What’s Causing Your Headache?


When your head is pounding, you just want to make it stop. But knowing what kind of headache you have is the first step to feeling better fast. Here’s how to find relief…

The kids need to be picked up from soccer practice, dinner has to be made and laundry is piling up. But when you’re hit with a headache, getting through routine tasks is a challenge. Headache specialists and neurologists generally categorize headaches into 5 types: tension headaches, migraines, cluster headaches, chronic daily headaches and hormonal headaches. Some people get only one kind; others are prone to different types at various times (but not at the same time). While each has its own triggers and symptoms, they’re often mistaken for one another. And that might prolong your pain. For intense and chronic headaches, see your doctor. Besides making a diagnosis and prescribing treatment, your doctor can make sure your symptoms aren’t caused by a more serious disorder, such as a brain tumor, aneurysm or meningitis. Determining the kind of headache you have is critical to proper treatment, says Susan Hutchinson, M.D., director of the Orange County Migraine & Headache Center in Irvine, Calif., and author of The Woman’s Guide to Managing Migraine (Oxford University Press).

Headache Types

1. Tension headache
This is the most common type of headache – the kind you notice on a Monday morning or during a traffic jam when you’re running late.

Some describe it as a tight band around the head. It usually targets the area a baseball cap would cover, like the forehead, temples, top of the head and, sometimes, the eyes.

While frustrating, “a tension-type headache typically doesn’t interfere your ability to carry out activities,” says Sheena Aurora, M.D., clinical associate professor of Neurology and Neurological Sciences at Stanford University School of Medicine, where she is part of the Headache Clinic.

Common causes: Environmental triggers, such as eyestrain from poor lighting and bad posture. Certain emotions – particularly grief, stress, depression and anxiety – can also bring on or worsen them.

Best treatments: This type of headache responds well to over-the-counter treatments such as ibuprofen (Advil), naproxen (Aleve), acetaminophen (Tylenol) and Excedrin, a caffeine-acetaminophen-aspirin combo.

2. Migraine
Migraines are commonly misdiagnosed as tension headaches, Dr. Hutchinson says. (Here are 10 other migraine myths debunked.)

Actually, a migraine is a vascular headache, meaning pain is caused by inflamed and swollen blood vessels in the brain.

Migraine pain throbs or pulsates and is often felt more strongly on one side of the head. Plus, it can cause vomiting, nausea, and sensitivity to light, noise and smells.

Nearly 36 million Americans – 12% of the population – suffer from migraines, according to the American Migraine Federation (AMF). And three times as many women have them as men.

Because migraines are debilitating, they cost the U.S. $20 billion each year in medical expenses and lost productivity, the AMF estimates.

Some sufferers (about 10%-15%) have pre-migraine symptoms, called an aura, says Dr. Hutchinson. This can make you see flashing lights or zigzag lines, or cause a loss of vision. It may make one side of your body tingle or slur your speech.

The aura generally lasts less than an hour, Dr. Hutchinson says. And then the headache hits.

Common causes: Notable triggers include certain foods (including chocolate and aged cheeses), changes in weather and barometric pressure, skipped meals, too much or too little caffeine, alcohol, lack of sleep, stress and hormonal changes.

Family history also increases your likelihood of migraines.

Best treatments: Because of their severe symptoms, migraines respond better to prescription medications than over-the-counter pills.

Botox Injections have been shown to treat migraine headaches very effectively.

A class of drugs called triptans (Imitrex, Zomig and Treximet) is most effective because they’re vasoconstrictors, meaning they help inflamed blood vessels shrink to their normal size.

Lifestyle modifications, such as regular exercise and avoiding trigger foods, can also reduce frequency and duration.

Could these surprising triggers be causing your headache?

If you get auras before your migraines, you may be able to head off the pain before it strikes. Dr. Hutchinson suggests either a triptan or non-steroidal anti-inflammatory drug (NSAID) as preventative measures.

3. Cluster headaches
Considered the most painful of all headaches, cluster headaches are also referred to as “suicide headaches” because the intense pain can drive sufferers to consider killing themselves.

