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Headache

fotolia 45799554Headaches are very common and are responsible for millions of doctor visits each year. More than 9 in 10 adults will experience a headache sometime in their life. Nearly 2 out of 3 children will experience headache in childhood by age 15. Headaches can vary in frequency and severity. Some headaches may recur or last for weeks at a time. The level of pain caused by a headache can range from mild to disabling. Moderate to severe headaches may also be accompanied by symptoms such as nausea or increased sensitivity to noise or light. Headaches can be so debilitating for some people that they cannot work or attend school.

Types of Headaches

The International Headache Society has classified more than 150 types of headaches. They are categorized primarily as “primary headaches” or “secondary headaches”. It is possible for people to have more than one type of headache disorder.

Primary headaches occur independently and are not caused by another medical condition. The most frequent type of primary headaches are:  migraine, tension-type headache and cluster headache. It's uncertain what causes a primary headache. There are changes in nerve cell activity and the levels of brain chemicals called neurotransmitters. Certain types of primary headache, such as migraines, run in families. Episodes of headache may ease or even disappear for a time and recur later in life. Secondary headaches are the result of a different medical condition causing pain-sensitive nerve endings to be pressed on or pulled or pushed out of place. They may result from underlying conditions including fever, infection, medication overuse, stress or emotional conflict, high blood pressure, psychiatric disorders, head injury or trauma, stroke, tumors, and nerve disorders (particularly trigeminal neuralgia, a chronic pain condition that typically affects a major nerve on one side of the jaw or cheek).

Headaches and Sleep

Headaches can often result from a sleep disorder. For example, tension-type headache is regularly seen in persons with insomnia or sleep-wake cycle disorders. Nearly three-fourths of individuals who suffer from narcolepsy complain of either migraine or cluster headache. Migraines and cluster headaches appear to be related to rapid eye movement (REM) and other sleep periods.  Hypnic headache awakens individuals mainly at night but may also interrupt daytime naps. Reduced oxygen levels in people with sleep apnea may trigger early morning headaches. Getting the proper amount of sleep can ease headache pain. Generally, too little or too much sleep can worsen headaches, as can overuse of sleep medicines. Daytime naps often reduce deep sleep at night and can produce headaches in some adults. Some sleep disorders and secondary headache are treated using antidepressants. Check with your doctor before using over-the-counter medicines to ease sleep-associated headaches.

When to See a Doctor for Headaches

Not all headaches require a doctor’s attention. However, some headaches can signal a more serious medical disorder that requires prompt medical care. Immediately call or see a physician if you or someone you're with experience any of these symptoms:

  • Sudden, severe headache that may be accompanied by a stiff neck.
  • Severe headache accompanied by fever, nausea or vomiting that is not related to another illness.
  • “First” or “worst” headache, often accompanied by confusion, weakness, double vision or loss of consciousness.
  • Headache that worsens over days or weeks or has changed in pattern or behavior.
  • Recurring headache in children.
  • Headache following a head injury.
  • Headache and a loss of sensation or weakness in any part of the body.
  • Headache associated with convulsions (seizures).  
  • Two or more headaches a week.
  • Persistent headache in someone who has been previously headache-free, particularly in someone over age 50.
  • New headaches in someone with a history of cancer or HIV/AIDS.

Diagnosis

How and when a person experiences a headache is very important information for making a diagnosis and following treatment. Keeping a headache diary can be helpful for recording headache symptoms and identifying a trigger. After a period of time, one may begin to see a pattern. In most cases, a physical exam, medical history and headache history can provide enough information for your doctor to diagnose your type of headache and determine the best treatment. However, in some cases, additional tests may be ordered to identify the cause or rule out other medical conditions. Some specific tests that may be ordered in select cases include Neuroimaging and Electroencephalogram (EEG).  

Treatment

The headache treatment your doctor recommends depends on several factors: the type of headache (migraine, tension-type, cluster or secondary headache), the severity (mild, moderate or severe), the frequency (a couple times a year, or several times a week), and results of previous treatments. At-home headache treatments may be effective for mild headaches and may include simple relaxation techniques. A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches. Over-the-counter medications, such as acetaminophen, aspirin, or ibuprofen may also be helpful. (Do not give aspirin to children.) If over-the-counter remedies do not control your pain, you may benefit from a prescription headache medication. Prescription medications used for migraine headaches include ergotamines, isometheptene (Midrin®), and triptans, such as Axert® (almotriptan), Imitrex® (sumatriptan), Maxalt® (rizatriptan), Relpax® (eletriptan), Treximet® (sumatriptan and naproxen), and Zomig® (zolmitriptan).

Medications may also be used to relieve other migraine symptoms, such as nausea and vomiting. If you get headaches often, your doctor may prescribe medication to prevent headaches before they occur. It is important to take these medicines every day as prescribed, even when you are not having a headache. People who take pain medications regularly for 3 or more days a week may develop medication overuse, or rebound, headaches. All types of pain pills (including over-the-counter drugs) can cause rebound headaches. If you think this may be a problem for you, talk to your health care provider. Additional treatment options for headaches include dietary changes and biofeedback. Primary headaches are rarely eliminated entirely. However, you and your doctor can usually develop a treatment plan that leads to fewer, less severe headaches. This can take time, and may require a trial period of different treatment options.