Information Source on Headaches
Oh my aching head! Nearly everyone has had a headache. The most common type of headache is a tension headache. Tension headaches are due to tight muscles in your shoulders, neck, scalp and jaw. They are often related to stress, depression or anxiety. You are more likely to get tension headaches if you work too much, don't get enough sleep, miss meals or use alcohol.
Other common types of headaches include migraines, cluster headaches and sinus headaches. Most people can feel much better by making lifestyle changes, learning ways to relax and taking pain relievers.
Headaches can have many causes, but serious causes of headaches are rare. Sometimes headaches warn of a more serious disorder. Let your health care provider know if you have sudden, severe headaches. Get medical help right away if you have a headache after a blow to your head, or if you have a headache along with a stiff neck, fever, confusion, loss of consciousness or pain in the eye or ear.
What is a Migraine Headache?
Migraine is a medical condition. Most people who suffer from migraines get headaches that can be quite severe. A migraine headache is usually an intense, throbbing pain on one, or sometimes, both sides of the head. Most people with migraine headache feel the pain in the temples or behind one eye or ear, although any part of the head can be involved. Besides pain, migraine also can cause nausea and vomiting and sensitivity to light and sound. Some people also may see spots or flashing lights or have a temporary loss of vision.
Migraine can occur any time of the day, though it often starts in the morning. The pain can last a few hours or up to one or two days. Some people get migraines once or twice a week. Others, only once or twice a year. Most of the time, migraines are not a threat to your overall health. But migraine attacks can interfere with your day-to-day life.
We don’t know what causes migraine, but some things are more common in people who have them:
- Most often, migraine affects people between the ages of 15 and 55.
- Most people have a family history of migraine or of disabling headache.
- They are more common in women.
- Migraine often becomes less severe and less frequent with age.
How Common are Migraines?
Migraine pain and symptoms affect 29.5 million Americans. Migraine is the most common form of disabling headache that sends patients to see their doctors.
What Causes Migraines?
The exact cause of "migraine headaches" is not fully understood. Most researchers think that migraine is due to abnormal changes in levels of substances that are naturally produced in the brain. When the levels of these substances increase, they can cause inflammation. This inflammation then causes blood vessels in the brain to swell and press on nearby nerves, causing pain.
Genes also have been linked to migraine. People who get migraines may have abnormal genes that control the functions of certain brain cells.
Experts do know that people with migraines react to a variety of factors and events, called triggers. These triggers can vary from person to person and don’t always lead to migraine. A combination of triggers—not a single thing or event—is more likely to set off a migraine attack. A person’s response to triggers also can vary from migraine to migraine. Many women with migraine tend to have attacks triggered by:
- lack of or too much sleep
- skipped meals
- bright lights, loud noises, or strong odors
- hormone changes during the menstrual cycle
- stress and anxiety, or relaxation after stress
- weather changes
- alcohol (often red wine)
- caffeine (too much or withdrawal)
- foods that contain nitrates, such as hot dogs and lunch meats
- foods that contain MSG (monosodium glutamate), a flavor enhancer found in fast foods, broths, seasonings, and spices
- foods that contain tyramine, such as aged cheeses, soy products, fava beans, hard sausages, smoked fish, and Chianti wine
- aspartame (NutraSweet® and Equal®)
To pinpoint your migraine triggers, keep a headache diary. Each day you have a migraine headache, put that in your diary. Also write down the:
- the time of day your headache started
- where you were and what you were doing when the migraine started
- what you ate or drank 24 hours before the attack
- each day you have your period, not just the first day (This can allow you and your doctor to see if your headaches occur at the same or similar time as your period.)
- Talk with your doctor about what sets off your headaches to help find the right treatment for you.
Are there different kinds of migraine?
There are many forms of migraine. The two forms seen most often are migraine with aura and migraine without aura.
Migraine with aura - previously called classical migraine. With a migraine with aura, a person might have these sensory symptoms - or the so-called “aura” - 10 to 30 minutes before an attack:
- seeing flashing lights, zigzag lines, or blind spots
- numbness; or tingling in the face or hands
- disturbed sense of smell, taste, or touch
- feeling mentally “fuzzy”
Only one in five people who get migraine experience an aura. Women have this form of migraine less often than men.
Migraine without aura - previously called common migraine. With this form of migraine headache, a person does not have an aura but has all the other features of an attack.
How can I tell if I have a migraine headache or just a bad tension-type headache?
