Many, if not all of us, know what that throbbing sensation in our head is. While disrupting to our daily and professional lives, headaches are among the most common ailments that are experienced by everybody at some point in their lives and can manifest in many different forms.
With “headache” being an umbrella term, there are a wide variety of different types and causes for this discomfort. It’s important to understand the characteristics and symptoms of your pain to identify if it is caused by a serious condition or not.
Tension Headache
Tension headaches are very common and are the most common type of headache. While these can be a nuisance and disruptive to patients, they are typically not considered a medical emergency.
It is usually described as a band like or vise-grip like pain. It is not associated with any other symptoms. No photophobia, phonophobia, etc.
Tension headaches refer to muscle tension and not necessarily stress. Although these can be triggered by stress, the muscle around the head gets tight and creates uncomfortable pressure on the head.
Massages, acupuncture, and over the counter medications such as Ibuprofen or Naproxen can help with tension type headaches. However, the best way to treat any type of headache is to find the underlying cause and treat that. This way we treat the cause and not the symptom.
Cluster Headache
Cluster headaches are the most severe type of primary headache. Overall, they are not common, and are almost exclusive to men. They typically happen around the same time each year, usually they can happen in fall or springtime. In between the cluster the person is totally or near totally headache free. Patients can have one to many attacks each day. Each attack is short and typically lasts 30 minutes or so.
The pain is very intense, unilateral, around the eye. It is a sharp intense pain associated with ipsilateral nasal congestion, tearing and redness of the eye. Cluster headaches, as the name refers, happen as a cluster in time. They usually happen as a cluster for 2-12 weeks.
The exact cause of cluster headaches is currently unknown, and these types of headaches aren’t generally associated with certain triggers like migraine and tension headaches are.
Cluster headaches need to be treated by a headache specialist and it usually involves medications during the clusters. However, as with all types of headaches, the best way is to diagnose the underlying cause and treat it instead of symptomatic treatment.
Migraine Headache
Migraines are the most talked about type of headache and are a very common condition. It’s estimated that about 17-20% of Americans have migraine headaches. Some say it is more common than Asthma and Diabetes combined, and it is more prominent in females.
To be diagnosed with migraines one must have certain symptoms that fit the ICHD (International Classification of Headache Disorders) criteria. However, simply put, if one has a moderate to severe headache that is accompanied by other symptoms such as nausea with or without vomiting, light, and sound sensitivity it is called a migraine. Migraines are very disabling conditions and can severely affect one’s personal and professional life. It is very poorly understood and unfortunately the typical treatment options are not very effective.
The pain of migraines can be one sided or bilateral. It can be found anywhere on the head. It is typically a throbbing, pounding pain. Although it is often described as pressure, squeezing, explosive, stabbing, ice pick, sharp, and shooting among others.
There are many triggers for migraines including certain food, alcohol, processed meat, menstrual cycle and other hormonal changes, weather changes, heat, dehydration, etc. However, at The National Headache Institute, we determine the root cause and by treating this, the triggers become a non-issue.
Hemicrania Continua Ice Pick Headache
A hemicrania continua ice pick headache is an intensely painful type of headache. This condition severely disrupts daily life, and it is highly recommended to seek medical attention.
It is characterized by a continuous daily headache on one side of the head. It does not change side and it is continuous. The pain can vary in intensity during any given day but there are no pain free periods.
There is often a superimposed intermittent short, severe, stabbing/shooting pain. To diagnose Hemicrania Continua, one should have the above criteria for at least 3 months without any headache-free period and accompanied by at least one other symptom such as tearing and/or redness of the eye, nasal congestion, runny nose, drooping of the eyelid, or contracture of the pupil of the eye. This type of headache is rare. The cause is unknown.
Thunderclap Headache
Living up to its name, a thunderclap headache induces a severe and sudden pain, hitting like a clap of thunder. While uncommon, these headaches can signal life-threatening conditions.
The intensity of the pain peaks within 30-60 seconds and can last a few hours followed by a few days of milder headache. It may be accompanied by other symptoms such as nausea, vomiting, confusion, change in vision, etc.
This type of headache could be caused by brain aneurysms or bleeding around the brain. Therefore, it should be taken very seriously, and it warrants a full work-up including MRI and may be even an angiogram of the brain.
Allergy or Sinus Headache
Allergy and sinus headaches are pressure like pain over the sinuses in the face and forehead. They tend to happen during allergy season, and they may be the only presenting symptom of your allergies. It is an overly diagnosed type of headache and is not as common as it is diagnosed. Many tension type headaches or even migraines are misdiagnosed as allergy/sinus headaches. Proper tests need to be done by a headache specialist to correctly diagnose the condition.
Hormone Headache
Headaches that happen during times of hormonal changes are called hormonal headaches. Menstrual cycles and pregnancy are prime examples of hormonal changes. These headaches could have the characteristic of a migraine or tension headache. A full and complete hormone profile, including metabolites of the hormones, is used to properly diagnose and treat this condition. Many times, it is not the progesterone or the estrogen themselves that trigger the headache but their toxic metabolites.
Caffeine Headache
Caffeine is a drug, and it is habit forming. When someone consumes a lot of caffeine, the nerve cells up-regulate their caffeine receptors by building more receptors. In these instances, once caffeine is eliminated from the body and the person has not consumed any more for a period, the body goes through withdrawal and one of the symptoms is headache.
