Know Your Symptoms – The Major Headache Types

"Pulsing", "pounding", "throbbing." To anyone who has ever suffered from headache, these descriptions are all too familiar. Nearly everyone experiences some form of head pain at one time or another. In fact, it is estimated that each year, 70% of the population will have at least one headache and over 5% of the population will seek medical attention for their headaches.

Fortunately, most headaches aren't associated with serious underlying conditions and can be treated with nonprescription medications. However, some severE headaches need a doctor's attention and may require prescription drugs. There are several different types of headache and, depending on their severity and frequency, they may require different treatments. Sometimes, it can be difficult to distinguish one type of headache from another. So, it's important to "know your symptoms" in order to help your doctor identify the type (or types) of headache you have and recommend or prescribe the best available treatment.

One key to headache management is good communication between patient and doctor. Your doctor will need to obtain a careful history and description of your headache symptoms. Following is a basic overview of some of the major headache types; it may help you to understand your headache and describe its symptoms accurately to your doctor. This should not be used for "self-diagnosis" – that's your doctors job. This overview should serve, instead, as a guide to help you understand the major headache types as you work with your doctor to find a treatment tailored to your needs. It should also be pointed out that many patients may suffer from more than one type of headache or from a subtype of one of the major headaches.

Migraine Headache: Migraine is the best known and most researched type of headache, although its exact mechanism is not fully understood. It affects almost three times as many women as men. Migraine usually occurs on one side of the temple, but can affect both sides of the head at the front or back. A typical migraine attack usually lasts anywhere from four hours to more than a day, if not appropriately treated.

It may be preceeded by an "aura," which consists of symptoms or sensations ranging from visual disturbances (such as flashes of light or geometric patterns) to muscle weakness or difficulty speaking. The aura is followed by head pain, which builds quickly to a peak intensity and slowly tapers off. The pain peak is usually more severe than with tension headache. Symptoms associated with migraine include nausea, vomiting, and extreme sensitivity to light and sound. During an attack, migraine sufferers may be unable to engage in activities that require any type of exertion (i.e., stair climbing). There are several subtypes of migraine, which the treating doctor will need to consider when evaluating a migraine patient.

Tension-Type Headache: This type of headache is the most common. It usually consists of a dull pain that spreads across the head, typically on both sides. Many patients suffering from this type of headache describe it as the sensation of a "band tightening around the skull." Other effects of the headache may include mild sensitivity to light or sound, light-headedness, blurred vision and a general feeling of inability to function normally. There is some overlapping of symptoms between this type of headache and a migraine.

Cluster Headache: As the name implies, these type of headaches occur in bunches, or "clusters," followed by pain-free periods. They are less common that migraine, affecting less than 1% of the population, and typically occur five times more often in men than women. Patients who suffer from cluster headaches usually describe a very severe, localized pain from behind and around one eye, they often say " it feels like a nail being driven into the eye." Symptoms associated with cluster headache occur on the same aide of the head as the pain. They included tearing from the eye or discharge from the nostril. Each cluster consists of regularly occurring headaches that may last for months. The headaches usually occur relatively close together and possibly at the same time of day or night. They are typically briefer than migraine attacks; each headache may last from a half hour to several hours. When a cluster of headaches ends, it may be several months before another cluster occurs.

Local Head or Neck Pain: This is a general term used to describe pain that does not fall into one of the major headache categories, but is problematic enough to bring to the patient in for a medical evaluation. It is commonly caused by muscle injury or surrounding tissue irritation, but may also be caused by irritation of a joint or the spine of the neck. The pain usually occurs in a localized area, such as the back or side of the head, the temple, or the cheekbones. It can be described as steady and dull rather than throbbing or sharp. As the pain is generally caused by an accident or overuse of the muscle/joint, the problem is usually resolved with rest, physical therapy, biofeedback, and/or medications.

