Some people say the pain is like a band slowly tightening around their head. Others describe pain that worsens when someone turns on a light. Both are descriptions of headaches, but they are symptoms of very different types of headaches that are generally treated quite differently.
While nearly everyone gets an occasional headache, people with chronic headaches live in fear of when the next headache will strike, and they suffer when it does. Headache specialists say the key in treating a headache successfully is uncovering what kind of headache you have. And you don't have to be a neurologist to begin classifying your headache. Below, Richard Lipton, MD, a professor of neurology, epidemiology and social medicine at Albert Einstein College of Medicine in Bronx, describes the symptoms of the most common types of headaches to help you distinguish the type of headache you tend to get.
How common are headaches?
Headache is a nearly universal human experience. In any given year, 90 percent of Americans say they've had at least one headache not caused by a cold, the flu, a hangover or a head injury. But even though headache is a nearly universal human experience, there are headache-prone individuals who have frequent attacks, where headache becomes a significant medical symptom and not just a problem of everyday life.
What are the main types of headaches?
There are two categories of headaches, primary headaches, where the headache problem is the disorder, and secondary headaches, where the headache is a symptom of an underlying condition like a stroke, a brain tumor or an infection. If we look at the primary headaches, there are four major kinds, migraine, tension-type headache, cluster headache and then the fourth group is a miscellaneous group of other, usually uncommon headache types.
How can the type of pain you have help doctors make a diagnosis?
One issue is the quality of the pain. Is it throbbing? Is it a steady ache? Another feature is the location of the pain. Is it in the eye? On one side of the head? On both sides of the head? Another feature of the pain is the frequency and duration. Do attacks last 10 minutes? Do they last 10 days? Do they occur every day? Do they occur only occasionally?
What is a cluster headache?
Cluster headache derives its name from the fact that the attacks tend to occur in clusters. So a person with cluster will have a long period where they don't have any headaches at all, and then they'll have what what's called cluster phase; where they will begin having attacks on a daily or near-daily basis for weeks or months. The cluster attacks tend to be short, they last 15 to 90 minutes.
Cluster headaches are always one-sided. The pain is usually in or around one eye, and it is accompanied by redness or tearing of the eye, drooping of the lid, nasal stuffiness and features of that kind. But the hallmark of cluster headache is the fact that the attacks cluster in time.
How common are cluster headaches?
Cluster headache is quite rare. Cluster affects perhaps 2 in every 100,000 people. Given the severity of cluster attacks, that's a good thing. Of the primary headache disorders that we're discussing, the one that is predominant in men is cluster headache. The other disorders are more common in women.
What are features of tension and migraine headaches?
Migraine headaches and tension-type headaches are the two most common forms of primary headache and, interestingly, they're defined in opposition, both by features of pain and by the features that accompany pain.
Where tension headache pain tends to be on both sides of the head, migraine pain tends to be just on one side of the head. Where tension-type headache pain tends to be mild or moderate, migraine pain tends to be moderate to severe. Where tension-type headache pain is a steady ache or a pressure, or some people describe a hat-band of pain, migraine pain is typically described as throbbing or pulsing. And where tension headache is not influenced by routine physical activity, migraine sufferers usually find, if they move around, if they bend over, if they cough, that makes their pain worse.
Similarly, the disorders are defined in opposition in terms of associated symptoms. Migraine is characterized usually by nausea and vomiting and/or sensitivity to light and sound, or an aura, which involves visual displays that usually precede or accompany a headache. Tension-type headache is defined by the absence of those very same features.
How long do tension headaches usually last?
Tension-type headaches typically will begin at the end of a stressful day, at three or four or five in the afternoon, and they typically last from one hour to six hours, though they may last even longer.
How common are migraine headaches?
Roughly 12 percent of the population gets migraine. That's 18 percent of American women and 6 percent of American men. So projecting to the U.S. population, we estimate that there are 28 million Americans who have migraine.
How long do the migraine headaches last and how often do they occur?
Migraine headaches last four to 72 hours. On average, untreated, they last 24 hours. Treated, it depends how good your treatment is, but they could last as little as one minute.
On average, migraine attacks occur once or twice a month, although patients who go to see headache specialists often have more frequent headaches, which is why they go to see a specialist.
What can trigger a migraine?
Migraine has many triggers and, in fact, one of the simplest and most useful things that a person with migraine can do is to learn to identify their headache triggers so they can avoid them if they're avoidable or plan to manage them if they're the sorts of triggers that are unavoidable.
It's important to know that triggers vary enormously from person to person and there's a very long list of triggers, including dietary triggers and sometimes people get the advice, "Well, if you have migraine, you should avoid soft cheese, red wine, all alcohol, anything fermented, anything with preservatives, anything with nitrates, anything with chocolate, anything with NutraSweet and so forth." My view is that, although all of those factors are migraine triggers for some people, for any individual person, the triggers are individual.
In addition to those dietary triggers, hormonal factors are an important trigger, so many women find that they get headaches the day before menstrual flow begins or the day that flow actually begins. That effect, we believe, is an effect of estrogen withdrawal. For that reason, menopause is a difficult time for many women because the estrogen levels bounce around and, when they decline, that can initiate headache.
There are a number of other triggers for migraine. Some people find that travel and shifts in time schedules, too much sleep, too little sleep trigger migraines. Falling barometric pressure, which is something that happens in anticipation of a rainstorm, is a migraine trigger.
Interestingly, people don't tell their doctors a lot of the things that they notice, because they're afraid their doctors will think that they're making foolish or crazy connections. But the reality is that learning to recognize your triggers gives you an opportunity to intervene to prevent your headache, so it's well worth paying attention to.
What are the signs that a headache might be due to an underlying medical problem?
Although the overwhelming majority of people with recurrent headaches have primary headaches, sometimes headache is symptomatic of a serious underlying disorder. There are a series of red flags that suggest that might be the case. One red flag is new onset of headache after the age of 55, and that may imply either inflammation of the arteries of the head or, on rare occasions, a brain tumor. Headaches associated with a fever or a stiff neck may reflect an infection, such as meningitis, that requires medical attention. Headaches that are associated with neurologic symptoms, other than typical aura, are alarming. While tingling or numbness that occurs for 5 or 10 minutes prior to the onset of headache is not alarming, weakness, difficulty moving one side of the body and double vision are good reasons to go to the doctor. In addition, a headache that begins very suddenly is a red flag. So if you go from having no pain at all to having very severe pain, that may be a first manifestation of stroke and, if that happens, that's a good reason to seek medical care.
What's the biggest myth about headaches?
The reality is that, if people are living with pain, with anxiety, with limitations on their ability to either do the things they want to do or make the plans they want to make because of headaches, that's a very good reason to seek medical care. Headache is not a problem that you need to learn to live with. It's a problem that you need to learn to manage and live without.