HEADACHE

Headaches: Causes, Symptoms and Treatments

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A headache is defined as "a pain or ache in the head...It accompanies many diseases and conditions, including emotional distress."1

Headaches are one of the most common symptoms that can be experienced. Most people will experience a headache at some point of their lives.2 They can affect anyone regardless of age and gender.

The World Health Organization (WHO) reports that around 47% of the world's adult population will have experienced a headache within the last year. As well as being symptoms of other conditions, headache disorders can lead to the development of other illnesses. Depression is three times more common in individuals with severe headaches than healthy people.3

Contents of this article:

What is a headache?
What causes headaches?
Signs and symptoms of headaches
Tests and diagnosis
Treatment and prevention
You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.

Please note that we have also written separate articles about migraines, cluster headaches and hangovers. These all go into further detail about these specific conditions.

Fast facts on headaches
Here are some key points about headaches. More detail and supporting information is in the main article.
Headaches can be stand alone illnesses or the symptom of another condition.
Depending on the specific type of headache, they can last for any time between a few hours and several weeks.
Primary headaches are caused by problems with or overactivity from pain-sensitive structures in the head.
The most common form of primary headache is the tension-type headache.
A wide variety of conditions can cause secondary headaches, ranging from hangovers to brain tumors.
The most common form of secondary headache is the rebound headache (medication-overuse headache).
Health care providers will usually diagnose a headache from a history and description of its symptoms.
The most common suggested treatment for headaches is rest and pain relief medication.
Overuse of pain medication can lead to the development of rebound headaches.
It is estimated that 50% of people experiencing headaches self-treat rather than see a health care provider.
What is a headache?
mannequin head in vice
The pain from tension-type headaches have been described as "vise-like."
Headache is a broad term that encompasses many different things. Headaches are pains that occur in any region of the head; they can occur on both sides the head or be isolated to a certain location.

Headaches can radiate across the head from a central point or have a pincering vise-like quality. They can be sharp, throbbing or dull, appear gradually or suddenly and last for multiple days or less than an hour.4

There are multiple ways to define headaches. The International Headache Society (IHS) categorize headaches as primary headaches or secondary headaches, depending on what has caused them.5

What causes headaches?
Primary headaches
Primary headaches are stand alone illnesses which are caused directly by the overactivity of, or problems with, structures in the head that are pain-sensitive. This includes the blood vessels, muscles and nerves of the head and neck, as well as chemical activity taking place inside the brain.

Primary headaches can occur when pain-sensitive structures in the head do not work properly.
Common primary headaches include migraines, cluster headaches and tension headaches.

There are other types of headache that are considered to be primary headaches, although on occasion they can be symptoms of another illness and, therefore, secondary conditions. These headaches can be categorized under the following associations:

Direct physical stimuli, such as temperature and external pressure
Pain over the scalp (epicranial)
Physical exertion
Other miscellaneous headaches.
Secondary headaches
Secondary headaches are headaches that are symptoms of another condition that stimulates the pain-sensitive nerves of the head. There are a vast number of different conditions that can cause secondary headaches, ranging in severity from an alcohol-induced hangover to a brain tumor.

Woman with brain freeze
Secondary headaches can be the result of serious conditions such as stroke, but can equally be a consequence of eating cold food too quickly.
In addition to those two examples, the following list should serve to illustrate the variety of different conditions that can cause secondary headaches:

Blood clots
Brain freeze (ice cream headaches)
Carbon monoxide poisoning
Concussion
Dehydration
Glaucoma
Influenza
Overuse of pain medication (rebound headaches)
Panic attacks
Stroke
As headaches can be a symptom of a serious condition, it is advised that medical advice should be sought if headaches are experienced that are more severe than may have previously been experienced.

For example, if the headache is more painful and disruptive than previous headaches, worsens or fails to improve with medication or is accompanied by other symptoms such as confusion, fever, sensory changes and stiffness, a health care provider should be contacted.

