Headaches are a common complaint of pain that most people experience at some point in their life. Described as pain in the head or face, headaches can range from mild to severe. Headaches happen in different areas of the head and cause different types of pain.
Who gets headaches?
Anyone can experience a headache. Headaches are one of the most common medical complaints in the world. As many as 75% of adults around the world have reported a headache in the last year.
Headaches tend to be hereditary, meaning that they run in families. Children may have headaches, especially if their parents suffer from headaches.
While some people only have one or two headaches yearly, others may have them several times a week. Headaches are the most common reason for missed work or school and visits to the doctor.
What causes headaches?
Headaches can have several causes. Most are not caused by serious illness. Headaches happen when triggers irritate the nerves and blood vessels in the brain. The cause is not always specific or known.
Headaches can be from environmental causes or triggers:
- Foods: Fermented foods, chocolate, cheese, processed foods, foods with monosodium glutamate (MSG), nitrates
- Caffeine - either too much or not enough
- Alcohol, specifically red wine
- Strong odors, chemicals, and perfumes
- Lack of sleep
- Medications: Hormones like estrogen and nitroglycerin
Types of headaches
There are many types of headaches. Headaches generally fall into two main categories: primary and secondary headaches. The cause of the headache determines which category they end up in.
Primary headaches are not related to another medical problem. Blood vessels and nerves in the head send pain signals that overexcite the pain receptors in the brain. These headaches may also be genetic.
These headaches can include the following:
- Migraines cause severe throbbing or pulsating head pain. This may include nausea, vomiting, and sensitivity to light and sound. Pain is on one side of the head. This pain can last for hours or days.
- Cluster headaches are one of the most painful headaches. They often start in the middle of the night around one eye or the side of the head. These headaches occur frequently and can last for weeks or months.
- Tension headaches are mild to moderate headaches that feel like a band is squeezing the head. This is the most common headache. The pain is on both sides and feels like it wraps around the head.
- Trigeminal autonomic cephalgias cause severe pain in or around one eye. It causes redness, tearing, drooping of the eyelid, and a runny nose. Episodes can be random or persistent.
- Chronic daily headaches are a variety of headaches that happen for 15 or more days per month. These occur for longer than three months. These are not caused by another medical problem. Pain is on both sides and not relieved by medication.
Secondary headaches come from a separate medical problem. This can be from many problems like neck, eye, sinus, or dental problems. Secondary headaches cover a much larger number of headache types.
These headaches include:
- Sinus headaches are related to sinus infections, inflammation, and congestion of the sinuses.
- Spinal headaches are caused by leaking or low spinal fluid from a lumbar puncture.
- Medication-overuse headaches can occur when using headache relief medications more than three times a week. You can experience relief, but the headache returns or worsens when the medication wears off.
- Thunderclap headaches are severe, sudden headaches that last about 60 seconds. These are uncommon but are emergent as they are signs of stroke, brain bleeding, or infections.
Causes of secondary headaches can include:
- Blood vessel injury
- High blood pressure
- Ear infection
- Sinus infection
- Brain inflammation, like encephalitis
- Medication overuse
- Brain tumor
- Trigeminal neuralgia
- Head injury
- Panic attacks
- Brain aneurysm
Symptoms of a headache
General headache symptoms can differ depending on the type of headache. Symptoms also vary from person to person. Typically, headaches have some of the following characteristics:
- Gradual onset
- Pain on both sides of the head
- Dull ache or pressure around the head
- Mild to moderate pain
- No nausea, vomiting, or other symptoms
Each type of headache has varying symptoms based on the causes.
How are headaches diagnosed?
If you are having frequent or severe headaches, contact your healthcare provider. Tell your provider what symptoms you experience, so you get the right diagnosis. With so many types of headaches, having the right treatment makes a difference.
Your provider will do a physical and neurological exam. They will review your medical history. During the exam, they will look for things in your lifestyle that may cause headaches. They will ask questions about the headaches like:
- How long do they last?
- What do they feel like?
- How painful are the headaches?
- Where are the headaches?
- How long have you had them?
- How much caffeine do you drink daily? How much water?
- How much sleep do you get each night?
- Are you stressed?
Your provider may order blood tests, a CT scan, or an MRI of the brain. You may also get a referral to a neurologist who specializes in treating headaches.
Treating and preventing headaches
Once the provider determines the type of headaches you have, you will begin treatment. Providers often encourage lifestyle modification, including improved management of sleep, stress, diet, water intake, and weight.
Determining your triggers will also help decrease your headaches. You may need to lower stress levels and avoid foods that cause headaches. Stay away from situations that trigger you. Use biofeedback techniques to monitor increases in heart rate, breathing rate, or muscle tension to become aware of triggers.
Medications are available, too. Use caution with over-the-counter (OTC) pain relievers as they can cause overuse headaches. Prescription medications can be provided for moderate to severe headaches. Preventative medications may be necessary to reduce the frequency of your headaches.
When to contact a doctor
Immediately contact a physician or seek emergency care if you have:
- A sudden, severe headache
- A severe headache with high fever, nausea, vomiting, or stiff neck
- The “worst” headache of your life, especially if there is also confusion, weakness, vision changes, or loss of consciousness
- Headache after head injury
- Headache with neurological symptoms such as difficulty speaking, seeing, and walking; numbness; paralysis; dizziness; or seizures
Headaches are a common complaint and have many causes. Headaches often run in families. Determining the cause of the headaches can help reduce them. Treatments are available if lifestyle changes do not help.
Headaches are the most common medical complaint worldwide.
Headaches tend to be hereditary or run in families.
Primary headaches have no other medical cause.
Secondary headaches result from another medical problem.
Headache symptoms can vary from person to person.
Lifestyle changes can help decrease headaches.
Severe, sudden headaches are emergencies and require medical attention.
Mayo Clinic. Headache
Cleveland Clinic. Headaches
Johns Hopkins. Headache
National Institute of Neurological Disorders and Stroke. Headache: Hope Through Research