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Tension HeadachesThese are by far the most prevalent type of headache that affects adults and teenagers— about 80% of the population has had one at one time or another. Tension headaches cause a dull aching pain, tightness, or pressure (like a band) around your forehead or the back of your head and neck. These headaches are also called stress headaches because they are often caused by mental or emotional stress, anxiety, or physical stressors on the body, such as lack of sleep or poor posture. For most of us, tension headaches occur episodically, but for some people, they can be chronic, occurring several times each week or even daily. The good news is that they can be short-lived when treated by over-the-counter pain relievers.
MigrainesMore than 10% of people worldwide suffer from migraines, with women affected more than men by a factor of 3. Migraine headaches cause an intense, pounding, throbbing pain, often on just one side of the head. Along with the pain, people can have a multitude of other symptoms: sensitivity to light, noise, or smells; nausea or vomiting; or blurred vision. As a precursor to a migraine headache, some people also experience auras, which present as visual disturbances such as zigzags, shimmery or wavy vision, bright flashes of light, or even blind spots. Migraines can last from 4-72 hours and can occur as frequently as once a week or as rarely as once or twice per year. Although the exact cause is not fully understood, we do know that there are many environmental factors that can trigger migraines, ranging from certain foods and drinks to stress, changes in sleeping patterns, intense exercise, and bright lights or loud noises. Hormonal changes in women (pregnancy, menopause, points during the monthly cycle) can also trigger migraines. Knowing your specific migraine triggers is important for preventing them. There are also numerous medications that are used to treat migraines when they occur.
Sinus HeadachesSinus headaches are caused by sinusitis, an inflammation and swelling in your sinuses, which are the air-filled cavities above and on the sides of your nose. When you have allergies or a respiratory infection like a cold or the flu, your sinuses can fill with mucous, and if they don’t drain properly, the pressure builds up, causing a headache. Sinus headaches are therefore accompanied by symptoms such as a runny nose and nasal congestion and can cause pain and pressure in your cheekbones, forehead, or the bridge of your nose. The intensity of pain and pressure may also noticeably change when you move or turn your head, especially when you bend down. The best way to treat a sinus headache is to treat the underlying sinusitis. For some people, antihistamines or decongestants may not be the best choice – they can sometimes be too drying or they may not be safe to use because they raise your blood pressure. In those cases, a steroid nasal spray or saline irrigation (i.e., pre-packaged sprays which are made with distilled water) may be a better option. You can also use a homemade saline solution as long as you use distilled water or boiled water (at room temperature) to reduce infection risk. Interestingly, many people with frequent headaches attribute them to sinus problems when they are actually having migraines! This is why we always recommend discussing chronic headaches with your clinician to make sure you are getting the right kind of treatment.
Cluster HeadachesThankfully, cluster headaches are fairly rare, occurring in less than 1 person in 1,000, as this type of headache is the most severe. These cause a burning or piercing pain behind one eye (although the pain can radiate to other parts of the face). The pain is almost always confined to one side of the head and will either throb or be constant in its intensity. Unlike migraines, where lying down in a dark room may help, most people with cluster headaches cannot sit or lie still due to the pain and will often pace during an attack. Also, unlike migraines, they are more common in men than in women. Cluster headaches tend to happen in groups (hence the name “cluster”), occurring 1-3 times per day over a cluster period lasting 2 weeks to 3 months. The headaches may go away completely for a time only to return. While there is no cure for cluster headaches, there are treatments as well as some preventive measures, too.
Medication Overuse or Rebound HeadachesAdding insult to injury for the chronic headache sufferer is the possibility of developing a medication overuse headache (MOH). Also called a rebound headache, this type can occur in people who have frequent migraine, cluster, or tension headaches and use medications 10-15 (or more) times per month. Although all pain-relieving medications have the potential to cause medication overuse headaches, a higher risk of MOH seems to occur with:
- Common, over-the-counter (OTC) pain relievers like aspirin and acetaminophen (e.g., Tylenol) – especially if the recommended daily dosage is exceeded
- Combination pain relievers like Excedrin, which combines caffeine, aspirin, and acetaminophen, or the prescription medication Fiorinal, which contains the sedative butalbital
- Specific migraine medications such as triptans (e.g., Imitrex) and certain ergots
- Opiates, particularly those that combine codeine and acetaminophen (e.g., Tylenol with codeine)
Seeking Medical Attention for HeadachesAlthough frequent headaches can sometimes be debilitating and significantly affect your quality of life, most are not caused by serious or life-threatening disorders. Your clinician can determine whether you need additional testing to establish the cause of your headaches and work with you to create a treatment plan. There are some headache symptoms that you should not ignore. Those include the following:
- "Thunderclap" headaches – come on suddenly (within seconds), and feel like the worst headache of your life
- Headache with a fever and stiff neck
- Headache with loss of consciousness or confusion
- New headache with weakness, numbness, or vision changes