Nearly everyone at some point has experienced a headache. The World Health Organization estimates that 47 percent of adults have experienced a headache in the past year.
However, not all headaches are the same. Some may cause a person minor discomfort, but some can be extremely painful and debilitating. Some headaches may also indicate the presence of other serious health problems.

What is a headache?

A headache is pain or discomfort in the head, scalp or neck, according to the National Institutes of Health.

Headache disorders fall into two broad categories. A primary headache is a headache due to the headache condition itself and not brought on by another cause while a secondary headache is a headache caused by another condition.

Primary headaches include tension-type headaches, migraines and cluster headaches.

Tension-type headaches are often described as experiencing pain that feels like a tight band is squeezing your head or a weight is sitting on your head. It is the most common type of headache and accounts for about 90 percent of all headaches.

“Tension headaches are brought on by stress, anxiety, depression and sleep disturbances,” said Dr. C. David Gordon, a neurologist with Novant Health Neurology Specialists – Randolph.

Tension-type headaches can become disabling when they are chronic. Overusing painkillers to treat tension-type headaches can cause daily chronic headaches. “These are analgesic-fueled headaches and once the patient stops taking the painkillers they often improve,” Gordon said.

Though tension headaches are common, the most prevalent headache type Gordon sees at his practice is migraine. “Thirty-six million Americans suffer from migraine headaches,” he said. “More people have migraines than have diabetes or asthma.”

Migraines are common and debilitating headaches, according to the International Headache Society. The society said that migraines can be present with or without an aura. Migraines without aura are recurrent headaches that last anywhere between four to 72 hours.  Patients describe the moderate to severe pain as throbbing in one area of the head. During an episode, patients are very sensitive to light and sound and they may also experience nausea and vomiting. Routine physical activity such as walking can aggravate the pain. Women are more likely than men to suffer from migraines.  “Approximately 20 percent of women suffer from migraine headache compared to roughly 8 percent of men,” Gordon said. “Hormones such as estrogen play a role in migraines. Many women will have migraines at ovulation and as a period approaches,” he added.

“Migraines can be very debilitating,” the doctor said. “Migraines contribute to more missed work than any other disease, so not only is it painful for the patient but it’s costly to our society as a whole.”
In cases of migraines with aura, patients experience warning symptoms hours or even a day before the attack including fatigue, sensitivity to light or sound, nausea or blurred vision. The migraine will develop gradually over five to 20 minutes and usually last less than an hour.
“In about one out of 50 patients, migraines will be chronic, which can produce headaches 15 or more days per month,” Gordon said.

Cluster headaches cause intense, repeated bouts of pain on one side of the head. During a bout with cluster headaches, the pain can occur at the same time each day (often at night) and become intense for a half-hour to an hour. Episodes occur regularly for a week to a year and are separated by periods without pain. Patients may also experience watery eyes and a stuffy nose during an attack.

Cluster headaches present very differently from migraines, according to Gordon. “They tend to affect mostly men,” Gordon said. “It’s a number of headaches on a clustering of days with a cluster of symptoms.”
“The headaches usually last from 30 minutes to 90 minutes and tend to strike at night during REM sleep when patients will wake up to extreme pain on one side of the head,” he added.  The pain associated with the cluster headache will wind down and disappear as quickly as it came on, Gordon said.  “Cluster headaches can be very hard to diagnose,” Gordon said. “Patients will wake up in the middle of the night in intense pain. They’ll go to the emergency room. The next night they might experience the same pain so it might take a while for a provider to understand it’s a cluster headache.”

Secondary headaches are caused by other conditions such as high blood pressure or infections such as sinusitis or meningitis. A mild head injury can cause a headache and so can tumors in the head. Blood vessel problems, such as a hemorrhage following the rupture of an aneurysm, can also cause a severe headache.

What are the causes of a headache?

A number of factors can trigger a tension-type headache including stress, depression, anxiety, a head injury, or holding your head and neck in an abnormal position.

The pain in a tension headache usually affects both sides of the head, starting at the back and spreading forward. It can be accompanied by soreness in the shoulders, neck or jaw.

Researchers are not certain what causes migraines. The scientific community sees it as an attack on the brain because of genetic predisposition and an inflammatory component associated with the disease.  “Patients may have a genetically susceptible brain. Weather changes or hormonal changes and foods that you eat or caffeine or smoking cigarettes all can trigger a migraine,” Gordon said.

Foods that can trigger migraines may include chocolate or certain types of cheese or seasonings such as monosodium glutamate or nitrites in processed meats. Other triggers may include caffeine withdrawal, alcohol and lack of sleep.

Headaches that keep reoccurring are known as rebound headaches and can be due to overuse of pain medications. People who regularly take pain medications more than three times a week may be susceptible to rebound headaches.

Treatment

Fortunately, there are many treatments for headaches, according to Gordon, who says there has been significant improvement in classifying the types of headaches over the last 30 years. “Most treatments are abortive, but by next year it’s likely we’ll have a preventive injection treatment for migraine,” Gordon said.

Do you suffer from frequent headaches? It may be time to be evaluated. Visit NovantHealth.org to find a Novant Health neurologist near you.