Headache
What is a headache?
A headache can be defined as pain that is felt in the head or upper neck. The kind of pain associated with a headache may be described as dull, sharp, constant, throbbing, mild or intense. The brain itself does not contain receptors for pain, therefore cannot feel pain. Instead, the pain associated with a headache is caused by the irritation or inflammation of a variety of tissues including:
- Meninges (coverings of the brain);
- Periosteum (membranes covering the bones);
- Muscles that encase the skull;
- Sinuses;
- Nerves and/or blood vessels, and;
- Eyes and/or ears.
Headaches are one of the most common health-related conditions. Most commonly experienced by people 20-50 years of age, they are usually caused by more than one contributing factor.
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Inflammation
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
Causes
Headaches are broadly categorized as being either primary or secondary, depending on the cause.
Primary headaches
Primary headaches are:
- Not due to an underlying condition;
- Usually not dangerous, and;
- Usually recurrent.
There are three main types of primary headaches: tension, migraine and cluster.
Tension headaches
These are:
- The most common type of primary headache;
- Usually mild and short-lived, and;
- Either episodic or chronic. If they occur fewer than 15 days per month, they are episodic. If they occur more than 15 days per month, they are chronic.
The exact cause of tension headaches is still to be clearly understood. One popular explanation is that they are caused by contractions of the muscles covering the skull. It is thought that when the muscles that cover the skull undergo stress, they spasm and cause pain.
Another explanation suggests that changes in the levels of chemical messengers in the brain may cause tension headaches. In particular, the changes in the levels of the serotonin and endorphin messengers have been identified as potentially contributing to the pain associated with tension headaches.
Other factors that may cause or contribute to tension headaches include:
- Depression;
- Poor posture;
- Stress;
- Sleep disturbances;
- Clenching of jaw muscles, and;
- Grinding of teeth.
Migraine headaches
These are:
- Less common than tension headaches;
- Usually more severe and debilitating, and;
- Longer-lasting - up to 72 hours.
There is often a family history in people who experience migraine headaches. Migraines are caused by multiple complex interactions, but primarily thought to be a malfunction in the nerves of the brain. For some people who experience migraine headaches, there may be certain triggers such as certain foods or beverages, hormonal changes, or stress.
Cluster headaches
These are:
- The least common type of primary headache;
- Recurring - they generally occur at the same time each day, and;
- Severe and debilitating, come in groups and may be separated by lengthy pain-free periods.
Cluster headaches are thought to be caused by abnormalities in an area of the brain called the hypothalamus. The hypothalamus is where the body's biological clock is located. The cyclic nature of cluster headache attacks can be explained by the involvement of the hypothalamus. Once a cluster period has begun, alcohol can make the headache worse.
Secondary headaches
Secondary headaches are:
- Due to another underlying condition, and;
- Either benign (cause no serious harm) or dangerous.
They may be due to:
- A head injury;
- Infection;
- An allergic reaction;
- Sinusitis;
- Medication - some headaches are a side effect of taking a certain medication;
- Imbalance of hormones or metabolism;
- Disorders of the joint where the jaw meets the skull (temporomandibular joint);
- Severe high blood pressure (hypertension);
- Sudden bleeding from a blood vessel on the surface of the brain (subarachnoid hemorrhage);
- Tumor, and;
- Inflammation of the arteries (giant cell arteritis).
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Infection
Entry into the body of microorganisms that can reproduce and cause disease.
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Inflammation
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
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Metabolism
The sum of all chemical changes that take place within an organism to maintain growth and development and convert food into energy and building blocks.
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Serotonin
A chemical messenger within the brain that is thought to play a role in mood and behavior. Many antidepressant medications act by increasing the amount of serotonin in the brain.
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Subarachnoid hemorrhage
Bleeding into a space between two of the membranes that surround the brain, the arachnoid and pia meninges. It is usually associated with an aneurysm or weakened blood vessel.
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Tumor
A growth caused by an abnormal and uncontrolled reproduction of cells.
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Hormonal
Relating to hormones, which are chemicals secreted in one part of an organism and transported to another part of that organism, where they have a specific effect.
