What You Should Know About Headaches

“Most people have experienced headaches from common causes like stress, tiredness, hunger, sore muscles, and eye strain,” said Rahul Parikh, DO, Catholic Health Primary Care Physician. “For others, headaches are chronic and can cause debilitating symptoms that limit their ability to do everyday activities.”

There are more than 150 types of headaches, some more common than others. Headaches are classified into two types: primary and secondary:

• Primary headaches are the most common. They are the central concern unrelated to a separate underlying medical condition.

• Secondary headaches are symptoms of other health issues, such as high blood pressure, stroke, sinus infection, or injury.

Common primary headaches

Tension headaches

Tension headaches are the most common type of headaches. They present with a constant, dull pain that feels like an ever-tightening band around the head. Pain often occurs on both sides and commonly affects the frontal/occipital areas of the head. Muscle spasms/contractions can also occur in the neck.

Common triggers of tension headaches include:

• Stress, anxiety and depression

• Fatigue

• Neck strain 

• Eye Strain

• Hunger

• Arthritis in the neck

• Conditions that affect the muscles and joints in the neck and jaw

Tension headaches can range in duration from 30 minutes to several hours and, in some cases, several days.

“You can treat a tension headache with over-the-counter medicine like acetaminophen and ibuprofen,” said Dr. Parikh. “However, never take any medicine without checking with your doctor to ensure you do not have an allergy or are taking other medicines that can interact and cause complications.”

She also noted that at-home treatment is only helpful for occasional tension headaches. If you have frequent headaches, you should meet with your doctor to discuss the intensity and duration of your symptoms and what treatment options would be most effective.

“Sometimes it is as simple as lifestyle modifications like stress management, healthy eating and regular exercise,” she said. 

Migraine headaches

Migraines cause intense, pounding pain or a pulsing sensation typically on one side of the head, beginning around the eye and temple before spreading to the back of the head. They may last for hours or even days.

Bright lights, noise, smells, and movement can worsen the pain, leading to nausea, vomiting or vision changes. In some cases, there is also an associated aura with symptoms that may include halos, flashing/bright lights, wavy lines, or tingling in the hands or face.

Common migraine triggers include:

• Food sensitivity

• Light sensitivity 

• Smell sensitivity 

• Weather changes (sensitivity to barometric pressure, heat and humidity)

• Stress, anxiety or depression

• Diet

• Skipping a meal

• Aged cheese

• Nitrates (cured meat and fish)

• Alcohol (red wine)

• Chocolate

• Caffeine levels

• Hormonal changes (for women)

“Your doctor may recommend prescription medication if you have several migraines a month alongside lifestyle modifications to reduce triggers,” said Dr. Parikh. “Treating a migraine in its earliest phase can help prevent symptoms from worsening.”

She noted that you also may need to see a specialist, such as a neurologist or pain management specialist, or explore holistic treatments like acupuncture.

Cluster headaches

Cluster headaches are rare. They typically start suddenly and occur in a series of headaches, one after another, throughout the day. As one headache subsides, another begins. Each headache can last from 15 minutes to three hours. This cluster of headaches can continue for weeks or months.

A cluster headache causes severe pain behind or around the eyes and, in some cases, can cause nasal congestion and eye tearing on the same side as the headache. Sometimes, the eyelid droops.  

The cause of cluster headaches is not clearly known, but they are more common in men.

“Cluster migraines require medical intervention,” said Dr. Parikh. “You and your doctor can identify triggers and explore treatment options like prescription medication and lifestyle changes.”

The difference between migraines and cluster headaches

Cluster headaches and migraines are both intense, debilitating headaches. However, there are key differences between the two. Knowing the difference is critical for proper diagnosis and treatment.

Some of the main differences between migraine and cluster headaches include:

• Accompanying symptoms — Migraines often include symptoms such as nausea, vomiting and sensitivity to light and sound. Cluster headaches may also cause eye watering or redness, or nasal congestion. 

