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Frequently Asked Questions About Headaches

1. What Types of Headaches Are There?

There are several types of headaches – 150 diagnostic headache categories have been established!

Below is a list of the most common types of headaches.

Tension headaches: Also called chronic daily headaches or chronic non-progressive headaches, tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time.

Migraines: The exact causes of migraines are unknown, although they are related to blood vessel contractions and other changes in the brain as well as inherited abnormalities in certain areas of the brain. Migraine pain is moderate to severe, often described as pounding, throbbing pain. They can last from 4 hours to 3 days and usually occur 1 to 4 times per month. Migraines are associated with symptoms such as light sensitivity; noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. When a child is having a migraine they often look pale, feel dizzy, have blurred vision, fever, stomach upset, in addition to having the above listed symptoms.

A small percentage of pediatric migraines include recurrent (cyclic) gastrointestinal symptoms, in which vomiting is most common. Cyclic vomiting means that the symptoms occur on a regular basis — about once a month. These types of migraines are sometimes called abdominal migraines.

Mixed headache syndrome: Also called transformed migraines, this is a combination of migraine and tension headaches. Both adults and children experience this type of headache.

Cluster headaches: The least common, although the most severe, type of primary headache, the pain of a cluster headache is intense and may be described as having a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term “cluster headache” refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into “remission”) for months or years, only to recur.

Sinus headaches: Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

Acute headaches: Seen in children, these are headaches that occur suddenly and for the first time and have symptoms that subside after a relatively short period of time. Acute headaches most commonly result in a visit to the pediatrician’s office and/or the emergency room. If there are no neurological signs or symptoms, the most common cause for acute headaches in children and adolescents is a respiratory or sinus infection.

Hormone headaches: Headaches in women are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Chemically induced hormone changes, such as with birth control pills, also trigger headaches in some women.

Chronic progressive headaches: Also called traction or inflammatory headaches, chronic progressive headaches get worse and happen more often over time. These are the least common type of headache, accounting for less than 5% of all headaches in adults and less than 2% of all headaches in kids. Chronic progressive headaches may be the result of an illness or disorder of the brain or skull.

2. Are Headaches Hereditary?

Yes, headaches, especially migraines, have a tendency to run in families. Most children and adolescents (90%) who have migraines have other family members with migraines. When both parents have a history of migraines, there is a 70% chance that the child will also develop migraines. If only one parent has a history of migraines, the risk drops to 25%-50%.

3. What Causes Headaches?

Headache pain results from signals interacting between the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain. It’s not clear, however, why these signals are activated in the first place.

There is a migraine “pain center” or generator in the mid-brain area. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels, causing constriction, followed by the dilation of these vessels and the release of prostaglandins, serotonin, and other inflammatory substances that cause the pulsation to be painful. Serotonin is a naturally occurring chemical essential for certain body processes.

Headaches that occur suddenly (acute-onset) are usually due to an illness, infection, cold or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat) or otitis (ear infection or inflammation).

In some cases, the headaches may be the result of a blow to the head (trauma) or rarely a sign of a more serious medical condition.

Common causes of tension headaches or chronic nonprogressive headaches include emotional stress related to family and friends, work or school; alcohol use; skipping meals; changes in sleep patterns; excessive medication use; tension and depression. Other causes of tension headaches include eyestrain and neck or back strain due to poor posture.

Headaches can also be triggered by specific environmental factors that are shared in a family’s household, such as exposure to second-hand tobacco smoke strong odors from household chemicals or perfumes, exposure to certain allergens or eating certain foods. Stress, pollution, noise, lighting and weather changes are other environmental factors that can trigger headaches for some people.

Too much physical activity can also trigger a migraine in both adults and children.

Be sure to consult a doctor to find out what is causing your headaches.

4. How Are Headaches Evaluated and Diagnosed?

The good news for headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started.

If you have headache symptoms, the first step is to go to your family doctor. He or she will perform a complete physical examination and a headache evaluation. During the headache evaluation, your headache history and description of the headaches will be evaluated. You will be asked to describe your headache symptoms and characteristics as completely as possible.

