Why does your head hurt?
You’ve probably had a headache at least once, so you know what it feels like to have your head throb and want to avoid any loud noises. Some people have headaches more frequently than others. Does this mean that something is seriously wrong? What causes headaches? How do you get rid of one?
A headache is when you have pain in any part of your head. It can affect both sides or just one and can be in just one side or radiate to multiple areas. A headache can come on suddenly or gradually and last anywhere from less than an hour to a few days. The pain can be a dull ache, throbbing sensation or sharp pain. Typically, most headaches aren’t related to any serious illness. Usually, headaches are caused by a problem with pain-sensitive structures of your head and are called primary headaches. The most common reason is overactivity of certain chemicals in your brain, nerves or blood vessels of your skull or muscles of your head/neck. In reality, it is often a combination of these factors that contribute to a headache occurring. The most common types of primary headaches are cluster headaches, migraines, migraines with aura and tension headaches. Secondary headaches are caused by an underlying disease.
Cluster headaches come on suddenly and without any warning. This most often occurs shortly (within one to two hours) after falling asleep. Symptoms usually include excruciating pain near one eye with possible radiation to other areas, restlessness, excessive tearing/redness/swelling around the affected eye, eyelid drooping of affected eye, stuffy/runny nose on affected side, forehead/facial swelling and either pale or flushed face. A cluster headache attack usually last somewhere between 15 minutes to 3 hours and it is possible to have more than one attack during a day. When you have a cluster headache attack, you are likely to have multiple attacks over the next 6 – 12 weeks. Then most people enter a period of remission that has no headaches, which can last months or years.
Migraines are a severe throbbing or pulsing pain in your head. Once it starts, it can last for 4 – 72 hours. Besides the pain, it often includes nausea, vomiting and sensitivity to light and sound. The pain is severe to the point of being debilitating. A migraine is divided into four stages: prodrome, aura, headache and post-drome. Prodrome occurs a day or two before the headache starts and includes symptoms of constipation, food cravings, neck stiffness, increased thirst/urination, frequent yawning and mood changes (from depression to euphoria). Most people don’t have an aura, but for those that do, it occurs before or during the headache and is often visual changes (flashes of light or wavy vision) and/or sensory (touching), motor (movement) or verbal (speech) disturbances. These typically start slowly and build up over several minutes and go away after 20-60 minutes. Once the headache portion starts, in addition to the previously mentioned symptoms, some people have blurred vision and lightheadedness. After the headache has gone away, you enter the post-drome stage and usually feel either extremely tired or elated. Some people also have confusion, moodiness, dizziness, weakness and continued sensitivity to light/sound for up to 24 hours after the headache has resolved.
Tension headaches are a mild to moderate pain that is described as having a tight band around your head. Some people also have a tenderness of their scalp, neck and shoulders. While they are the most common type of headache, there currently isn’t a clearly defined cause. It is known that most are triggered by stress. They last somewhere between 30 minutes to a week. This is called episodic tension headaches. Others have chronic tension headaches that are continuous.
The treatment for headaches depends on the type. The overall goal for any of them is to decrease the severity of pain, decrease the duration and prevent future headaches. Cluster headaches are usually treated with oxygen and medications, such as sumatriptan, octreotide, lidocaine and dihydroergotamine. Migraines (with or without auras) are treated with pain relievers like ibuprofen or aspirin for mild cases. For more severe cases, sumatriptan or other similar medication are used along with ergotamine, anti-nausea medication, opioid pain medication and glucocorticoids. Tension headaches are treated by taking ibuprofen or aspirin. Most often, this is enough to provide relief. If not, your doctor may prescribe sumatriptan or other similar medication and/or opioid pain medication. For some people, the use of cold packs provides relief. For others, using a heating pad or hot shower works better. Most people find that resting in a quiet and dark room is extremely helpful.
If you ever have an abrupt, severe headache (like a thunderclap), a headache with fever/nausea/vomiting/stiff neck/mental confusion/seizures/numbness/speaking difficulties, headache after a head injury, sudden/severe headache unlike any other or a headache that worsens over days/changes in pattern, then you need to go to the emergency room. All of these are signs that something is seriously wrong, like stroke, meningitis, encephalitis or brain tumor, and need prompt medical treatment. Do not drive yourself, instead call 911.
For most headaches, prevention is key! Most of the strategies involve lifestyle changes. One the most important is to have a regular sleep schedule that ensures you get enough sleep without getting too much. Exercising regularly helps to reduce stress. Having a consistent daily schedule is also beneficial because it allows for adequate sleep and regular meals (missing meals has been thought to contribute to the onset of some headaches). Using relaxation techniques can also reduce stress. Practicing good posture techniques can decrease tension in your muscles, which sometimes contribute to headache development.
While following these techniques work in most cases, some people need medication in order to prevent their headaches from reoccurring. Only your doctor can help you decided what is best for you based off of your headache symptoms, frequency and duration.
Headaches are something that no one wants to experience. Unfortunately, we all do at some point. The good news is there are treatment options and prevention techniques available. If you have any questions or concerns about headaches, please speak with your doctor. If you would like more information, please visit Medline’s headache page at https://medlineplus.gov/headache.html