Headaches are one of the most common reasons that people see their primary care physician. They account for 20% of outpatient visits to neurologists. People with chronic headaches report disabling symptoms that interfere with daily activities. Sources of headaches are often a combination of factors including musculoskeletal, psychological, neurovascular, nutritional, and chemical imbalances in the brain.
This society has classified hundreds of different types of headaches into two categories: primary headaches and secondary headaches. Primary headaches are the most common headache type and have a single cause. They are not the result of an underlying disease or process. They include migraine, tension-type, cluster, and others.
Secondary headaches are classified according to their causes. Examples of secondary headaches are headaches attributed to temporomandibular joint (TMJ) disorders and cervicogenic headaches, which are attributed to mechanical disorders of the neck. Secondary headaches can also be a warning sign of more serious underlying problems like brain tumors, aneurysms, inflammatory diseases and abnormalities of the spinal fluid. Both are treated by various clinicians including osteopaths, dentists, chiropractors, massage therapists, and physical therapists.
Sources of headaches are often a combination of factors, including musculoskeletal, psychological, neurovascular, nutritional, and chemical imbalances in the brain. Headaches tend to run in families. Some headaches relate to or are indicative of a disease process; some are life-threatening and others benign. Thus, a thorough medical evaluation is necessary with any onset of a new or ongoing headache. Most researchers agree that there is a musculoskeletal component in tension-type, cervicogenic, and TMJ disorder related headaches.
Many have sought numerous different treatment approaches, have accepted that their headaches are a fact of life, and have become dependent on medications to relieve their symptoms.
Common Types of Headaches
Tension Headaches are the most common. They are usually not as severe as migraines and usually do not cause nausea or vomiting. Instead you may feel an ache or pressure especially at the temples and behind the eyes and/or at the base of the skull or in the upper neck.
Migraine Headaches can be diagnosed using a set of criteria including:
Lasting between 4-72 hours
At least five previous episodes
At least two of these four symptoms: one sided pain, throbbing pain, moderate to severe pain, pain that is worsened by routine activities or interferes or prevents these activities
At least one of these symptoms: nausea and/or vomiting or if neither of these are present, then sensitivity to light or sound
Mixed Headache Syndrome (transformed migraines) are a combination of tension and migraine headache.
Sinus Headaches which are the result of a sinus infection accompanying a head cold. The pain will feel like a deep constant pain in the cheekbones, forehead or the bridge of the nose and intensifies with movement or straining.
Cluster Headaches are recurring headaches coming in groups or cycles (clusters). Men are more often affected than women and are characterized by a sudden appearance of severe pain on one side of the head frequently accompanied by a watery eye and either nasal congestion or a runny nose on the same side as the pain.
Hormone headaches are usually associated with changing hormone levels occurring during menstruation, pregnancy and menopause. Birth control pills can also cause these headaches.
Rebound headaches are due to the overuse of painkillers for headaches. Aspirin, acetaminophen (Tylenol), ibuprofen (Motrin, Advil) as well as prescription drugs when overused can ironically lead to headaches.
Headaches – History, Examination and What to Expect
Your doctor will take a detailed medical history to help them determine what type of headaches you might be having. Your doctor will ask questions about when your headaches occur, how long they last, how often they come on, the location of the pain, and any symptoms that accompany or precede the headaches.
It is important to provide your doctor with a list of things that cause the headache, aggravate the headache, and things that you have done to relieve a headache.
Keeping a diary about your headaches before seeing the doctor will help you answer these questions.
For most headache sufferers, special diagnostic tests will not be necessary. However, a headache evaluation may include a CT scan or MRI if a structural disorder of the central nervous system is suspected. Both of these tests produce cross-sectional images of the brain that can reveal abnormal areas or problems. Skull X-rays are not helpful. An EEG (electroencephalogram) is also unnecessary unless you have experienced a loss of consciousness with a headache.
The good news for headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started.
If your headache symptoms become worse or become more frequent despite treatment, ask your doctor for a referral to a headache specialist.
Preparing for Your Visit with a Doctor
Keep and bring a lifestyle diary of headache frequency
Keeping a headache diary, particularly when you first begin to have headaches, can help identify the triggers for your headaches so you can avoid them. When a headache occurs, write down the date and time it started. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were doing just before the headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop as well as the symptoms you felt while having the headache.
Other lifestyle measures that may reduce the number of migraines include:
Avoiding cigarettes, caffeine, and alcohol
Exercising regularly
Getting enough sleep each night
Relaxing and reducing stress in your life
Eating regular meals
Once a headache or migraine symptoms begin, it helps to:
Rest in a quiet, darkened room
Drink fluids to avoid dehydration, especially if you have vomited
And be prepared to answer:
When did you first develop headaches?
How often do you have them?
Do you experience symptoms prior to the headaches?
Where is the pain exactly?
How long does it last?
At what time of day do the headaches occur?
Does the eating of certain types of food precede your headaches?
If you’re female, at what time in your monthly cycle do they occur?
Are the headaches triggered by physical or environmental factors, such as odor, noise, or certain kinds of weather?
What words most accurately describe the pain of your headache: throbbing, stabbing, blinding, piercing, for example