A headache evaluation may include a CT scan or MRI if a structural disorder of the central nervous system is suspected. Both of these tests produce cross-sectional images of the brain that can reveal abnormal areas or problems. Skull X-rays are not helpful. An EEG (electroencephalogram) is also unnecessary unless you have experienced a loss of consciousness with a headache. Sinus X-Ray – although the CT scan and MRI provide more details, your doctor may use this test if your symptoms seem to indicate sinus problems. Eye Exam – an eye pressure test performed by an eye doctor (ophthalmologist) will rule out glaucoma or pressure on the optic nerve as causes of headaches. Spinal Tap – a spinal tap is the removal of spinal fluid from the spinal canal (located in the back). This procedure is performed to look for conditions such as infections of the brain or spinal cord. The test can itself cause a temporary headache. Blood Chemistry and Urinalysis. These tests may determine many medical conditions, including diabetes, thyroid problems, and infections, which can cause headaches.

If your headache symptoms become worse or become more frequent despite treatment, ask your doctor for a referral to a specialist. Your family doctor should be able to provide the names of headache specialists. If you need more information, contact one of the organizations in the resource list for a list of member doctors in your state.

5. How Are Headaches Treated?

Your doctor may recommend different types of treatment to try or he or she may recommend further testing, or refer you to a headache specialist. You should establish a reasonable time frame with your family doctor to evaluate your headache symptoms.

The proper treatment will depend on several factors, including the type and frequency of the headache and its cause. Not all headaches require medical attention. Treatment may include education, counseling, stress management, biofeedback and medications. The treatment prescribed for you will be tailored to meet your specific needs.

6. What Medications Can Treat Headaches?

* Aspirin
* Sinus relief medications
* Acetaminophen (Tylenol)
* Non-steroidal anti-inflammatory medications (Aleve)
* Sedatives for sleep
* Codeine and prescription narcotics
* Over-the-counter combination headache remedies containing caffeine (such as Anacin, Excedrin, Bayer Select)
* Ergotamine preparations (such as Cafergot, Migergot, Ergomar, Bellergal-S, Bel-Phen-Ergot S, Phenerbel-S, Ercaf, Wigraine and Cafatine PB)
* Butalbital combination pain-relievers (Goody’s Headache Powder, Supac, Excedrin)

7. What Are Rebound Headaches?

While small amounts of these medications per week may be safe (and effective) — at some point, the continued medication use can lead to the development of low grade headaches that just will not go away.

8. What Food Triggers Headaches?

Some of the most common food, beverages, and additives associated with headaches include:

* Aged cheese, red wine, alcoholic beverages, and some processed meats.
* Food preservatives (or additives) contained in certain foods can trigger headaches. The additives, nitrates and nitrites, dilate blood vessels, causing headaches in some people.
* Cold foods: Cold food, like ice cream, can cause headaches in some people. It’s more likely to occur if you are over-heated from exercise or hot temperatures. Pain, which is felt in the forehead, peaks 25 to 60 seconds and lasts from several seconds to one or two minutes. More than 90% of migraine sufferers report sensitivity to ice cream and cold substances.

9. Is Caffeine a Headache Treatment or a Headache Trigger?

Caffeine can be both beneficial and harmful for a headache sufferer. Caffeine is a common ingredient in many prescription and over-the-counter headache medications. Caffeine additives make pain-relievers 40% more effective in treating headaches. Caffeine also helps the body absorb headache medications more quickly, bringing faster relief.

While caffeine-containing medications can be beneficial, these medications, combined with consuming too much caffeine (coffee, tea, soft drinks or chocolate) from other sources, may make you more vulnerable to getting rebound headaches.

10. What Are Abortive Medications?

Abortive medications, when used at the first sign of a migraine, can stop the process that causes the headache pain. By stopping the headache process, abortive medications help prevent the symptoms of migraines including pain, nausea, and sound and light sensitivity. Some medications should not be used during a migraine aura; please follow the instructions of your doctor.

11. Do Children Outgrow Headaches?

Headaches may get better as your child gets older. The headaches may disappear and then return later in life. By junior high school, many boys who have migraines outgrow them, but in girls, migraine frequency increases because of hormone changes. Migraines are three times more likely to occur in adolescent girls than in boys.