• Duration and frequency—Migraines can last from 4 to 72 hours. Cluster headaches occur in short bursts ranging from 15 minutes to 3 hours and can occur multiple times a day. 

• Location of the pain — Migraines usually affect one side of the head or behind the eyes. Cluster headaches usually affect one eye or temple. 

• Pain type and intensity — Migraines usually have a throbbing, pulsing pain. Cluster headaches have a sharp, stabbing pain. 

• Timing and triggers — Environmental factors, stress or hormonal changes can trigger migraines. Cluster headaches often occur at the same time each day, usually at night. 

Can you have migraines and cluster headaches?

It is possible to have both migraines and cluster headaches. Research suggests 10% to 17% of people with cluster headaches also have migraines. A 2019 study found that chronic cluster headache seems to be slightly more common in people who also have migraine. If you have both, your treatment will depend on which one is causing your pain. 

It is also possible to have more than one type of headache at the same time, such as a combination of a migraine and tension headache, known as a mixed tension migraine.

How are migraines and cluster headaches diagnosed?

Physicians diagnose migraines and cluster headaches by evaluating your symptoms and reviewing your medical history. They may order additional tests to rule out other conditions. Diagnostic tests include:

• Blood tests

• Computed tomography (CT scan) 

• Electroencephalogram (EEG)

• Magnetic resonance imaging (MRI)

• Neurological exam

How to treat migraines and cluster headaches

The goal of treatment for migraines and cluster headaches is to prevent attacks and decrease the severity of symptoms. Treatment depends on the type of headache. 

Migraine treatment

Migraine treatments include: 

• Lifestyle changes, including avoiding triggers.

• Over-the-counter pain relievers, such as ibuprofen or aspirin.

• Prescription medications, such as triptans or anti-nausea medication.

• Preventive treatments for chronic migraines.

Cluster headache treatment

• Cluster headache treatments include: 

• Abortive treatments, such as oxygen therapy and triptans.

• Lifestyle changes, such as managing stress or avoiding smoking or drinking alcohol during clusters.

• Preventive medications, including corticosteroids or verapamil.

Talk to your physician if you have new or worsening symptoms or side effects from treatment.

 Living with migraines and cluster headaches 

Living with migraines or cluster headaches can be challenging. However, there are ways to manage the conditions to improve your quality of life: 

• Identify and avoid triggers, such as certain foods, stress or sleep patterns.

• Maintain a regular sleep schedule.

• Practice relaxation techniques to manage stress, such as deep breathing.

• Seek support from a health care provider for long-term management.

• Stay hydrated.

Common secondary headaches

Sinus headaches
Sinus pressure causes sinus headaches. Your sinuses are air-filled spaces located behind your nose, forehead and cheekbones. When allergies or infections irritate those spaces, they increase mucus production, which causes pressure and pain.

Rebound headaches
Rebound headaches are usually associated with medication problems or substance abuse issues. They are sometimes called medication-overuse headaches. Pain from rebound headaches varies and may cause nausea, vomiting, anxiety, difficulty sleeping, irritability and depression.

Secondary headaches can also be caused by:

• High blood pressure

• Pregnancy

• Injury

• Stroke (call 9-1-1 immediately if you are showing signs of a stroke)

When is it not a headache? 

The National Headache Foundation recommends seeking emergency care or calling 9-1-1 if:

• You are confused or disoriented.

• You vomit uncontrollably.

• You cannot speak clearly or slur your words.

• You experience weakness or paralysis on one side of your body.

• You have your worst headache ever.

• You lose consciousness.

• You lose your vision, or it becomes blurry.

• Your headache causes abnormal or unusual symptoms that concern you.

• Your pain lasts longer than 72 hours.

Headaches vary in intensity, frequency and cause by person.

“We often recommend that patients keep a diary to determine if there is a pattern of specific triggers that cause their headache,” said Dr. Parikh. “Alongside a physical exam and other testing, this helps diagnose the type of headache or determine if it is another health condition. The sooner you can start treatment, the sooner you can find relief from painful headaches.”

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