To treat this type of headache, one must wean off the caffeine slowly. It helps if a headache specialist helps you to do so. This way they can support your detox with medication and even IV infusion of Vitamins and minerals such as Magnesium to make the withdrawal easier and less painful.
Exertion Headache
Exertion headaches occur during or less often immediately after an activity. It usually happens during a strenuous activity. It could be while lifting, running, or doing house chores. A subtype of exertion headache is sex headache or orgasm headache.
This subtype occurs during sexual activities, and it typically happens prior to or at the orgasm. The pain of these headaches is usually short lived and typically is relieved within a few minutes to hours of stopping the activity. It is a sharp, intense sudden pain. Most often, it is not associated with any serious underlying disease. However, even though extremely rare, vascular causes such as aneurysm should be ruled out due to its serious nature. Exertion headaches, including sex headaches, often create a fear of that activity due to the intensity of the pain.
The best way to treat the headache is to find out the underlying cause and treat it. Medications are often ineffective for exertion headache because it is so short lived.
Hypertension Headache
Hypertension headaches are rare but serious. The headache is usually caused by extremely high blood pressure. It forms a hypertensive emergency. It is typically a generalized headache and pulsating in nature. There is no set pressure number that can be diagnosed as this disorder; however, usually the systolic pressure is in 180’s or more.
This is a difficult condition to diagnose because any pain, including headache, can cause reflex hypertension. Therefore, to diagnose Hypertension headache the patient should have chronic arterial hypertension even in the absence of pain.
More serious causes of hypertensive crisis such as Pheochromocytoma, Pre-Eclampsia/Eclampsia, and hypertensive encephalopathy should be ruled out.
Treatment relies on immediate control of blood pressure. Very high pressures cannot be lowered quickly because it may lead to cerebral complications such as encephalopathy.
Rebound Headache
Also known as medication over use headache, it is very similar to a caffeine headache. It usually happens to chronic headache sufferers of any kind (migraine, tension, etc.) who self-medicate and are not on a preventive medication. Therefore, they must take breakthrough medication for their headaches very often. This causes the rebound phenomenon.
Patients usually get relief from pain by taking the medication, but within 2-3 hours the pain comes back. This gap gets narrower and narrower as the patient continues to take more medication. Any pain medication can cause this phenomenon, but it is most common with Narcotics and Opioid medications as well as over the counter headache and pain medications.
Caffeine containing headache medicines are particularly known for causing rebound headaches. This is one of the main reasons a true headache specialist almost never prescribes Narcotics, Opioids, or caffeine containing medications for any type of headache.
This headache disorder can get severe and disabling. It is difficult to treat. Often patients need to be hospitalized and go through medication detoxification. In some headache centers it may be possible as outpatient.
Post-Traumatic Headache
Some patients can develop any of the mentioned headache types after a trauma. This could be a head trauma like concussion or without any head trauma like a minor car accident. Usually, we cannot find any consistent specific damage to the brain, the spinal cord, or any other part of the nervous system in these patients. Therefore, the mechanism of these headache remains unknown even though there are several theories about them. These headaches are treated with medication.
Spinal Headache
Spinal headaches occur after a lumbar puncture, which is a diagnostic procedure. Once the spinal needle is withdrawn, at the end of the procedure, in some patients the track of the needle does not close properly thus leaving a tunnel through which the spinal fluid can leak out. The amount of the leak is very minute and not visible. These headaches, characteristically, get very bad when the patient stands up and improve significantly when the patient lays down.
Although post Lumbar Puncture is the most common cause of this headache, it can happen after trauma to the lower back such as falling from a ladder on your back or buttock. It also rarely happens spontaneously without an apparent cause.
The treatment is simple and very effective. It is called a “Blood Patch”. Patient’s own blood is drawn and injected in the area of the leak track. The blood clots and stops further leaking of the spinal fluid.
Benign Intracranial Hypertension
Formerly known as Pseudotumor Cerebri, this headache is caused by an increase of the pressure inside the cranium. This is usually due to accumulation of extra Cerebrospinal fluid which in turn puts pressure on the brain and its lining (meninges) causing pressure like generalized headache. There is also increased pressure on the optic nerve which causes visual disturbances such as blurry vision or loss of peripheral vision.
This type of headache is not very common, but not rare either. However, it is extremely important to diagnose this disorder promptly because if not diagnosed and treated promptly, it can lead to permanent damage to the optic nerve causing partial or total loss of vision.
It is diagnosed by performing a lumbar puncture and measuring the pressure of the Spinal fluid. High opening pressure is diagnostic. Usually, we drain the spinal fluid and patients report immediate improvement of the headache, which confirms the diagnosis.
Treatment is started with a medication called Acetazolamide which is also used for altitude sickness. If the intracranial pressure cannot be controlled by medication, the patient may need a permanent shunt to drain the extra fluid from the brain to the abdomen. This is called Ventriculo-Peritoneal or VP shunt. It is placed by a neurosurgeon.
Treating your headache
At the National Headache Institute, we have been able to identify several causes for migraines and other headaches. We first properly diagnose the root cause, and then form a personalized treatment plan that most often does not even involve medication, and instead natural and innovative therapies. By treating the root cause, the pain is eliminated and there is usually no need for further medication or treatment.
If you’ve been suffering from or have a history of headaches, contact us today to get your life back!