12. Can Headaches Be Prevented?

Headaches can cause untold pain and suffering. But, you don’t have to resign yourself to be a headache sufferer. There are steps you can take to prevent headaches. Here are just a few ways to keep headaches at bay.

o Follow your treatment plan. Avoid taking medications that have not been ordered by your doctor.
o Reduce emotional stress. Take time to relax and take time away from stressful situations. Learn relaxation skills, such as deep breathing and progressive muscle relaxation.
o Reduce physical stress. Proper rest and sleep will allow you to deeply relax so you can face the stressors of the new day. When sitting for prolonged periods, get up and stretch periodically. Relax your jaw, neck and shoulders.
o Exercise regularly. Get at least 20 minutes of exercise three times a week. But, don’t over do it!
o Keep a regular routine. Eat meals and snacks at about the same times every day, and get enough sleep at night.
o Quit smoking. Smoking can trigger headaches and make any headache, especially cluster headaches, worse. Ask your doctor for information about smoking cessation programs in your community.
o Seek help when you are unable to cope. Talk to a friend, family member, religious or health care professional if your problems are getting to you.
o Know your headache triggers. Keep a headache diary to keep track of what triggers your headaches and avoid these triggers in the future.
o Preventive therapy. Women who often get headaches around their menstrual period can take preventive therapy when they know their period is coming.

Additional information about migranes and headaches

Are Migraines Hereditary?

Yes, migraines have a tendency to run in families. Four out of 5 migraine sufferers have a family history of migraines. If one parent has a history of migraines, the child has a 50% chance of developing migraines, and if both parents have a history of migraines, the risk jumps to 75%.

Can Migraines Be Prevented?

* Yes. You can reduce the frequency of your migraine attacks by identifying and then avoiding migraine triggers. You can keep track of your headache patterns and identify headache triggers by using a headache diary.
* Recalling what you ate prior to an attack may help you identify chemical triggers.
* Stress management and coping techniques, along with relaxation training, can help prevent or reduce the severity of the migraine attacks.
* Women who often get migraines around their menstrual period can take preventive therapy when they know their period is coming.
* Migraine sufferers seem to have fewer attacks when they eat on a regular schedule and get adequate rest.
* Regular exercise — in moderation — can also help prevent migraines.

Can Allergies Cause Headaches?

It is a misconception that allergies cause headaches. However, allergies can cause sinus congestion, which can lead to headache pain. If you have allergies, the treatment for your allergy will not relieve your headache pain. The two conditions generally must be treated separately. See your doctor to ensure proper treatment.

What Are Some Techniques I Can Use to Relax?

Below are a few relaxation exercises. But first, be sure that you have a quiet location that is free of distractions, a comfortable body position, and a good state of mind. Try to block out worries and distracting thoughts.

o Rhythmic breathing: If your breathing is short and hurried, slow it down by taking long, slow breaths. Inhale slowly then exhale slowly. Count slowly to five as you inhale, and then count slowly to five as you exhale. As you exhale slowly, pay attention to how your body naturally relaxes. Recognizing this change will help you to relax even more.
o Deep breathing: Imagine a spot just below your navel. Breathe into that spot, filling your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon. With every long, slow exhalation, you should feel more relaxed.
o Visualized breathing: Find a comfortable place where you can close your eyes, and combine slowed breathing with your imagination. Picture relaxation entering your body and tension leaving your body. Breathe deeply, but in a natural rhythm. Visualize your breath coming into your nostrils, going into your lungs and expanding your chest and abdomen. Then, visualize your breath going out the same way. Continue breathing, but each time you inhale, imagine that you are breathing in more relaxation. Each time you exhale imagine that you are getting rid of a little more tension.
o Progressive muscle relaxation: Switch your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body. Notice areas that feel tense or cramped. Quickly loosen up these areas. Let go of as much tension as you can. Rotate your head in a smooth, circular motion once or twice. (Stop any movements that cause pain!) Roll your shoulders forward and backward several times. Let all of your muscles completely relax. Recall a pleasant thought for a few seconds. Take another deep breath and exhale slowly. You should feel relaxed.
o Relaxing to music: Combine relaxation exercises with your favorite music in the background. Select the type of music that lifts your mood or that you find soothing or calming. Some people find it easier to relax while listening to specially designed relaxation audio tapes, which provide music and relaxation instructions.
o Mental imagery relaxation: Mental imagery relaxation, or guided imagery, is a proven form of focused relaxation that helps create harmony between the mind and body. Guided imagery coaches you in creating calm, peaceful images in your mind — a “mental escape.” Identify your self-talk, that is, what you are saying to yourself about what is going on with your illness. It is important to identify negative self-talk and develop healthy, positive self-talk. By making affirmations, you can counteract negative thoughts and emotions. Here are some positive statements you can practice.
o Let go of things I cannot control.
o I am healthy, vital, and strong.
o There is nothing in the world I cannot handle.
o All my needs are met.
o I am completely and utterly safe.
o Every day in every way I am getting stronger