Risk factors
Primary headaches
The risk factors for primary headaches may vary, depending on the type of headache experienced. Some typical risk factors for primary headaches may include:
- Smoking;
- Excessive alcohol consumption;
- A family history of headaches;
- Being female;
- Being an adult between 20-50 years of age, and;
- Stress.
Secondary headaches
The risk factors for secondary headaches depend on the underlying cause.
Signs and symptoms
Tension headaches
Tension headache symptoms may include:
- Pain that can be described as a dull ache, with constant pressure as if someone has placed a tight rubber band around the head;
- Muscle tightness in the head, neck or jaw;
- Mild sensitivity to light or noise, and;
- Irritability.
Migraine headaches
Symptoms of migraine may include:
- Moderate to severe pain that is often described as throbbing or pounding;
- Pain that can affect the whole head, one side of the head, or can shift from one side to the other;
- Pain that is aggravated by movement;
- Nausea and vomiting;
- Sensitivity to light and noise;
- Blurred vision, and;
- Bright flashing dots or lights, or blind spots (aura).
Migraine headaches can occur with or without aura. Migraine headaches without aura are more common.
Cluster headaches
Symptoms may include:
- Severe and intense pain that is described as throbbing or constant;
- Pain that is located behind one eye, or in the region of one eye and doesn't change locations during that episode;
- Pain that lasts a short time, which can disappear only to come back later that day, and;
- Runny eyes or nose on the same side of the face as the headache.
The locations of tension, migraine and cluster headaches.
Secondary headaches
The symptoms associated with a secondary headache may vary, depending on the underlying condition causing the headache.
Some secondary headaches may be associated with a more serious underlying condition and require prompt medical care. Some symptoms of secondary headaches that call for prompt medical care may include:
- A sudden and severe onset of headache associated with a stiff neck;
- Headaches associated with a fever;
- Convulsions;
- Headaches associated with confusion or a loss of consciousness;
- Persistent headaches in someone who was previously headache-free, and;
- Recurring headaches in children.
One cause of secondary headache, giant cell arteritis, is treated as a medical emergency and its symptoms may include:
- Persistent and severe headache, usually over the temple area;
- Jaw pain with eating;
- Blurred or double vision;
- Scalp tenderness, fever, and;
- Unexplained weight loss.
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Convulsions
Involuntary, abnormal contractions of muscles, leading to uncontrolled shakes and jerks of the body.
Methods for diagnosis
Diagnosing the cause of a headache may involve taking a detailed patient history, performing a physical examination and, when required, ordering diagnostic tests
While taking a patient history, some common questions that a doctor may ask may include:
- What does the headache feel like?
- When does the headache occur?
- How long does it last?
- Where is the pain felt?
- When did it begin?
- Is this the worst headache of your life?
- Is this the same as headaches you have had before?
- What makes it worse?
To help determine the cause of a headache, the doctor may ask if any of the following symptoms accompany the headache:
- Fever;
- Vomiting;
- Visual disturbances;
- Seizures;
- Confusion;
- Dizziness;
- Weakness or impaired movement, and;
- Eye pain.
If the history-taking indicates a primary headache, there may be no need to carry out further diagnostic testing and an appropriate treatment plan can be made. However, if the history-taking indicates an underlying condition, then further testing may be required.
Diagnostic testing
Blood tests and urinalysis
Laboratory tests of the blood and urine can help determine whether other medical conditions such as diabetes, thyroid disorders (hyperthyroidism / hypothyroidism) or infection are the cause of the headache.
Lumbar puncture
A lumbar puncture may be used to determine whether subarachnoid hemorrhage, meningitis or abnormal cerebrospinal fluid pressure is the cause of the headache.
Computerized tomography
A computerized tomography (CT) scan of the head may be used to determine if subarachnoid hemorrhage, a brain lesion, sinusitis or a related condition is the cause of the headache.
Magnetic resonance imaging
A magnetic resonance imaging (MRI) scan may be used to determine if a lesion, infection or abnormal build-up of fluid in the brain is the cause of the headache.
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Computerized tomography
A scan that uses X-rays to create a 3D image of the body. This can detect abnormalities more effectively than a simple X-ray can.
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Diabetes
A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterized by high blood sugar levels. Also known as diabetes mellitus.
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Infection
Entry into the body of microorganisms that can reproduce and cause disease.
