What are Headaches?

Headache is a pain or discomfort in the head, scalp, or neck. It can be felt as a sharp, stabbing, burning, nagging, pounding, or pulsating pain in the head, as well as pressure or tight band around the head. This may come with tension in muscles of the shoulders, neck, scalp and/or jaw, often aggravated with stress. This can also result in significant emotional distress, depression, or anxiety.

While primary headache disorders rarely have an identifiable cause, the multitude of triggers and causes for headaches in general is enormous. Overworking, lack of sleep, too much sleep, missing meals or not drinking enough water, using alcohol or street drugs – are all factors that can increase the chance for headache. Headaches may also be triggered by chocolate, cheese, monosodium glutamate (MSG), and other dietary products. People who drink caffeine can have headaches when they do not get their usual daily amount. Other common causes include, but are not limited to, holding the head in one position for a long time, poor sleep position, overexertion, straining the eyes, environmental and occupational allergies, clenching or grinding the teeth in sleep.

While occasional headaches can be successfully treated with use of over-the-counter medications, patients who regularly experience more than 4 headache days a month will require a more individualized care plan. These patients should seek an evaluation by one of our headache specialists for targeted and comprehensive management.

The most common primary headache disorders include:

Migraines

Migraine headaches are severe, recurrent headaches, generally accompanied by other symptoms like visual disturbance, nausea, light sensitivity, or dizziness. They tend to begin on one side of the head, although the pain may spread to both sides. Some patients may experience an "aura" (warning symptoms before the headache) followed by the most consistent type of migraine pain - throbbing, pounding, or pulsating pain. This pain is usually exacerbated by movement or routine physical activities.

Females are four times more likely to suffer from migraines and these headaches are often hormone-related, affecting the most productive years of their lives. Each migraine can last anywhere from four hours to three days. Migraines lasting longer than this can potentially leave the patient unable to care for the family and/or eliminate the enjoyment of activities of daily living. 

What Causes Migraines?

The exact cause of migraines is unknown. For many years, scientists believed that migraines were linked to expanding and constricting blood vessels on the brain's surface. However, it is now proven that migraine is a more complex neurological disorder and is thought to be related to a certain type of “wiring” in the brain as well as to genetic causes.

While typically a primary headache disorder, migraines seem to be triggered by a multitude of external factors, including but not limited to:

• Emotional stress - This is one of the most common triggers of most types of headaches. Migraine sufferers are generally highly affected by stressful events. Repressed emotions surrounding stress, such as anxiety, feeling down, worry, excitement, and fatigue lead to neurochemical imbalance, increase in muscle tension, and dilation of the blood vessels going into the skull and brain, which all can intensify severity of the migraine.
• Sensitivity to specific chemicals and preservatives in foods - Certain foods and beverages, such as aged cheese, alcoholic beverages, food additives such as nitrates (in pepperoni, hot dogs, luncheon meats), and monosodium glutamate (MSG, commonly found in Chinese food, for example) may be responsible for triggering migraines in many patients.
• Caffeine - While caffeine is sometimes helpful in treating an acute migraine attack, excessive caffeine consumption or withdrawal from regular caffeine use can cause caffeine rebound headaches.
• Changing weather conditions, hormonal fluctuations in females before and during menstrual cycles, excessive fatigue, dehydration, skipping meals, and changes in normal sleep patterns are some of other common triggers of migraine.

Tension headaches

Tension headaches tend to be on both sides of the head, often starting at the back of the head and spreading forward. The pain may feel dull, squeezing, like a tight band. While most patients with uncomplicated episodic tension headaches will never seek medical attention (due to relatively low impact of the headache to the quality of their lives), patients with chronic tension headaches will require special treatment to overcome the burden of having frequent (or even daily) headaches and to become fully functional members of their families and society.

Cluster headaches

Cluster headache is the least common type of primary headache disorder, and occurs mostly in men. Like in the case of migraines, the cause of cluster headaches remains unknown. The pain of cluster headache is excruciatingly severe, and unlike migraine, has very distinctive features – such as stabbing quality of pain around one eye or the temple, frequently associated with redness of the affected eye and excessive tearing. It can occur several times a day, lasting from 30 minutes to three hours with each attack. Cluster headache may come in cycles, may have diurnal or circadian variations (occurring exclusively at night or at certain hours of the day), can be seasonal. Without proper treatment, the patient can feel these effects for weeks or months.