Headaches are a very common medical problem, and a frequent cause of missed school or work.
As painful as a headache can be, it rarely indicates a serious condition. By age 15, about 75% of people experience headaches at least once in awhile. The vast majority of headaches in young adults are vascular (caused by dilated blood vessels), muscular (caused by muscle contractions), or a combination of the two.
Types of Headaches
Headaches are generally classified as tension headaches, cluster headaches, or migraines.
Tension headaches are by far the most common type. The symptoms are described as a feeling of constant pressure or tightness around the head, often like a hatband that is too tight. Tension headaches typically come on gradually, often in the morning or early afternoon, and may worsen as the day goes on. The pain can be mild to moderately severe–with a steady, dull quality rather than a throbbing sensation. Tension headaches may last a few hours or continue for several days. Over-the-counter pain relievers, such as ibuprofen (Advil and others) and acetaminophen (Tylenol and others), should take care of the pain.
It’s unclear what triggers tension headaches, but stress and fatigue are believed to play a role. If you suffer from frequent tension headaches, it may be helpful to keep a headache “diary” to identify possible triggers. In your diary, record the time of day when a headache occurs, your emotional state at the time, how much sleep you had the night before, what you had to eat or drink that day, and any other potentially relevant information. Reducing stress, establishing regular sleep patterns, following a healthy diet, and getting regular exercise may help prevent tension headaches.
Cluster headaches are an extremely painful form of headache. They are easy to distinguish from other types by their severity, pattern of onset, and the location and quality of the pain. Cluster headaches often awaken a person from sleep (typically between 2 a.m. and 3 a.m.), but they can occur at any time. The pain is described as excruciating, penetrating, burning, or “like someone is boring a hole in your head,” and it is centered in or around one eye. During or after the headache, the eye may weep and appear bloodshot and your nose may run.
These headaches occur in “clusters”-happening several times a day, often for several weeks or months at a time, with a headache-free period before the next bout. Cluster headaches are more common in men, typically beginning in adolescence or early adulthood. Over-the-counter pain relievers are not as effective with this type of headache. If you suffer from cluster headaches, your doctor can prescribe an effective medication to treat the pain (such as the anti-inflammatory drug indomethacin). A variety of other medications may be tried, including a drug called ergotamine, which may also help prevent attacks. During a cluster, it’s important to avoid alcohol and cigarettes because both can trigger these excruciating headaches.
Migraines are another extremely severe type of headache-one that is more common in women. Like cluster headaches, migraines are easy to distinguish from garden-variety headaches. Many migraine sufferers experience warning symptoms several hours or even several days before the headache. During this “prodromal” phase, the individual may be more sensitive to light or odors and may experience mood or appetite disturbances and increased fatigue. Some migraines are preceded by an “aura”-odd visual disturbances, such as sensations of flashing or bright light or a reduced visual field. Tingling or numbness on one side of the face or body also may occur. Women may have more migraines during their menstrual periods.
The headache itself comes on gradually–beginning on one side of the head and spreading to the other–and is described as a pulsating or throbbing pain. During the migraine, the person may be extremely sensitive to light and noise and often experiences nausea, vomiting, chills, and weakness. Migraines may last a day or longer. They typically end with a gradual easing of pain, sometimes accompanied by vomiting and then a deep sleep.
If you suffer from migraines, see a doctor. Several types of effective medications are available to reduce the severity and frequency of attacks. The medication ergotamine and related drugs can halt a migraine in progress. Several prescription migraine medications are available in nasal, injectable, or suppository form to speed drug delivery and bring faster relief. Self-help measures are also very important in managing migraines. A variety of dietary and lifestyle factors can trigger attacks. The most common dietary triggers include alcohol (especially red wine); certain cheeses; chocolate; and foods containing monosodium glutamate (MSG), nitrites, or nitrates. Stress-reduction and relaxation techniques also may help prevent migraines. In some women, birth control pills are a contributing factor.
Although headaches rarely indicate a life-threatening medical problem, you should seek immediate medical care if you experience the following:
- The “worst headache of your life” or any extreme headache that is either your first bout with severe headache or is different from other headaches you’ve experienced
- Rapid-onset (within a few minutes), excruciating headache
- Head pain that arises after a head injury
- Headaches with other unexplained symptoms, such as blurred vision, stiff neck, rash, fever, or loss of consciousness
- Numbness, weakness, and visual disturbance in someone who doesn’t have a history of migraine.
- A severe headache that intensifies with activity or movement