Recent developments on headache causes from MNT news
Mötorhead and the dangers of headbanging
The term "headbanging," does not sound particularly healthy, but can any medical harm come from rocking out in time to the music at a concert using a "violently rhythmic movement of the head"? The case of a Motörhead fan published in The Lancet suggests it can.
Older people with migraines 'more likely to have silent brain injury'
In 2009, 10% of males and 22% of females in the US reported experiencing migraines or severe headaches, according to the Centers for Disease Control and Prevention. Now, a new study suggests older individuals who suffer from migraines may be more likely to have silent brain injury and have double the odds of experiencing "silent strokes," compared with those who do not have migraines.
High stress levels 'increase frequency of headaches'
Whether a result of our work, home or social lives, all of us go through stressful periods. Now, new research has linked high-stress levels to an increased occurrence of headaches - an association that has long been suspected.
Signs and symptoms of headaches3,6
There are many different types of headache that can be experienced, affecting different areas of the head in different ways, with differing intensities for different amounts of time. Here are the characterizing symptoms of some of the more prominent forms of headache:

Tension-type headaches7,8
Tension-type headaches are the most common form of primary headache. They are described as feeling like a tight band around the head, with a constant, dull ache being felt on both sides. Sometimes the pain spreads to or from the neck. They normally begin slowly and gradually in the middle of the day.

Woman with migraine
Migraine can be accompanied by blurred vision, lightheadedness, nausea and sensory disturbances.
Tension-type headaches can be either episodic or chronic. Episodic attacks are normally a few hours in duration, but can last for several days. In contrast, attacks are considered to be continuous is they occur for 15 or more days a month for a period of at least 3 months.

Migraines9
Migraine is the second most common form of primary headache and has been ranked as the seventh-highest specific cause of disability worldwide.5 They can last for any amount of time between a few hours and 2-3 days.

A migraine headache may cause a pulsating, throbbing pain that can occur on either one side or both sides of the head. The aching can also be accompanied by blurred vision, lightheadedness, nausea and sensory disturbances.

Medical News Today has a Knowledge Center article dedicated to migraines, which can be viewed for further information.

Rebound headaches10
Rebound, or medication-overuse headaches are the most common secondary headache, caused by the excessive use of medication to treat headache symptoms. They usually begin early in the day and persist throughout, improving with pain medicine but worsening when its effects wear off.

Rebound headaches can cause a number of symptoms, and the pain can be different each day. Along with the aching, rebound headaches can cause neck pain, restlessness, nose stuffiness and unrestful sleep.

Cluster headaches11
Cluster headaches are a relatively uncommon form of primary headache that affect less than one in every 1,000 adults. They strike quickly, once or more daily at the same time each day and often without warning. They usually last between 45-90 minutes and persist for the duration of a cluster period, normally 4-8 weeks.

The pain caused by cluster headaches is severe, often described as sharp or burning, and is normally located in or around one eye. The affected area can become red and swell, the eyelid can droop and the nasal passage on the affected side can become stuffy and runny.

Tests and diagnosis of headaches7
The health care provider will usually be able to diagnose a particular type of headache through a description of the condition. The type of pain and the timing and pattern of attacks are useful to this end, and keeping a diary of the symptoms can help both the patient and the health care provider to find out precisely what type of headache it is.

If the headache is a particularly complex one, then a health care provider may request tests to eliminate other possible causes. Further testing could include blood testing, X-rays and brain scans, such as computerized tomography (CT) and magnetic resonance imaging (MRI)
$1 billion a year is spent on brain scans for headache sufferers
Guidelines warn doctors against using brain scans for routine headache and migraine cases. Despite this, 12% of patients presenting with headache to a doctor are given scans, according to a study by researchers at the University of Michigan Medical School.
Headache treatment and prevention3,7,12,13
The most common methods recommended for treating headaches are rest and pain relief medication. Generic pain relief medication can be bought over the counter, or health care providers can prescribe preventative medication, such as tricyclic antidepressants, anti-epileptic drugs and beta blockers.

It is important to follow the advice of health care providers as overusing pain relief medication can lead to rebound headaches. The treatment of rebound headaches involves the reduction or stopping of pain relief medication. In extreme cases, a short hospital stay may be required in order to do this.

Self-care
There are a number of things that can be done within the daily routine that can ease the pain of headaches:

Man with icepack on his head
Applying a heat pack or ice pack to your head or neck can help ease the pain of headaches.
Apply a heat pack or ice pack to your head or neck
Avoid things that are stressful
Eat regular meals
Exercise regularly
Get enough rest and regular sleep
Have a hot shower.
Alternative therapies
In addition to the treatment methods mentioned above, there are also several alternative forms of treatment that can be pursued.

Any alternative forms of treatment are best discussed with a health care provider prior to beginning them.

Acupuncture
Chiropractic treatment
Cognitive behavior therapy
Herbal health products
Hypnosis
Meditation.
The WHO report that 50% of people with headaches are self-treating. This means that many people that develop headache disorders do not receive the optimum treatment. The WHO is currently involved with the Global Campaign against Headache; an initiative that aims to raise awareness of headache disorders and improve access and standards of care worldwide.