15 days out of every month. Taking pain medicine so often makes headaches happen more often instead of making them better.
• Women may have headaches caused by changes in hormones. This may happen with monthly menstrual periods, pregnancy, menopause, or birth control pill use.
• A cluster headache is an uncommon type of headache that can cause sudden severe pain on one side of the head, usually around or behind an eye. The headaches often last 30 to 45 minutes and end as suddenly as they begin. The headaches may happen at the same time every day for several weeks and then go away for a few months. You may get them at night after you have fallen asleep. The days or weeks when you are having the headaches are called a cluster period. Most people with cluster headaches have 1 or 2 cluster periods a year. The cause of cluster headaches is not known. They happen in men more often than women. Cluster headaches may be triggered by stress, bright lights, lack of sleep, or the use of alcohol or cigarettes.

Other causes of headaches include:

• Drinking too much alcohol
• Side effects of some medicines
• A head injury or concussion
• A cold or flu
• TMJ (temporomandibular joint syndrome), which is a problem in the joint where your jaw bone meets your skull, just in front of your ears
• Carbon monoxide poisoning
• Giant cell arteritis, which causes the arteries in the temple area on the sides of your face to become swollen and painful
• Morning headaches caused by sleep apnea, a condition that means you stop breathing for more than 10 seconds at a time many times while you sleep
• Rarely, a tumor causes a headache. These headaches often happen first thing in the morning every day and may get worse over a few days or weeks. They may have other serious symptoms such as vision changes, weakness in arms or legs, nausea, or dizziness. When you have a headache with these symptoms, or if you are worried, check with your healthcare provider right away.
• A sudden severe headache with weakness, numbness, or tingling, especially on one side of your body, and sudden trouble with vision, speech, balance, or walking can be caused by a stroke. Strokes are caused by a clot or bleeding into the space around your brain. If you are having these symptoms of a stroke, call for emergency help right away.

What are the symptoms?

Symptoms depend on the kind of headache you have. Symptoms may include:

• A feeling like a tight band around your head
• A dull and steady pain that worsens through the day, sometimes with a sore or stiff neck
• Intense pain on one side of the face or head
• Feeling of fullness or pressure in your face or head
• A headache that is most painful when you bend over and put your head down
• Throbbing or pounding headache, often on one side of the head
• Pain that gets worse with physical activity
• Extreme sensitivity to light, smells, and sounds
• Nausea or vomiting
• Trouble concentrating
• Trouble sleeping

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. To help you and your healthcare provider find the best prevention and treatment, try to keep a record of:

• When the headaches started
• Date and time of each headache
• How long each headache lasted
• Type of pain (for example, dull, sharp, throbbing, or a feeling of pressure)
• Location of pain
• What medicine you took and how well the medicine worked
• What you ate, what you were doing, or any other possible triggers

Tests are often not needed, but may include:

• X-rays
• CT scan, which uses X-rays and a computer to show detailed pictures of your head
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the brain and blood vessels

How is it treated?

Treatment depends on the kind of headache you have. Several kinds of medicine may help. Your provider may also recommend:

• Physical therapy
• Biofeedback therapy, which uses a machine to help you learn to control muscle tension
• Counseling
• Relaxation techniques such as deep breathing and progressive muscle relaxation

You can get more information from:

• American Migraine Foundation
  800-255- 2243
  https://americanmigrainefoundation.org/
• National Headache Foundation
  800-843-2256
  http://www.headaches.org/