What Are Headaches?

Headache disorders are one of the most common neurological (brain-related) conditions worldwide. In fact, more than 15% of people worldwide experience a headache on any given day. 

While the exact cause of most headaches is unknown, scientists believe that the neurological cause may involve the facial nerve, the neurotransmitter “serotonin,” and other brain chemicals. In some cases, headaches are not a stand-alone condition and may instead be a symptom of another condition—such as a sinus infection or head trauma. 

The symptoms and severity of headaches depend on the type of headache you have. There are four main types of headaches: migraine, tension, cluster, and secondary type. Fortunately, there are many over-the-counter (OTC) treatments available for headaches. If you are experiencing headaches that are severe or debilitating, your healthcare provider can prescribe you additional treatment and help you find ways to reduce pain.

Types

There are four main types of headaches—all of which differ in their symptoms, duration, location, and severity.

• Migraine: A severe form of headache that usually affects one side of your head. Migraine attacks can last anywhere from four to 72 hours.
• Tension: Tension-type headaches cause mild to moderate pain on both sides of the head. The headaches can be as short as a few minutes or last for several days. Tension headaches are the most common type of headache.
• Cluster: Cluster headaches are a less common type of headache. People with cluster headaches experience pain in one side of the head, which can last anywhere from 15 minutes to three hours. People with this type of headache can have episodes daily or several times a month.
• Secondary: Secondary headaches occur as a symptom of a different underlying condition, such as a sinus infection, head trauma or injury, or substance use or withdrawal. Symptoms of secondary headaches can differ depending on the underlying condition you are experiencing.

Symptoms

Headache symptoms can vary from person to person and depend on the type of headache that you have.

Migraine 

Symptoms of migraine include:

• Pulsing or throbbing head pain
• Light sensitivity
• Noise sensitivity
• Nausea or vomiting
• Foggy vision 
• Aura (a symptom that causes you to see flashing lights or zig zag lines)

Tension Headache 

People with tension headaches may experience:

• Pain on both sides of the head
• Neck and shoulder pain
• Pressure or tightness on the head 
• Difficulty sleeping 

Cluster Headache 

Cluster headaches tend to have more sudden and intense pain than tension headaches. Symptoms may include:

• Pain on one side of the head
• Eye symptoms such as drooping eyelid, tears, and redness 
• Stuffy nose
• Restlessness 
• Sweating 

Causes and Risk Factors

With the exception of secondary headaches which are a symptom of another condition, researchers aren’t sure what exactly causes headaches. Currently, headache researchers are studying different theories about several brain chemicals and biological factors that could help explain why people experience headaches and what determines their severity and duration. 

Each type of headache has its own theories of causes and separate risk factors or triggers. 

Migraine 

Early research suggests that serotonin (a neurotransmitter commonly called the “feel-good” hormone) might lead to migraine symptoms. Scientists currently believe that serotonin can release a protein called CGRP in some people that activates a facial nerve called the trigeminal nerve—a nerve that sends pain signals to the brain, which results in migraine headaches.

Some people may be more likely to experience migraine than others. Risk factors for migraine include having a family history of migraine and experiencing other health conditions such depression, anxiety, epilepsy, or a sleep disorder. Women are also three times more likely to get migraine than men.

Tension Headaches 

Tension-type headaches occur when the muscles in the scalp and neck become tense. However, scientists don’t know the exact reason headache-related muscle tension happens. Some research suggests that extreme stress, mood disorders, and head injury can increase your risk of muscle tension which can result in a tension headache. Research on tension headaches remains ongoing.

Common risk factors for tension headaches include emotional stress, eye strain or fatigue, smoking, physically overexerting your body, and excessive use of caffeine. Similarly to migraine, people who have a family history of tension headaches and are assigned female at birth experience tension headaches at higher rates.

Cluster Headaches

There are two main theories that researchers have developed about the cause of cluster headaches. 

The first: A dysfunction in the hypothalamus (a part of the brain that is responsible for sleep, body temperature, hormone regulation, and blood pressure) could lead to cluster headache symptoms.

The second: A release of histamine (a chemical that releases in response to an injury, allergy, or inflammation) in the brain may cause head pain and eye and nose-related symptoms.

Risk factors for cluster headaches can include alcohol and tobacco use, exposure to bright lights, taking certain medications, physical overexertion, and heat (such as hot weather or hot baths).

Diagnosis

Receiving a correct diagnosis for the specific type of headache you have is important to figure out the treatment that is right for you. If you begin to experience new symptoms or a change in your headache symptoms, it’s good practice to see your healthcare provider. 