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MRI
A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.
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Subarachnoid hemorrhage
Bleeding into a space between two of the membranes that surround the brain, the arachnoid and pia meninges. It is usually associated with an aneurysm or weakened blood vessel.
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Cerebrospinal fluid
The clear fluid that surrounds and protects the brain and the spinal cord.
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Lumbar puncture
A procedure that uses a needle to collect a sample of cerebrospinal fluid, which is the clear fluid surrounding the brain and spine, from the lower back (lumbar region) for analysis. It can also be performed to remove any excess fluid or to deliver medications.
Types of treatment
Primary headache
Treatment of primary headaches may require a combined approach to factor in a number of triggers and causes. Some common treatments may include:
- Pain-relief medications, such as acetaminophen or ibuprofen;
- Avoiding known triggers, such as certain foods or drinks (especially caffeinated and alcoholic drinks);
- Getting enough sleep;
- Stress management;
- Making changes to any medications that may be causing the headache as a side effect;
- Treating the underlying condition causing the headache, and;
- Exercise.
Migraine headaches
Migraine headaches may be treated with medications to ease the associated symptoms. Pain-relief medication used to treat migraine headaches may include:
- Acetaminophen;
- Non-steroidal anti-inflammatory drugs (NSAIDs);
- Aspirin, and;
- Triptans, which act on serotonin receptors in the nerves and blood vessels and decrease the release of the molecule associated with pain in the brain.
Migraine headaches may be associated with symptoms other than pain. Treatment for these symptoms may include:
- Antiemetic medication (to treat nausea and vomiting), and;
- Hydration.
Some people may experience frequent migraines. Treatment for recurring migraine headaches may involve preventative medication such as:
- Beta-blockers including propranolol and metoprolol;
- Serotonin antagonists including pizotifen;
- Calcium-channel blockers;
- Antiepileptic medications including topiramate, and;
- Ergot derivatives including methysergide.
It is important to take into account that all medications may be associated with side effects of varying severity.
Secondary headache
Depending on the cause, the treatment for a secondary headache may vary. Treatment may require further consultation with a medical specialist, such as a neurologist, optometrist or an ear, nose and throat (ENT) specialist to assess the underlying condition and establish an appropriate treatment plan.
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Beta-blockers
Substances that hinder the activity of hormones such as adrenaline by blocking the beta receptors, found in many organs but particularly the heart and blood vessels. These are used to treat a range of conditions including high blood pressure and migraines.
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Neurologist
A doctor who specializes in conditions of the nervous system.
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Optometrist
A health professional trained to detect eye conditions and prescribe glasses.
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Serotonin
A chemical messenger within the brain that is thought to play a role in mood and behavior. Many antidepressant medications act by increasing the amount of serotonin in the brain.
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Calcium-channel blockers
Also called a calcium antagonist. A group of medications that is used to treat high blood pressure and other conditions. It works by blocking calcium from entering cells of the heart and blood vessels, which ultimately lowers blood pressure.
Potential complications
Primary headache
The complications associated with primary headaches may vary according to their type, frequency and severity.
People who experience regular headaches may be more likely to also experience:
Secondary headache
The complications associated with secondary headaches may vary widely according to their underlying condition.
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Anxiety
A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.
Prognosis
Primary headaches
By avoiding known triggers, a person can ease episodes of primary headaches. However, episodes of primary headaches can often persist and the type of headache may change, so that people may experience both tension headaches and migraine headaches. How often people experience episodes of headaches can vary widely; some people may experience headaches weekly, while for others it may be years between episodes.
A younger age of onset, such as during childhood, may be associated with an increased risk of experiencing headache as an adult.
Secondary headaches
The prognosis of secondary headaches may vary widely depending on the underlying condition causing the headaches. The nature of the underlying condition will influence the prognosis.
Prevention
Primary headaches
For people who experience primary headaches, reducing the frequency and/or severity of the headache episodes may be achieved by:
- Avoiding known triggers such as certain foods or beverages;
- Maintaining good posture to ease muscle tension;
- Eating a healthy diet;
- Maintaining good stress management;
- Avoiding drinking too much alcohol;
- Eating regular meals;
- Quitting smoking;
- Avoiding eye strain, and;
- Staying well hydrated.
