Headaches are the most common form of pain and a significant reason for missed work, school days and doctor visits. Without proper treatment, headaches can be severe and interfere with daily activities. They can range in frequency and severity. Some individuals may experience them once or twice a year, while others may experience them more than 15 days a month. Some headaches may recur or last for weeks at a time. Pain can range from mild to disabling and may be accompanied by symptoms such as nausea or increased sensitivity to noise or light.
Why headaches hurt
Brain tissue itself lacks pain-sensitive nerves and does not feel pain. Headaches occur when pain-sensitive nerve endings called nociceptors react to headache triggers (such as stress, certain foods or odors or the use of medicines) and send messages through the trigeminal nerve to the thalamus, the brain’s “relay station“ for pain sensation from all over the body. The following explains what each of these body parts does regularly:
- The trigeminal nerve. One of 12 pairs of cranial nerves that start at the base of the brain and sends information about touch, pain, temperature and vibration in the head and neck.
- The thalamus. Controls the body’s sensitivity to light and noise and sends messages to brain parts that manage awareness of pain and emotional response to it.
Other parts of the brain may also be involved in the process, which can cause nausea, vomiting, diarrhea, trouble concentrating and other neurological symptoms.
Types
Each of the three major headache types has different symptoms and responds to different treatments. Here’s what you need to know about each:
Tension headaches
Pain results from stress-related muscle tension in the neck, shoulders and head. Researchers think that fluctuations in brain chemicals called neurotransmitters, which regulate pain perception, may also play a role.
Symptoms
- A dull ache frequently described as a vise-like squeezing of the head, sometimes accompanied by a stiff or sore neck
- Pain usually above the eyes or in the back of the head
- Usually moderate pain
- Pain may fade in and out over a day or several days
What to do
For occasional tension headaches, over-the-counter pain relievers like aspirin, acetaminophen or ibuprofen can be effective. However, avoid overusing them, as this can cause rebound headaches—headaches triggered by medication withdrawal. If you experience chronic headaches, it’s essential to consult your doctor. To help prevent tension headaches, avoid activities that stress your neck muscles, such as reading with your head tilted downward. Acupuncture may also be worth considering, as some people report that regular treatments reduce the intensity and frequency of their headaches.
Migraines
Researchers once believed that migraine pain was caused by the dilation and constriction of blood vessels in the head. However, it’s now understood that migraines are likely due to a disorder in nerve pathways and brain chemicals. Potential triggers include hormonal changes associated with menstrual cycles (since most migraine sufferers are women), oral contraceptives, sleep pattern disruptions, skipping meals, weather changes, bright or flashing lights, loud noise, stress and certain foods—especially chocolate, red wine, aged cheeses and smoked meats. Genetics may also play a role in your susceptibility to migraines, which are more common in young women.
Symptoms
- Mild to severe pulsing or throbbing pain, usually on one side of the head, that lasts from several hours to several days
- Pain usually gets worse if you move around, look at a bright light or hear a loud noise
- Pain often interferes with daily activities; nausea or vomiting can also occur
Headaches are sometimes preceded by visual changes called auras. You may lose your vision during an aura or see shimmering, jagged, flashing lights or colors. Some people also feel nauseated or irritable right before a migraine begins.
What to do
Over-the-counter pain relievers like aspirin can be effective for mild migraines, but for frequent or severe cases, prescription medications are often more suitable. Your doctor can guide you in choosing from options like beta-blockers and calcium channel blockers, which prevent blood vessels from swelling, or antidepressants, which boost neurotransmitter levels. Alternative treatments such as acupuncture, relaxation exercises, yoga, biofeedback and herbal remedies may also offer relief. However, researchers at a meeting of the American Headache Society warned that some herbal remedies could interact with migraine medications or even make them toxic. Always consult your doctor before using herbal supplements. In addition, be sure to eat regular meals, get adequate sleep and steer clear of foods that trigger your migraines. Medications can help stop a migraine once it starts.
Cluster headaches
Why you hurt
Cluster headaches are far less common than tension headaches or migraines. Some researchers believe they may be linked to a lack of oxygen. In contrast, others suggest that fluctuating neurotransmitter levels or heightened sensitivity in nerve pathways could be contributing factors. Inflammation is also thought to play a role. Potential triggers include alcohol, exposure to hot or cold wind, high altitudes, stress and smoking. Cluster headaches are more common in the spring or fall, and most sufferers are male.
Symptoms
- Knife-like pain limited to one side of the head, often in or around one eye, that usually lasts no more than an hour
- Headaches in clusters, either several times in one day or for several days in a row, with recurrences at the same time of day, usually for six to eight weeks at a time
- Nighttime onset, perhaps painful enough to wake you
- Tearing in the eye on the affected side, redness or swelling around the eye or a droopy eyelid
- A stuffy or runny nose along with a headache
What to do
To prevent cluster headaches from occurring, doctors usually prescribe migraine medications. Once you have pain, inhaling oxygen can bring relief within a few minutes. Some people benefit from certain types of triptan medicines.
When to see a doctor about a headache
- Your headaches get stronger and more frequent
- Your headaches last more than 24 hours or recur two or three times per week
- If you also have numbness, blurred vision, memory loss or dizziness
- If you get a headache after hitting your head
- If exercise brings on a headache
- If your headaches interfere with daily life
- If a fever over 100 degrees accompanies your headache, you find it painful to bend your head forward or light hurts your eyes.
- If the headache is accompanied by nausea, vomiting or drowsiness
- If you have severe pain around one eye with blurred vision
Source: National Institute of Neurological Disorders and Stroke; SupportLinc EAP