At your appointment, your healthcare provider will ask you about your symptoms, learn about your family history and lifestyle, and perform a physical exam. In some cases, they may also order diagnostic tests to rule out other conditions and confirm a diagnosis. 

These tests may include:

• Magnetic resonance imaging (MRI) scan: This scan takes images of the brain and can look for potential suspects of head-related symptoms, such as tumors, bleeding, or fluid retention. 
• Computer tomography (CT) scan: If you recently experienced a head injury, your provider may order this diagnostic test to see any signs of trauma and assess potential brain damage. 
• Cerebrospinal fluid sample: Cerebrospinal fluid is a body fluid that appears in the brain and spinal tissue. Taking a sample of this fluid and testing it can help your provider learn whether the cause of your symptoms is due to a brain bleed, tumor, infectious disease, or autoimmune condition.  
• Blood tests: It is standard practice for healthcare providers to take a sample of your blood to test it for a complete blood cell count, or CBC test. The CBC test evaluates the current status of your red and white blood cells. In some cases, your provider can also order a C-reactive protein test—a test that can determine if you have inflammation in your body and brain. 

Using this information, your primary care provider or neurologist (a doctor who specializes in the brain and spinal cord) can understand the type of headache you have and how to proceed with treatment. 

Treatment

Over-the-counter treatments are available to manage the headache pain associated with most headache disorders. For severe pain, your provider may prescribe you certain medications to reduce the frequency and severity of your symptoms. In some cases, drug-free treatments can also help you manage your condition. The goal of treatment is to lower your symptoms, prevent the onset of severe symptoms, and improve your quality of life. 

Treatments for headaches include:

• Over-the-counter (OTC) medications: Typically the first line of treatment, OTC painkillers commonly include Tylenol (acetaminophen) and non-steroidal anti-inflammatory drugs such as Advil (ibuprofen). 
• Serotonin receptors: If OTC medications don’t help, your provider can prescribe you serotonin receptor drugs to help you reduce inflammation and ease symptoms. The most common type of serotonin receptor is Triptans, a class of medications to improve headache pain. 
• Lifestyle changes: Alongside medication, you might find that lifestyle changes also help improve your symptoms. Some drug-free pain relief methods include staying hydrated with fluids, getting sleep, resting your eyes in a dark and quiet room, and placing a cold compress or ice pack on your forehead. 

Preventing Headache Episodes

There is no surefire way to prevent all headaches. However, some prevention tips can help you lower the severity of your headaches and reduce how often headache episodes or attacks occur. Some techniques include:

• Setting a consistent sleep schedule by waking up and going to sleep at the same time each day 
• Getting 30 minutes of exercise five days a week 
• Drinking enough fluids throughout the day to stay hydrated
• Not missing meals and eating nutritious foods 
• Limiting your caffeine intake 
• Learning stress management techniques such as meditation, breathing exercises, or spending time with your loved ones
• Using a journal to write down information about your headache episodes and potential triggers that can lead to symptoms 
• Seeing a mental health professional if you need emotional support or want help with implementing lifestyle changes 

Co-occurring Conditions 

In some cases, a headache disorder can co-occur with other health conditions. During your diagnostic process, your healthcare provider may also choose to test you for other diseases—especially if they are concerned that you might be at risk for them. These conditions include:

• Heart conditions: High blood pressure, diabetes, and stroke commonly co-occur with migraine. These conditions can change how your blood flows to the brain which can lead to headache symptoms. 
• Psychiatric disorders: Having major depression, bipolar disorder, or anxiety increases your risk of developing migraine. 
• Restless legs syndrome: As many as one in three people with restless legs syndrome also have migraines. Research suggests that a chemical imbalance in your brain can contribute to migraine and restless legs syndrome symptoms.
• Chronic pain conditions: People with fibromyalgia (a condition that causes body pain, fatigue, and trouble sleeping) may be twice as likely to develop a headache disorder. 

A Quick Review 

Migraine, tension headaches, cluster headaches, and secondary headaches are four types of headache disorders. Living with any of these types of headaches can be frustrating and debilitating. 

These conditions can produce symptoms such as throbbing head pain, light and sound sensitivity, and nausea. While there is no outright cure for headaches, the good news is that several treatment options are available to help you manage symptoms and prevent future headache episodes. Medication and lifestyle changes are the two most common types of treatment. 

If you notice that you are experiencing symptoms or have a change in your headache symptoms, it’s a good idea to see your healthcare provider. They can test you for headache disorder and co-occurring conditions, as well as prescribe you with stronger medications to help you reduce symptoms and improve your quality of life.