Compared with migraine, tension-type headache is generally less severe and rarely disabling. Compare your symptoms with those in this chart to see what type of headache you might be having.
|Intensity and quality of pain|
|Intense pounding or throbbing and/or debilitating||x|
|Distracting, but not debilitating||x|
|Location of pain|
|One side of head||x|
|Both sides of head||x||x|
|Sensitivity to light and/or sounds||rare||x|
|Aura before onset of headache||x|
Note: Rebound headache may have features of tension and/or migraine headache.
Although fatigue and stress can bring on both tension and migraine headaches, migraines can be triggered by certain foods, changes in the body’s hormone levels, and even changes in the weather.
There also are differences in how types of headaches respond to treatment with medicines. Although some over-the-counter drugs used to treat tension-type headaches sometimes help migraine headaches, the drugs used to treat migraine attacks do not work for tension-type headaches for most people.
You can't tell the difference between a migraine and a tension-type headache by how often they occur. Both can occur at irregular intervals. Also, in rare cases, both can occur daily or almost daily.
How can I tell if I have a migraine or a sinus headache?
Many people confuse a sinus headache with a migraine because pain and pressure in the sinuses, nasal congestion, and watery eyes often occur with migraine. To find out if your headache is sinus or migraine, ask yourself these questions:
In addition to my sinus symptoms, do I have:
- moderate-to-severe headache
- sensitivity to light
If you answer “yes” to two or three of these questions, then most likely you have migraine with sinus symptoms. A true sinus headache is rare and usually occurs due to sinus infection. In a sinus infection, you would also likely have a fever and thick nasal secretions that are yellow, green, or blood-tinged. A sinus headache should go away with treatment of the sinus infection.
When should I seek help for my headaches?
Sometimes, headache can signal a more serious problem. You should talk to your doctor about your headaches if:
- you have several migraine headaches per month and each lasts for several hours or days
- your headaches disrupt your home, work, or school life
- you have nausea, vomiting, vision, or other sensory problems (such as numbness or tingling)
- you have pain around the eye or ear
- you have a severe headache with a stiff neck
- you have a headache with confusion or loss of alertness
- you have a headache with convulsions
- you have a headache after a blow to the head
- you used to be headache-free, but now have headaches a lot
What tests are used to find out if I have migraine?
If you think you get migraine headaches, talk with your doctor. Before your appointment, write down:
- how often you have headaches
- where the pain is
- how long the headaches last
- when the headaches happen, such as during your period
- other symptoms, such as nausea or blind spots
- any family history of migraine
- all medicines you are taking for your medical problems, even over-the-counter medicines ( bring medicines in their containers to the doctor)
- all the medicines you have taken in the past that you can recall and, if possible, the doses you took and any side effects you had
Your doctor may also do an exam and ask more questions about your health history. This could include past head injury and sinus or dental problems. Your doctor may be able to diagnose "migraine headaches" just from the information you provide the doctor.
You may get a blood test or other tests, such as CT scan or MRI, if your doctor thinks that something else is causing your headaches. Work with your doctor to decide on the best tests for you.
Are migraine headaches more common in women than men?
Yes. About three out of four people who have migraines are women. Migraines are most common in women between the ages of 20 and 45. At this time of life women often have more job, family, and social duties. Women tend to report more painful and longer lasting headaches and more symptoms, such as nausea and vomiting. All these factors make it hard for a woman to fulfill her roles at work and at home when migraine strikes.
I get migraines headaches right before my period. Could they be related to my menstrual cycle?
More than half of migraines in women occur right before, during, or after a woman has her period. This often is called “menstrual migraine.” But, just a small fraction of women who have migraine around their period only have migraine at this time. Most have migraine headaches at other times of the month as well.
How the menstrual cycle and migraine are linked is still unclear. We know that just before the cycle begins, levels of the female hormones, estrogen and progesterone, go down sharply. This drop in hormones may trigger a migraine, because estrogen controls chemicals in the brain that affect a woman’s pain sensation.
Talk with your doctor if you think you have menstrual migraine. You may find that medicines, making lifestyle changes, and home treatment methods can prevent or reduce the pain.
Can migraine be worse during menopause?
If your migraine headaches are closely linked to your menstrual cycle, menopause may make them less severe. As you get older, the nausea and vomiting may decrease as well. About two-thirds of women with migraines report that their symptoms improve with menopause.
But for some women, menopause worsens migraine or triggers them to start. It is not clear why this happens. Menopausal hormone therapy, which is prescribed for some women during menopause, may be linked to migraines during this time. In general, though, the worsening of migraine symptoms goes away once menopause is complete.
Can using birth control pills make my migraines worse?
