Most people will experience headaches during their lifetime. While the majority of headaches are not much more than a painful nuisance, for many, chronic headache is a disabling condition that can wreak havoc on their physical, economic and social life. For a small portion of people, a headache will be the presenting symptom of a serious underlying condition.
Most headaches can be treated by a primary care physician, however, for some, a referral to a neurologist
may be necessary.
The International Headache Society
has identified and classified nearly 130 different types of headaches, and the treatments are numerous. At the Martha Jefferson Neuroscience Center, our neurologists perform a comprehensive evaluation to diagnose the type of headache that is being suffered, and will tailor the treatment to the needs of the patient.
The most common types of headaches are:
The evaluation of a headache will include a detailed history, physical and neurological exam. Frequently, this is enough to diagnose the type of headache and appropriate treatment. Sometimes additional studies are necessary such as lab work and/or imaging of the brain.
Headaches are most commonly treated with medications, either taken on a regular basis to prevent the occurrence of the headache or used as needed to abort the headache once it attacks. There are many different types of medication that are prescribed. Each treatment plan is tailored to provide maximum benefit and is based on the type of headache and the patient’s individual needs. Identifying and avoiding headache triggers is also an important component of the treatment plan. For select patients, additional modes of treatment such as Botox injections or biofeedback may be helpful.
When is a headache an emergency?
Headaches can sometimes represent a medical emergency such as bleeding in or around the brain, or brain swelling. Seek immediate medical attention if the headache:
- has a sudden onset and is the worse headache you have ever had
- is accompanied by confusion, difficulty staying awake, vision changes or weakness
- is accompanied by fevers and neck stiffness
- follows a head injury
The most common type of headache, tension headaches are caused by sustained contraction of the muscles in the neck and scalp. The muscle contraction can occur as the result of stress, poor posture, depression or an injury. Tension headaches can also be triggered by a variety of conditions such by an infection, caffeine withdrawal or allergies. Pain is usually as an aching pressure felt in a band-like distribution around the head, although pain in front of one or both eyes as well as the base of the head is also common.
A migraine is a common type of headache that typically causes a severe throbbing pain on one side of the head, and may be accompanied by other symptoms including nausea, vomiting and sensitivity to light and noise. Some people may experience an “aura” before the headache begins. The aura can last from minutes to hours and may consist of vision changes such as a growing blind spot, flashing lights, or visual distortions. In rare cases, weakness and/or numbness on one side of the body, abnormal speech, disorientation or brief loss of consciousness may occur. Sometimes an aura can occur without being followed by a headache.
The cause of migraines remains unclear, but is thought to result from abnormal brain activity associated with changes in blood flow in the region of the brain. Migraines can be triggered by a variety of mechanisms, including stress, hormonal changes (such as occurs in a woman’s menstrual cycle), odors and foods. Migraines commonly run in families.
A less common type of headache is the cluster headache, so called because the headaches occur in clusters over periods ranging from days to months. The attacks are followed by remission lasting several months before the headache cluster returns. The headache is characterized by severe pain on one side of the head in the region of the eye, often accompanied by tearing and/or nasal discharge on the affected side. The headaches usually last no longer than 90 minutes but can occur several times a day during the cluster period.