A headache is pain arising from the head or upper neck region of the body. The pain originates in the structures and tissues that surround the skull. Headaches can be mild to severe, dull or sharp, intermittent or constant, and acute or chronic.
What are the three types of headaches?
Headaches are classified by the International Headache Society as one of three types: primary headaches, secondary headaches, and cranial neuralgias, facial pain, and other headaches.
What are primary headaches?
Primary headaches include:
- Tension headaches – This is the most common type of primary headache, and it affects women more than men. Around 5% of the general population suffers from tension headaches, according to the World Health Organization. Tension headaches are caused by contraction of the muscles that surround the skull. These muscles become stressed and inflamed, go into spasm, and pain results. The pain is felt at the base of the neck (trapezius muscles), the temples, and the forehead. The pain of tension headache is bilateral (both sides), and feels like pressure or a band-like tightness.
- Migraine headaches – These headaches affect children and adults, and after puberty, women are affected more than men. Migraines are the second most common type of primary headache. Migraine pain can occur on both sides of the head or one side only. The pain is often severe, and worsened by light, noise, and activity.
- Cluster headaches – This headache affects mostly men in their late 20s, but it can also affect children and women. These headaches are rare. Because they tend to occur daily for a cluster of time, cluster headaches are so named. The headaches will occur for a while, and then there will be a long period of time where no headaches occur. Cluster headaches are caused by sudden release of brain chemicals (serotonin and histamine). They are also triggered by certain medications and changes in sleep patterns. The pain of cluster headache may last for 30-90 minutes, occur 1-2 times each day, and occur at the same times each day. The pain is described as behind one eye, like a “hot poker,” and excruciating.
What are secondary headaches?
Secondary headaches are pains in the head due to an underlying structural problem of the neck or head. These headaches can result from dental abscesses, infected sinuses, bleeding of the brain, meningitis, or encephalitis. Head pain is a symptom of conditions like:
- Head trauma – Bleeding in the spaces between the layers of tissue around the brain, or bleeding within the brain itself.
- Concussions – Where head trauma occurs without bleeding.
- Whiplash – Neck strain can cause pain to go up toward the head.
- Aneurysm – A weakened area in a blood vessel wall can cause leaking of blood and headache.
- Temporal arteritis – Inflammation of the temporal artery.
What are cranial neuralgias, facial pain, and other headaches?
Cranial neuralgia describes inflammation of one of the 12 cranial nerves that branch off the brain, control muscles, and carry pain signals to and from the neck and head. The most common cause of facial pain is trigeminal neuralgia, which affects the fifth cranial nerve that supplies the face.
How are headaches diagnosed?
To diagnose a headache, the doctor will take a medical history, inquire about your symptoms, and conduct a physical examination. Tests are used to rule out underlying disease. Common diagnostic testing includes:
- Laboratory blood tests
- Computerized tomography (CT) scan)
- Magnetic resonance imaging (MRI) scan
- Lumbar puncture
- Blood tests
How are headaches treated?
The goal of headache treatment is to prevent the onset of headache, as well as alleviate pain when it occurs. Treatment varies according to the type of headache. Options include:
- Botox injections – One popular treatment for migraine headaches is Botox injections. The doctor injects the forehead and upper neck region with botulinum toxin A. This chemical substance works by blocking pain signals. According to a recent study, 66% of patients reported they felt better after Botox for migraine.
- Cervical epidural steroid injection (ESI) – For headaches arising in the cervical (neck) spine, an ESI can offer relief. The doctor injects a corticosteroid with or without an anesthetic into the space surrounding the spinal cord. In a recent research trial, the efficacy rate was 72% for cervical ESI.
- Occipital nerve block – For pain at the back of the head, the doctor can inject an anesthetic, corticosteroid, and/or neurolytic agent near the greater and lesser occipital nerves. In a prospective observational study involving lidocaine and methylprednisolone for cervicogenic headache, this block had a 91% success rate.
What medications work for prevention and treatment of headaches?
Many medications are used to prevent and treat headaches. These include:
- Ergots – Caffeine-containing medicines that include Cafergot and Treximet.
- Triptans – These are used for migraine attacks, and they are given at the start of the headache. Examples are Zomig, Imitrex, and Maxalt.
- Opioids – For severe pain, the doctor can prescribe a narcotic analgesic, such as hydrocodone, oxycodone, and codeine.
- Calcium channel blockers – These drugs work for headache prevention. Examples include Verelan and Calan.
- Beta blockers – These are used to prevent headaches. Examples include Lopressor and Betimol.
- Tricyclic antidepressants – These agents are used to prevent migraine headaches. Examples are nortriptyline and amitriptyline.
- Anticonvulsants – Examples include Depacon, Neurontin, and Topamax. These drugs are used for prevention of headaches.
Colorado Clinic offers top headache treatment at several locations in Northern CO including Boulder, Loveland, Greeley, Longmont and Fort Morgan. Most insurance is accepted with both medication management and interventional procedures being offered. Call us today!