In some women, birth control pills improve migraine. The pills may help reduce the number of attacks and their attacks may become less severe. But in other women, the pills may worsen their migraines. In still other women, taking birth control pills has no effect on their migraines.
The reason for these different responses is not well understood. For women whose migraines get worse when they take birth control pills, their attacks seem to occur during the last week of the cycle. This is because the last seven pills in most monthly pill packs don’t have hormones; they are there to keep you in the habit of taking your birth control daily. Without the hormones, your body’s estrogen levels drop sharply. This may trigger migraine in some women.
Talk with your doctor if you think birth control pills are making your migraines worse. Switching to a pill pack in which all the pills for the entire month contain hormones and using that for three months in a row can improve headaches. Lifestyle changes, such as getting on a regular sleep pattern and eating healthy foods, can help too.
Can Stress Cause Migraines?
Yes. Stress can trigger both migraine and tension-type headache. Events like getting married, moving to a new home, or having a baby can cause stress. But studies show that everyday stresses—not major life changes—cause most headaches. Juggling many roles, such as being a mother and wife, having a career, and financial pressures, can be daily stresses for women.
Making time for yourself and finding healthy ways to deal with stress are important. Some things you can do to help prevent or reduce stress include:
- eating healthy foods
- being active (at least 30 minutes most days of the week is best)
- doing relaxation exercises
- getting enough sleep
Try to figure out what causes you to feel stressed. You may be able to cut out some of these stressors. For example, if driving to work is stressful, try taking the bus or subway. You can take this time to read or listen to music, rather than deal with traffic. For stressors you can't avoid, keeping organized and doing as much as you can ahead of time will help you to feel in control.
How are Migraines Treated?
Migraine has no cure. But your migraines can be managed with your doctor’s help. Together, you will find ways to treat migraine symptoms when they happen, as well as ways to help make your migraines less frequent and severe. Your treatment plan may include some or all of these methods.
Medicine. There are two ways to approach the treatment of migraines with drugs: stopping a migraine in progress (called “abortive” or “acute” treatment) and prevention. Many people with migraine use both forms of treatment.
Acute treatment. Over-the-counter pain-relief drugs such as aspirin, acetaminophen, or NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen relieve mild migraine pain for some people. If these drugs don’t work for you, your doctor might want you to try a prescription drug. Two classes of drugs that doctors often try first are:
Triptans, which work by balancing the chemicals in the brain. Examples include sumatriptan (Imitrex®), rizatriptan (Maxalt®), zolmitriptan (Zomig®), almotriptan (Axert®), eletriptan (Relpax®), naratriptan (Amerge®), and frovatriptan (Frova®). Triptans can come as tablets that you swallow, tablets that dissolve on your tongue, nasal sprays, and as a shot. They should not be used if you have heart disease or high blood pressure. Ergot derivatives (ergotamine tartrate and dihydoergotamine), which work in the same way as triptans. They should not be used if you have heart disease or high blood pressure.
Most acute drugs for migraine work best when taken right away, when symptoms first begin. Always carry your migraine medicine with you in case of an attack. For people with extreme migraine pain, a powerful “rescue” drug might be prescribed, too. Because not everyone responds the same way to migraine drugs, you will need to work with your doctor to find the treatment that works best for you.
Prevention. Some medicines used daily can help prevent attacks. Many of these drugs were designed to treat other health conditions, such as epilepsy and depression. Some examples are:
- antidepressants, such as amitriptyline (Elavil®) or venlafaxine (Effexor®)
- anticonvulsants, such as divalproex sodium (Depakote®) or topiramate (Topamax®)
- beta-blockers, such as propranolol (Inderal®) or timolol (Blocadren®)
- calcium channel blockers, such as verapamil
These drugs may not prevent all migraines, but they can help a lot. Hormone therapy may help prevent attacks in women whose migraines seem to be linked to their menstrual cycle. Ask your doctor about prevention drugs if:
- your migraines do not respond to drugs for symptom relief
- your migraines are disabling or cause you to miss work, family activities, or social events
- you are using pain-relief drugs more than two times a week
Lifestyle changes. Practicing these habits can reduce the number of migraine attacks:
- Avoid or limit triggers.
- Get up and go to bed the same time every day.
- Eat healthy foods and do not skip meals.
- Engage in regular physical activity.
- Limit alcohol and caffeine intake.
- Learn ways to reduce and cope with stress.
Alternative methods. Biofeedback has been shown to help some people with migraine. It involves learning how to monitor and control your body’s responses to stress, such as lowering heart rate and easing muscle tension. Other methods, such as acupuncture and relaxation, may help relieve stress. Counseling also can help if you think your migraines may be related to depression or anxiety. Talk with your doctor about these treatment methods.
