Brain
Brain
Headache
Headache
Headache
Headache

Headache

Definition:
Headache involves any pain in the head associated with any cause. See also benign headache, classic migraine headache, and common migraine headache.

Alternative Names:
Cephalalgia; Pain - head

Considerations:

Although painful and annoying, the vast majority of headaches do not indicate a serious disorder. Tension headaches and migraine headaches account for 90% of all headaches.

The different types of headaches are usually caused by one of the following:

Some headaches are caused by a combination of these two causes.

The following characteristics indicate a headache that signals a potentially serious problem:

  • Involves sudden, violent pain (could indicate an aneurysm)
  • Gets worse over time and includes other symptoms
    • Speech changes
    • Visual changes
    • Personality changes
  • Awakens you from sleep (could indicate a brain tumor)
  • Includes nausea, vomiting, fever, and a stiff neck (could indicate meningitis)
Common Causes:

Tension headache is a common headache pattern that may or may not be associated with psychosocial stressors. Tension headaches are characterized by the following:

  • Pain usually felt in the back of the head and neck, and usually not one-sided
  • Pain that lasts for weeks or months with only brief periods of relief, although it may fluctuate in severity
  • Attacks that begin at any time of the day
  • Pain that can be described as a "tight band," pressing, but rarely throbbing, and never accompanied by fever.

Migraine headaches, which are often preceded by fatigue, depression, and visual disturbance (light flash, loss of peripheral vision), are characterized by the following:

  • Pain that is characteristically only on one side at a time, but may involve the entire head
  • Pain that is throbbing in nature and usually develops in the morning and gradually becomes worse after an hour or so
  • Attacks that may occur as often as every few days or weeks or as seldom as months apart. Migraines often continue for hours, but rarely last longer than a day or two.
  • Pain that may be aggravated bystress, alcohol, or certain foods (such as chocolate) and is frequently accompanied by nausea and vomiting and relieved by sleep
  • Having a family history of migraine headaches

Cluster headaches are a variation of migraine headaches and are far less common. They occur mostly in men, while typical migraines are more common in women. Cluster headaches are characterized by pain that:

  • Is often situated behind an eye (usually the same eye)
  • Comes on very suddenly and without warning
  • Peaks within 5 to 10 minutes and disappears in less than an hour
  • Is often triggered by alcohol
  • Will awaken you from sleep and will occur several times a day for weeks and then stop

Inflamed sinuses (acute sinusitis or chronic sinusitis) are characterized by the following:

  • Pain that usually begins during or after a bad cold, particularly if you have postnasal drip
  • Pain that it is localized to one specific area of the face or head
  • Pain that is worse in the morning, before mucus has had an opportunity to drain
  • Pain that it is made worse by coughing, sneezing, or sudden movements of the head
  • Pain that it is aggravated by alcohol, sudden temperature changes, and going from a warm room out into the cold (during cold seasons).
  • A history of hay fever and allergies

Temporal arteritis occurs mostly in people over age 50 and is characterized by the following:

  • Pain that is aggravated by chewing
  • Impaired vision
  • Aches and pains all over the body
  • The presence of a fever
  • Weight loss
  • Elevated blood ESR (erythrocyte sedimentation rate)
  • May progress to loss of vision

Other common causes of headaches include the following:

Rare causes include the following:

Home Care:

Headaches may be relieved by resting with the eyes closed and head supported or by relaxation techniques such as meditation. A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches.

Over-the-counter pain medications are often effective headache relievers. For tension headaches, acetaminophen (Tylenol), aspirin, or ibuprofen (Advil or Motrin) are often effective. Your health care provider may prescribe a nonsedating muscle relaxant.

Migraine headaches may respond to aspirin, naproxen (Aleve), or combination medications such as Excedrin Migraine.

Avoid giving aspirin or other salicylates to children because of the risk of Reye's syndrome.

Prescription medications used for migraine headaches include mixtures of ergotamine and caffeine (Cafergot), Midrin, sumatriptan, and others. Sometimes medications to relieve nausea and vomiting are helpful for migraine management.

Some medications may be given to prevent headaches before they occur. Examples of these include nortriptyline, atenolol, and verapamil.