Secondary headaches
The prevention of secondary headaches may depend on the underlying condition causing the headaches.
References
- Diagnosing Your Headache: Headache Evaluation. Accessed August 12 2014. link here
- Migraine Headache in Adults. Accessed August 12 2014. link here
- Diagnosing Migraines and Headaches With MRI. Accessed August 12 2014. link here
- Headache. Cleveland Clinic. Accessed August 12 2014. link here
- Headache Better Health Channel. Accessed August 12 2014. link here
- Headache | Johns Hopkins Medicine Health Library.Accessed August 12 2014. link here
- Headache Australia. Accessed August 12 2014. link here
- Headache Information Page: Accessed August 12 2014. link here
- Headache Prevention - Headache Awareness - EverydayHealth.com. Accessed August 12 2014. link here
- Migraines and Headaches: Treatment & Care. Accessed August 12 2014. link here
- Secondary Headache. Accessed August 12 2014. link here
10 Most frequently asked questions (FAQs)
A headache can be defined as pain that is felt in the head or upper neck. The kind of pain associated with a headache may be described as dull, sharp, constant, throbbing, mild or intense. What are the symptoms of headaches? Headache symptoms may vary depending on their type and cause: Pain location - headache pain may only occur on one side of the face or head, both sides, or it may alternate sides. Headache pain may be felt across the forehead, over the eye region, the temples, the scalp or the ears. Pain quality - headache pain can be described as dull, constant, throbbing, or piercing. Some types of headaches may also be associated with symptoms other than pain that may include nausea and vomiting, aversion to lights and noise, fatigue, visual disturbances, fever and convulsions. Headaches can have a number of causes that may include: food or beverage triggers, excessive alcohol consumption, stress, muscle tension, hormonal changes and sleep disturbances. Some headaches are caused by an underlying medical condition such as infection, thyroid disorders, allergic reactions, severe hypertension and lesions. Although anybody can get headaches, most people who experience headaches are adults aged between 20 and 50 years. How are headaches diagnosed? Diagnosis of headaches involves taking your medical history and performing a physical examination. If needed, further diagnostic testing may include blood tests, urinalysis, and imaging scans. How are headaches treated? Headache treatments vary with their type, frequency and severity. Lifestyle modifications that may reduce frequency and severity of headaches include good stress management, adopting correct posture, getting enough sleep, avoiding excessive alcohol consumption, not smoking, and eating a healthy diet. Other treatment includes specific medication to relieve pain and prevent further episodes. For headaches that are caused by another underlying condition, treatment may require further consultation with a medical specialist, such as a neurologist, optometrist or an ear, nose and throat specialist. Are there different types of headaches? Primary headaches, such as tension, migraine and cluster headaches, are not caused by another condition. Secondary headaches, however, may be serious if they are caused by a potentially dangerous underlying medical condition. What factors can trigger headaches? Common triggers of tension headaches include certain foods or beverages, hormonal changes, stress, sleep disturbances and muscle tension. Cluster headaches may be triggered by the part of the brain that regulates the body's biological clock. Secondary headaches can be triggered by an underlying condition that is mild, such as an allergic reaction or sinusitis, or serious, such as hypertension or a head injury. Most headaches are not caused by an underlying condition and therefore not considered serious. The prognosis of secondary headaches may vary widely depending on the underlying condition causing the headaches.
Related topics
A migraine is a type of headache that typically involves throbbing pain, nausea, vomiting and sensitivity to light and sounds. Migraines can worsen with normal activity and can last anywhere from four hours to three days. They are more common in women and in people between 20 to 50 years of age. Abdominal pain in children
There are many causes of abdominal pain in children. Conditions such as constipation or overeating are not serious and usually pass on their own. Other causes, such as appendicitis or bowel obstruction, can need urgent medical attention. Back pain is a common symptom of different underlying conditions such as arthritis and muscular sprains. Most back pain improves with appropriate treatment. However, prevention through good posture and safe lifting is equally important. Most pain associated with an illness, injury or surgery goes away within a few months of its onset. If pain continues after this time, it is defined as chronic pain. It can cause distress and discomfort and affect quality of life. How and why chronic pain occurs varies, but there are treatments available.