What are Rebound Migraines?
Women who use acute pain-relief medicine more than two or three times a week or more than 10 days out of the month can set off a cycle called rebound. As each dose of medicine wears off, the pain comes back, leading the patient to take even more. This overuse causes your medicine to stop helping your pain and actually start causing headaches. Rebound headaches can occur with both over-the-counter and prescription pain-relief medicines. They can also occur whether you take them for headache or for another type of pain. Talk to your doctor if you're caught in a rebound cycle.
I'm pregnant. Can my migraines still be treated?
Some migraine medicines should not be used when you are pregnant because they can cause birth defects and other problems. This includes over-the-counter medicines, such as aspirin and ibuprofen. Talk with your doctor if migraine is a problem while you are pregnant or if you are planning to become pregnant. Your doctor might suggest a medicine that will help you and that is safe during pregnancy. Home treatment methods, such as doing relaxation exercises and using cold packs, also might help ease your pain. The good news is that for most women migraines improve or stop from about the third month of the pregnancy.
I am breastfeeding. Will taking medicine for migraine hurt my baby?
Ask your doctor about what migraine medicines are safe to take while breastfeeding. Some medicines can be passed through breast milk and might be harmful to your baby.
What are some ways I can prevent migraine?
The best way to prevent migraine is to find out what triggers your attacks and avoid or limit these triggers. Since migraine headaches are more common during times of stress, finding healthy ways to cut down on and cope with stress might help. Talk with your doctor about starting a fitness program or taking a class to learn relaxation skills.
Talk with your doctor if you need to take your pain-relief medicine more than twice a week. Doing so can lead to rebound headaches. If your doctor has prescribed medicine for you to help prevent migraine, take them exactly as prescribed. Ask what you should do if you miss a dose and how long you should take the medicine. Talk with your doctor if the amount of medicine you are prescribed is not helping your headaches.
What should I do when a migraine begins?
Work with your doctor to come up with a plan for managing your migraines. Keeping a list of home treatment methods that have worked for you in the past also can help. When symptoms begin:
- If you take migraine medicine, take it right away.
- Drink fluids, if you don't have nausea during your migraine.
- Lie down and rest in a dark, quiet room, if that is practical.
Some people find the following useful:
- a cold cloth on your head
- rubbing or applying pressure to the spot where you feel pain
- massage or other relaxation exercises
What is a Sinus Headache?
Sinus headaches cause pain in the front of your head and face. They are due to inflammation in the sinus passages that lie behind the cheeks, nose, and eyes. The pain tends to be worse when you bend forward and when you first wake up in the morning. Postnasal drip, sore throat, and nasal discharge usually occur with these headaches.
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are extremely rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and occasionally by taking medications.
Headaches may occur if you have a cold, the flu, fever, or premenstrual syndrome.
Tension headaches are due to tight, contracted muscles in your shoulders, neck, scalp, and jaw. They are often related to stress, depression, or anxiety.
Overworking, not getting enough sleep, missing meals, and using alcohol or street drugs can make you more susceptible to them. Headaches can be triggered by chocolate, cheese, and monosodium glutamate (MSG). People who drink caffeine can have headaches when they don't get their usual daily amount.
Other common causes include:
- Holding your head in one position for a long time, like at a computer, microscope, or typewriter
- Poor sleep position
- Overexerting yourself
- Clenching or grinding your teeth
Tension headaches tend to be on both sides of your head. They often start at the back of your head and spread forward. The pain may feel dull or squeezing, like a tight band or vice. Your shoulders, neck, or jaw may feel tight and sore.
Migraine headaches are severe, recurrent headaches generally accompanied by other symptoms like visual disturbances or nausea. They tend to begin on one side of your head, although the pain may spread to both sides. You may have an "aura" (warning symptoms that start before your headache) and feel throbbing, pounding, or pulsating pain.
Other Types of Headaches
Cluster headaches are sharp, extremely painful headaches that tend to occur several times per day for months and then go away for a similar period. They are far less common.
If you are over age 50 and are experiencing headaches for the first time, a condition called temporal arteritis may prove to be the cause. Symptoms of this condition include impaired vision and pain aggravated by chewing. There is a risk of becoming blind with this condition. Therefore, it must be treated by your doctor right away.