If you are using pain medications more than 2 days a week, you may be suffering from rebound headaches. Rebound headaches are caused by a cycle of using pain medications for short-term relief, followed by the headache pain returning for increasingly longer periods of time despite taking more pain medications.

All types of pain pills (including over-the-counter drugs), muscle relaxants, some decongestants, and caffeine can cause this pattern. If you think this may be a problem for you, talk to your health care provider.

To treat rebound headaches, stop taking all pain medications and other possible triggers for several weeks. Ask your health care provider about possible treatments to use during the withdrawal period.

Call your health care provider if:

The following symptoms are serious -- if you cannot see your health care provider immediately, go to the emergency room or call the local emergency number (such as 911)

  • The headache comes on suddenly and is explosive or violent.
  • The headache gets worse over time or is associated with visual difficulties, slurring of speech, problems in moving arms or legs, or similar problems.
  • The headache is associated with fever and a very stiff neck.
  • The headache is associated with head injury.
  • The headache is the worst you have ever had and comes on suddenly.

For the following, see your health care provider soon, but not as an emergency:

  • The headache has persisted more than a few days.
  • The headaches are worse in the morning, and no other symptoms are present.
  • You have headaches frequently, and there is no known cause.
What to expect at your health care provider's office:

Your health care provider will obtain your medical history and will perform an examination of your head, eyes, ears, nose, throat, neck, and nervous system.

The diagnosis is usually based on your history of symptoms. A "headache diary" may be helpful for recording information about headaches over a period of time. Medical history questions documenting your headache in detail may include the following:

  • Location
    • Is the headache located in the forehead or around the eyes (frontal or periorbital)?
    • Is the headache located in the back of the head (occipital)?
    • Is the headache located near the temples (temporal)?
    • Is the headache behind the eyeball (retrobulbar)?
    • Is the headache all over (generalized)?
    • Is the headache on one side only (unilateral)? Is it always on the same side?
  • Quality/type
    • Is this the worst headache in your experience?
    • Is this a new type of headache for you?
    • Would you describe the headache as pulsating (throbbing)?
    • Is it severe? Is it moderately severe?
    • Is there a pressure or band-like sensation?
  • Time pattern
    • Does the headache occur upon awakening in the morning?
    • Did the headaches begin with this episode of illness?
    • How long have you had headaches?
    • How long does each headache last?
    • Does the headache awaken you from sleep?
    • Did other symptoms begin shortly after the headaches began?
    • Did the headaches begin suddenly?
    • Do headaches occur repeatedly (recurrent)?
      • Do they occur multiple times daily?
      • Do they occur over a period of weeks?
    • Are the headaches worse during the day and better at night?
    • Does the headache reach maximum intensity over 1 to 2 hours?
    • Did they develop rapidly?
    • At what age did headaches begin?
  • Aggravating factors
    • Are the headaches worse when you are lying down or in a reclining position?
    • Are the headaches worse when you are standing up?
    • Are the headaches worse when you cough, sneeze, strain, or lift (Valsalva maneuver)?
    • Are thew headaches triggered by reminders of a traumatic event?
    • Do they occur at a specific time related to your menstrual period?
  • Relieving factors
    • What home treatment have you tried? How effective was it?
    • Is the headache relieved by medication that contains ergotamine (such as Cafergot and Midrin) or "triptans" (such as sumatriptan)?
  • Associated complaints
    • Does nausea or vomiting accompany the headache?
    • Is the headache preceded by a pop/snap in the skull?
    • Do neurological symptoms (weakness, loss of speech, etc.) occur when you have a headache?
    • Is the headache preceded by temporary loss of half of the visual field or other visual problems?
    • Does the headache cause the eye to tear on the same side as where the headache is?
    • Is there nasal discharge or stuffiness on the same side as the pain?
    • What other symptoms are present?

Diagnostic tests that may be performed include the following:

If a migraine is diagnosed, medications that contain ergot may be prescribed. Temporal arteritis must be treated with steroids to help prevent blindness. Other disorders are treated as is appropriate.

Review Date: 11/14/2002
Reviewed By: Elaine T. Kiriakopoulos, M.D., M.Sc., Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2003 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.