In order to receive proper treatment, a correct diagnosis of your headaches must be made. To properly diagnose the cause(s) of the headaches, your doctor will first take a headache history.

Headache History

The most important part of your doctor’s evaluation of your headaches is what’s called the headache history. It is important to describe your headache symptoms and characteristics as completely as possible. Your headaches can be better diagnosed if you tell your doctor:

· How old you were when the headaches started
· How long you have been experiencing them
· If you experience a single type of headache or multiple types of headaches
· How often the headaches occur
· What causes the headaches, if known (for example, do certain situations, foods or medications trigger the headaches?)
· Who else in your family has headaches
· What symptoms, if any, occur between headaches
· If your school or work performance has been affected by the headaches

It is also important to tell your doctor how you feel when you get a headache and what happens when you get a headache, such as:

· Where the pain is located
· What it feels like
· How severe the headache pain is, using a scale from 1 (mild) to 10 (severe)
· How long the headache lasts
· If the headaches appear suddenly without warning or with accompanying symptoms
· What time of day the headache usually occurs
· If there is an aura (changes in vision, blind spots or bright lights) before the headache
· What other symptoms or warning signs occur with a headache (such as weakness, nausea, sensitivity to light or noise, appetite changes, changes in attitude or behavior)
· How frequent you get headaches

You should also tell your doctor if you’ve been treated in the past for headaches and what medications (both prescribed and over-the-counter) you have taken in the past and what medications are currently being taken. Don’t hesitate to list them, bring the bottles, or ask your pharmacist for a printout.

Studies performed by other doctors who may have evaluated your headaches in the past, including X-rays and other imaging tests are also very important — you should bring these to your appointment as well. This may save time and repetition of tests.

Physical and Neurological Examinations

After completing the headache history portion of the evaluation, the doctor will perform a complete physical and neurological examination. The doctor will look for signs and symptoms of an illness that may be causing the headaches, such as:

· Fever or abnormalities in breathing, pulse, or blood pressure
· Infection
· Nausea, vomiting
· Changes in personality, inappropriate behavior
· Mental confusion
· Seizures
· Loss of consciousness
· Excessive fatigue, wanting to sleep all of the time
· High blood pressure
· Muscle weakness, numbness or tingling
· Speech difficulties
· Balance problems, falling
· Dizziness
· Vision changes (blurry vision, double vision, blind spots)

Neurological tests focus on ruling out diseases of the brain or nerves that may also cause headaches, such as epilepsy or multiple sclerosis. Some of the tests may also look for a physical or structural abnormality in the brain that may cause your headache, such as:

· Tumor
· Abscess (an infection of the brain)
· Hemorrhage (bleeding within the brain)
· Bacterial or viral meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
· Pseudotumor cerebri (increased intracranial pressure)
· Hydrocephalus (abnormal build-up of fluid in the brain)
· Infection of the brain such as meningitis or Lyme disease
· Encephalitis (inflammation and swelling of the brain)
· Blood clots
· Head trauma
· Sinus blockage or disease
· Blood vessel abnormalities
· Injuries
· Aneurysm (an outpouching of the wall of a blood vessel that can leak or rupture)

Psychological Evaluation

An interview with a psychologist is not a routine part of a headache evaluation, but may be done to identify stress factors triggering your headaches. You may be asked to complete a computerized questionnaire to provide more in-depth information to the doctor.

After evaluating the results of the headache history, physical examination, neurological, and psychological examination, your doctor should be able to determine the type of headache you have, whether a serious problem is present, and whether additional tests are needed. Possible additional tests you may be given include diagnostic tests.

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