Rare causes of headache include:
- Brain aneurysm -- a weakening of the wall of a blood vessel that can rupture and bleed into the brain
- Brain tumor
- Stroke or TIA
- Brain infection like meningitis or encephalitis
Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches. When a headache occurs, write down the date and time the headache began, what you ate for the past 24 hours, how long you slept the night before, what you were doing and thinking about just before the headache started, any stress in your life, how long the headache lasts, and what you did to make it stop. After a period of time, you may begin to see a pattern.
A headache may be relieved by resting with your eyes closed and head supported. Relaxation techniques can help. A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches.
Try acetaminophen, aspirin, or ibuprofen for tension headaches. DO NOT give aspirin to children because of the risk of Reye syndrome.
Migraine headaches may respond to aspirin, naproxen, or combination migraine medications.
If over-the-counter remedies do not control your pain, talk to your doctor about possible prescription medications.
Prescription medications used for migraine headaches include ergotamine, dihydroergotamine, ergotamine with caffeine (Cafergot), isometheptene (Midrin), and triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), eletriptan (Relpax), almotriptan (Axert), and zolmitriptan (Zomig). Sometimes medications to relieve nausea and vomiting are helpful for other migraine symptoms.
If you get headaches often, your doctor may prescribe medication to prevent headaches before they occur. Examples of these include:
- Antidepressants such as nortriptyline (Pamelor), amitriptyline (Elavil), fluoxetine (Prozac, Sarafem), sertraline (Zoloft), or paroxetine (Paxil) for tension or migraine headache
- Beta-blockers such as propranolol (Inderal) for frequent migraine headaches
- Calcium channel blockers such as verapamil for frequent migraine headaches
- Anti-epileptic medicines such as topiramate (Topamax)
If you are using pain medications more than 2 days a week, you may be suffering from rebound headaches. Rebound headaches are caused by a cycle of using pain medications for short-term relief, followed by the headache pain returning for increasingly longer periods of time despite taking more pain medications.
All types of pain pills, also including over-the-counter drugs, muscle relaxants, some decongestants, and caffeine can cause this pattern. If you think this may be a problem for you, talk to your health care provider.
When to Contact a Medical Professional
Take the following symptoms seriously. If you cannot see your health care provider immediately, go to the emergency room or call 911:
- Your headache comes on suddenly and is explosive or violent.
- You would describe your headache as "your worst ever", even if you are prone to headaches.
- Your headache is associated with slurred speech, change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss.
- Your headache gets progressively worse over a 24-hour period.
- Your headache is accompanied by fever, stiff neck, nausea, and vomiting.
- Your headache occurs with a head injury.
- Your headache is severe and localized to one eye with redness in that eye.
- You are over age 50 and your headaches just began, especially with impaired vision and pain while chewing.
See your provider soon if:
- Your headaches wake you up from sleep.
- A headache lasts more than a few days.
- Headaches are worse in the morning.
- You have a history of headaches but they have changed in pattern or intensity.
- You have headaches frequently, and there is no known cause.
What to Expect at Your Office Visit
Your health care provider will obtain your medical history and will perform an examination of your head, eyes, ears, nose, throat, neck, and nervous system.
The diagnosis is usually based on your history of symptoms. A "headache diary" may be helpful for recording information about headaches over a period of time. Your doctor may ask questions such as the following:
- Is the headache located in the forehead, around the eyes, in the back of the head, near the temples, behind the eyeball, or all over?
- Is the headache on one side only?
- Is this a new type of headache for you?
- Would you describe the headache as throbbing?
- Is there a pressure or band-like sensation?
- When does the headache occur? How long have you had headaches? How long does each headache last?
- Does the headache awaken you from sleep? Are the headaches worse during the day and better at night?
- Did other symptoms begin shortly after the headaches began? Do headaches occur repeatedly?
- Does the headache reach maximum intensity over 1 to 2 hours?
- Are the headaches worse when you are lying down? Standing up?
- Are the headaches worse when you cough or strain?
- Do they occur at a specific time related to your menstrual period?
- What home treatment have you tried? How effective was it?
Diagnostic tests that may be performed include the following:
Head CT scan
Temporal artery biopsy
If a migraine is diagnosed, medications that contain ergot may be prescribed. Temporal arteritis must be treated with steroids to help prevent blindness. Other disorders are treated as is appropriate.
The following healthy habits can lessen stress and reduce your chance of getting headaches:
- Getting adequate sleep
- Eating a healthy diet
- Exercising regularly
- Stretching your neck and upper body, especially if your work involves typing or using a computer
- Learning proper posture
- Quitting smoking
- Learning to relax using meditation, deep breathing, yoga, or other techniques
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