Headaches are a very common medical complaint affecting millions of people annually, and nearly every person at some point in their life. What causes a headache? Are all headaches, migraines? While the terms “headache” and “migraine” are commonly used, not all headaches are the same. Unique symptoms and different treatments characterize the various types of headaches. Though the term “migraine” is often used informally to mean just an intense headache, understanding the various types and their respective treatments can help you in correctly treating and preventing them.
Three most common types of headaches include Tension, Cluster, and Migraines.
Tension headaches are actually the most common, manifesting as a steady, aching pain around the head (often towards the forehead). Tension headaches are generalized, meaning the pain is not only on one side of the head. Muscles in the neck, temporal area, and forehead may feel tight or tender. This type of headache can be triggered or worsened by anxiety, depression, and stress.
Cluster headaches are a more unique type of headache. Cluster headaches are characterized by sharp, deep pain usually located behind the eye, and occurring in “clusters” throughout the day. Repeated clusters of daily headaches may go on for 2-3 months. Cluster headaches are usually only on one side. This kind of headache is less common, and is sometimes associated with middle-aged men.
Migraine type headaches are a more severe and specific type of headache. Migraines are usually throbbing and severe, they occur only on one side at a time. They are often preceded by a “prodrome” period, which may manifest as odd smells or tastes, food cravings, irritability, sleeplessness, or fatigue. Nausea and vomiting are commonly associated as well. Interestingly, medical evidence suggests a genetic inheritance (Autosomal Dominant pattern with incomplete penetrance) to migraines. They are more common in women than men, in those with a positive family history, and may occur up to 1-2 times per month.
Irrespective of specific type, most headaches may be triggered or worsened by anxiety, depression, and stress. Especially in Migraines, serotonin depletion plays a major role, which underscores the importance of addressing depression and anxiety. High blood pressure can also play a significant role. However, sometimes headaches can be caused by a more serious, underlying problem.
Medication side effects of nitrates, alcohol withdrawal, or long-term analgesic use can result in headaches. Very dangerous causes of headaches include: Intracranial bleeding, Temporal Arteritis, Tumor or cancerous masses inside the brain or spinal cord, or serious infections such as meningitis, encephalitis, and brain abscesses.
In treatment for most headache types, it is important to address underlying causes. This means focusing on reducing and healthily coping with stress in your life, minimizing anxiety responses, and treating depression. It is impossible to underscore the key role these holistic, lifestyle treatments have in reducing frequency and severity of headaches.
Medications frequently used to treat all of these types of headaches include Acetaminophen (Tylenol), “NSAIDS” (Ibuprofen, Motrin, Aleve), and aspirin.
For Migraines, if the symptoms are moderate to severe and fail to resolve with acetaminophen or NSAIDs, then Triptans are a class of drug used to abort a severe migraine when it is starting. Unique for Cluster headaches, breathing high-flow oxygen via a nasal cannula is a very effective treatment. Sumitriptan may also be used in Cluster headaches.
Prevention of Cluster type is very effective when taking Verapamil daily (a calcium-channel blocker drug). For prevention of migraines, daily Propranolol (Beta-blocker), Amitriptiline (Tricyclic antidepressant), Verapamil (Calcium channel blocker), or centrally acting drugs like Valproic Acid can all be very effective.