Summary of Major headache Types and Symptoms

Migraine

May be preceeded by aura, usually one-sided, pain tends to be moderate to severe, pulsating and aggravated by physical activity, associated with nausea, vomiting, and sensitivity to light and sound; affects more women than men

Tension-type Headache

Dull, squeezing, nonpulsating pain, usually on both sides of head, tends to be less severe than migraine, mild sensitivity to light and sound; no nausea

Cluster Headache

Headaches occur in clusters with pain-free periods in between; pain is very severe, localized, and stabbing; attacks briefer than migraines; facial symptoms occur on same side as headache, affects more men than women

Local head or neck pain

If pain doesn't fit other headache categories, usually steady, dull and localized in head, temple, or cheekbones; usually caused by an injury or overuse of joints or muscles

Identifying Your Headache Triggers

If you have migraine headaches, you may have recognized that some things you do – or don't do – may provoke an attack. These are called migraine "triggers." When you seek medical help for your headache, it's not enough to discuss your symptoms with your doctor. It is also important to identify specific triggers of your headaches. By doing so, you may improve your condition by simply learning to avoid your specific triggers.

A trigger can be either an external factor or an internal factor that may lead to headache onset. Whatever it may be, the trigger is not the cause of the headache. Examples of external triggers include changes in weather, bright lights, or certain foods. Triggers that occur internally include exhaustion, hunger, or the relaxation period following stress.

Avoiding your triggers is not always easy, and susceptibility to triggers will vary from person to person. Factors such as age and sex can also influence how a trigger will affect each individual. For instance, younger people may have a higher tolerance of certain triggers and women may be affected more often by weather changes or certain odors than men. With women, susceptibility to triggers often increases during the pre- or postmenstrual period and decreases after menopause.

The following list contains many, but not all, of the triggers that may bring on migraines in some susceptible people:

Common Migraine triggers

Foods and Beverages Alcoholic beverages (especially red wine) Aged cheese Smoked or pickled fish Sour cream or yogurt Chocolate Nuts or beans Caffeine Nitrites, MSG, artificial sweeteners	Environmental Factors Bright flickering lights Weather changes Perfume Strong odors Second-hand cigarette smoke Polluted air Chemical fumes
Medications Diuretics Blood pressure medications Asthma medications Nitroglycerin	Lifestyle changes Change in sleep pattern Irregular eating habits Relaxation period follow stress
Hormonal Factors Menstruation Pregnancy and delivery (pregnancy relieves migraine in many women) Oral contraceptives Estrogen therapy	Physical Factors Blow to the head Physical exertion Sexual activity Neck injury

Doctors often ask headache patients to keep a diary in which they record the time their headaches began, how long they lasted, what may have triggered them, where the pain was located, and what the character of the pain was. Several triggers may be involved in the onset of your headaches, so it's important to identify as many as possible. Keeping a headache diary can be both helpful for you and your doctor. Not only does it provide valuable information that can help your doctor determine which treatment is appropriate, but it can help give you direction amid the confusion of recurring pain.

What is Analgesic Rebound Headache?

Many people who experience chronic head pain attempt to medicate themselves by taking a daily regimen of analgesics, or pain medications. These are the "rescue" drugs we all keep in our medicine cabinets – such as aspirin, acetaminophen, or combination pain medications. These drugs may be affective for many patients. However, we now know that overuse of these drugs may actually cause daily headaches rather than relieve them. This phenomenon is known as analgesic rebound headache.

The principle behind analgesic rebound headache is drug dependency. The body becomes accustomed to having a certain level of pain medication in the bloodstream; when blood levels fall, the headache recurs, or "rebounds." Over time, the recurring headaches may become transformed into a "chronic daily headache, "which can be very difficult to treat.

Overuse of prescription and nonprescription pain medications can undermine a doctor's efforts to control headache. A patient who takes an excessive amount of pain medications is not likely to benefit from a preventive medication until the pain medications are withdrawn. The pain medications compete with the preventive medication for binding sites in the brain known as receptors. By occupying the same binding sites as the preventive medication, affecting its ability to function properly. Many patients with analgesic rebound headaches require hospitalization to wean them from their drug dependence.

The message here is a very important one: overuse of pain medications can actually be a cause of constant or recurring headaches. That's why doctors ask headache patients to report exactly what medications they take, how often they take them, and in what amounts. Only when these medications are withdrawn can headaches be successfully treated. Your physician needs this information to determine the correct course of treatment.

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