Attacks occur suddenly and repeatedly over one or several days, usually at night, according to the Mayo Clinic. They typically last about 30-45 minutes.

When a cluster headache strikes, people often bang their head against a wall for relief, pace and complain of a piercing pain behind one eye. That eye may also produce tears, and the eyelid on the affected side might droop.

As the name implies, this kind of headache tends to “cluster” together for weeks or months, says Dr. Hutchinson.

Fortunately, it can also go away for months or years.

Other good news: It’s also relatively rare.

Less than 1% of the population is afflicted, and twice as many men than women, according to the American Headache Society.

Common causes: The cause for cluster headaches is unknown, according to the Mayo Clinic, but abnormalities of the hypothalamus may be involved.

Common triggers include alcohol, cigarette smoking, high altitudes, bright light, heat, and certain medications such as nitroglycerin, according to the National Institutes of Health.

Best treatments: Pure oxygen delivered through an oxygen mask is one of the most effective, quickest remedies, says the Mayo Clinic.

Traditional migraine drugs, such as Imitrex, also help. So might these alternative migraine treatments.

But because of intense pain, doctors often recommend injections – the fastest way to administer the medication – rather than pills.

4. Chronic daily headaches
This headache category can include the other kinds (migraine, tension or cluster), says headache specialist Frederick G. Freitag, D.O., associate professor at the Medical College of Wisconsin.

The difference is in its frequency. Chronic headaches strike 15 or more days a month for at least three months, according to the Mayo Clinic.

That means you have a headache more days than you are pain-free.

About 5% of the population get chronic headaches, also known as chronic daily migraine, rebound headaches and transformed migraines.

The syndrome typically starts with sporadic headaches over a long period of time. These are manageable and respond to over-the-counter medications. Then they become more frequent, causing sufferers to pop pain relievers more often than the drug’s packaging recommends.

These painkillers, however, actually make the pain more severe and frequent. That’s why they’re also known as medication-overuse headaches.

What’s too much? If you take pills for a headache more than twice a week, you’re overusing the medication, according to the National Headache Foundation.

Common causes: Most don’t have an identifiable cause, according to the Mayo Clinic.

Best treatments: Since over-the-counter treatments can make the problem worse, you’ll need to see a doctor for prescription medicine relief.

Preventive medications include beta blockers – originally used to treat heart conditions – such as propranalol (Inderal); anti-seizure medications, such as topiramate (Topamax) and valproic acid (Depakote); and tricyclic antidepressants, including nortriptyline (Pamelor) and Amitriptyline (Elavil), says the Mayo Clinic.

Botulinum toxin (Botox) injections may also provide relief.

But lifestyle changes, such as exercise, relaxation, meditation, stress-management, and getting 6-8 hours of uninterrupted sleep a night, can also help, according to the National Institutes of Health.

More tricks to keep pain away: Try changing your pillow or sleeping position, and practice good posture.

5. Hormonal Headaches
Estrogen fluctuations – up or down – are at the root of these headaches, also known as menstrual migraines or period headaches (because the levels of this hormone fluctuate and dip during those days in your cycle).

Not surprisingly, women usually start getting them during puberty, when a woman’s estrogen production goes up.

The good news: Another major hormonal shift – like pregnancy, perimenopause or menopause – can make you less susceptible.

Pregnancy, for example, makes estrogen levels rise, get very high and then stay fairly constant, says Dr. Hutchinson.

“For many women, migraines go away or get much better during pregnancy.”

Common treatments: Birth control pills can even out estrogen fluctuations throughout your cycle.

“For example, if birth control pills are given continuously and the woman only [stops taking them] every three months, her menstrual migraines may improve,” Dr. Hutchinson says.

This treatment is tricky, however, since estrogen can sometimes makes headaches worse.

Magnesium may also bring relief. According to Dr. Hutchinson, the ideal oral dose appears to be 400 mg daily, often taken as 200 mg twice a day.

By Mary Gustafson