Types of Headaches You Should Know About

Types of Headaches You Should Know About

Headaches are very common yet a unique condition in the human body. They originate in the head or upper neck. They are unique because the brain itself has no nerves that trigger a sensation of pain. There are tissues that cover the brain & spinal cord and encase the skull, sinuses and sense organs in the head. These tissues, the arteries and veins in the head get irritated or inflamed for unknown reasons causing a headache.

Headaches can be divided into 3 broad categories:

• Primary headaches: These are not caused by any other underlying medical condition
• Secondary headaches: These are caused by other medical conditions such as tumours, infections, diseases of blood vessels in the brain, hypertension or high BP, sinus congestion, etc. Even head injuries and medication overuse can trigger headaches.
• Cranial neuralgias that cause facial pain and headaches

For the purpose of this article, we will only cover primary and secondary headaches.

Risk Factors for Headaches

• Diet: Certain foods or ingredients such as caffeine, cheese, chocolate, and fermented foods
• Major or frequent changes in diet or skipping meals
• Alcohol
• Exposure to allergens or substances that cause allergy in the person
• Second-hand cigarette smoke
• Strong odours from perfumes, household or industrial chemicals
• Changes in sleeping patterns
• Depression, anxiety, and emotional stress due to professional or personal issues
• Excessive use of certain medication
• Poor posture leading to pain or strain in the eyes, neck, or back
• Harsh and bright lighting
• Loud and constant noise
• Rapid changes in weather
• Travel
• Hormonal treatment

Types of Primary Headaches

Tension Headaches:

These are caused by stress and can happen to anybody. This feels like a dull ache all over the head. The forehead, the scalp, neck, and shoulder muscles all feel tender to the touch. If over-the-counter drugs don’t work for this and the pain gets severe, the doctor may prescribe specific medication. When tension headaches become chronic (long-lasting episodes and frequent episodes), a deeper examination and diagnosis will be done by the doctor.

Cluster Headaches:

As the name implies, there is a series of headaches occurring in a day, at almost the same time every day. This is characterized by a sharp pain and burning sensation behind either eye and on the same side of the face as that eye. The person may also experience congestion in the nose and watering eyes. Each headache can last from 15 minutes to 3 hours, and the patient may suffer for months at a stretch with some breaks in between. Oxygen therapy and drugs such as sumatriptan and lidocaine are given to reduce the symptoms. Once reduced, the prevention plan involves another set of drugs.

Migraine:

This feels like a sharp and throbbing pain that starts from deep inside the head and is generally present on one side of the face only. The person may also experience nausea, vomiting, and visual disturbances called as the aura. The aura appears like flashing or shimmering lights, zig-zag lines, blind spots, and stars. The individual may also be sensitive to light and sound. Women, people with a family history of migraines, and those suffering from PTSD all are at risk of migraine headaches. There are also environmental triggers such as hormone fluctuations, certain foods, sleep deprivation, dehydration, skipping meals and exposure to certain chemicals. There are various drugs given to reduce the symptoms and also prevent future episodes.

Types of Secondary Headaches

Sinus or Allergy Headaches:

An allergic reaction can trigger this type. Seasonal allergens, sinus infections, and sinusitis can trigger this condition, characterized by pain focused in the sinus area and the forehead. One symptom of the condition is accumulation of mucous in the sinuses, creating a pressure on them. So treating this condition involves decongestants, nasal sprays, and anti-histamines that prevent allergic reactions.

Hormone Headaches:

Women who are experiencing hormonal fluctuations experience this type of headache along with migraine headaches. This typically happens during menstruation, pregnancy and the use of oral contraceptives. Some over-the-counter pain relievers can be consumed to relieve the headache. The person can also try yoga, relaxation techniques such as meditation and acupuncture, and eating a certain diet.

Caffeine Headache:

People who consume a lot of caffeine experience this headache when they reduce the consumption. Caffeine changes the brain chemistry, and your body gets used to it. Drastically changing that can trigger a headache (caffeine withdrawal). One way to overcome this is to gradually cut down on caffeine consumption and quit it altogether one day.

Exertion Headaches:

Intense physical activity such as weight-lifting, running or even sexual intercourse can cause a rush of blood to the skull which can cause this type of headache. This generally gets relieved after a couple of hours. If it does not, analgesic medicines are given to overcome this ache. However, if the condition lasts long and happens frequently, there may be an underlying cause which must be examined.

Hypertension Headaches:

When the person is experiencing a dangerously high blood pressure, it can trigger a throbbing headache on both sides of the head. The person may also experience blurred vision, numbness and tingling sensation in the body, shortness of breath (dyspnea), bleeding in the nose, and chest pain.

Rebound Headaches:

Over-the-counter medication taken to relieve pain or even headache can trigger headaches if continued for more than 15 days. That is why doctors warn people against medication overuse. The only solution is to stop using the medication. This will cause the pain to resume, but it will eventually reduce.

Post-traumatic Headaches:

Trauma or injury to the head can trigger headaches that can recur for as long as 6 to 12 months from the injury episode. Beta blockers and certain other categories of medication are given to reduce this headache over time.

When to See a Doctor

Although painful and often disabling, the vast majority of headaches are not due to worrisome underlying problems. However, the presence of certain symptoms suggests the need to be evaluated by your doctor. These headache “red flags” include:

1. Thunderclap Headache:very severe headache that reaches its maximum severity immediately (within a couple of minutes). Thunderclap headaches require emergent medical evaluation.
2. Positional Headache:headache that substantially changes in intensity in association with changes in position – e.g. standing from lying or vice-versa.
3. Headaches Initiated by Exertion:headache that starts while coughing, sneezing, and/or straining.
4. New Headaches:especially if older than 50 years of age, or if there are medical conditions that make worrisome headaches more likely (e.g. cancer, blood clotting disorder).
5. Substantial Change in Headache Pattern:significant increase in headache frequency or significant change in headache characteristics.
6. Constant Headache Always in the Same Location of the Head
7. Worrisome Neurologic Symptoms:about 1/3 of people with migraine have neurologic symptoms (“migraine aura”) that typically precede onset of a migraine headache. Commonly, aura symptoms consist of slowly spreading visual symptoms sometimes accompanied by tingling of the face and upper extremity. These symptoms resolve within 60 minutes. If these symptoms have immediate onset (as opposed to a slow progression of symptoms), last longer than 60 minutes, or do not completely resolve, medical attention is required. Medical attention is also required if other symptoms are present, such as weakness of one side of the body, change in level of consciousness, significant difficulty walking, or other symptoms that worry you.
8. Headache that never goes away
9. Systemic symptoms:including fever, chills, weight loss, night sweats

If any of these headache “red flags” are present, your doctor will want to evaluate you by asking questions about your headaches and general health, and by performing physical and neurologic examinations. Based upon these assessments, your doctor will be able to determine if further tests are needed.

While an episode of headache that lasts for a few hours and goes away with OTC drugs may not be serious, episodes that last longer or occur frequently require a doctor’s intervention. Do not self-medicate or try home-remedies. Instead, consult a doctor at a reputed hospital immediately. He/she will diagnose the underlying condition if any and design a course of treatment for quick relief, long-term recovery, and rehabilitation.

Dr Sathish Kumar V

Senior Consultant & In charge - Stroke Programme and Stroke Prevention Clinic.