Understanding Your Headache

A headache is a symptom, not a cause.  A number of causes could result in the symptom.

Types of Headaches

Headache disorders fall under three main categories: primary headache disorders, secondary headache disorders and painful cranial neuropathies and other facial pain/headaches. With primary headaches, the symptoms are due to the headache disorder and not due to a secondary cause such as a structural issue with the brain or other systemic illness or disease. Secondary headaches can be related to a variety of issues such as tumors, infections, circulation problems and medications. The majority of headaches are primary, with tension and migraine being the most prevalent.

Often, a headache can be benign and is not related to a serious disease. But, the pain associated with any headache disorder can be severe and disabling, warranting aggressive early treatment.

Tension Headache Symptoms

Tension headaches typically are bilateral, meaning the pain is felt on both sides of the head. They are often mild to moderate in intensity and are not worsened by activity. They can arise from musculoskeletal tension in the head and neck or from other physical or psychological stress.

Tension headaches are typically what people are referring to when they say they have a ‘normal’ or ‘regular’ headache. Tension headaches can be mild for some people and severe for others. Pain is subjective. And for some, these headaches can be frequent or even chronic and can impact quality of life.

Migraine Headache Symptoms

Migraines are often more disabling than tension headaches and typically last longer, from a number of hours to a matter of days. The pain is often described as a “throbbing” or “pulsing” sensation, tends to be on one side of the head and worsens with activity. People who experience migraines are often sensitive to light, noise and smells.

Cluster Headache Symptoms

Cluster headaches are characterized by a severe, sharp pain in or around the eye. Cluster headaches are associated with symptoms such as the eye turning red, the eyelid looking droopy or tearing, swelling of the eyelid or a runny nose. Like migraines, the pain tends to be on one side of the head. These headaches are often very severe. Cluster headache attacks are cyclical, occurring frequently over several weeks; then, the pain may disappear for several weeks. The attacks often occur at night.

Tension headaches, migraine headaches, cluster headaches and other types of primary headaches can all be chronic, which means the headaches occur 15 days or more a month, for at least three months. Various factors can influence the chronicity of the headache disorder.

What Causes Headaches?

There are several different causes for secondary headache types, a variety of influences affect primary headache disorders. 

• Genetic: Often seen in migraine, as they can run in families.
• Environmental: Different triggers include changes in weather and barometric pressures.
• Hormonal: Changes throughout a woman’s life — menses, pregnancy, breastfeeding, perimenopause, postmenopause, etc. — can bring on headaches.
• Overuse of pain relievers: Taking too many over-the-counter pain medications or prescription pain medications can worsen headaches.
• Food and beverage: Dehydration, alcohol, caffeine and other nutrition issues can cause a headache.
• Mood disorder: Underlying stress, anxiety and depression can impact headaches.

Migraine patients can make several lifestyle changes to reduce the risk of a migraine or make them less severe. 

When to Be Concerned About Headaches

A headache that comes on suddenly and can be described as the “worst” or “most severe headache of your life” should be evaluated immediately. For those who suffer from chronic headaches, any significant change in the headache pattern or symptoms may warrant an exam by a physician and, possibly, diagnostic tests. For someone who does not suffer from headaches, a sudden onset of headaches can be cause for concern.

It would be unusual for someone who has never had headaches to suddenly get headaches. Even if symptoms appear to be consistent with a migraine, a doctor should rule out a secondary cause

Keeping a Headache Journal

If you suffer from headaches, it can be beneficial to keep a “headache journal,” or diary. Regardless of the type of headache, a journal is an important way of gathering information that can be helpful in making a diagnosis.

“Every day you have a headache, mark it on your calendar,” she said. “This will help you identify triggers, patterns and the different trends of your headaches, which we can monitor in response to the therapy.”

Write down when the headache started, what may have triggered it, describe the pain and its location and severity, the duration of the headache, any symptoms associated with it and how it impacted your daily activities.

Headache Treatment

Headache treatment focuses on addressing the causes of the individual’s triggers. Medication is an option, but it is not always the answer.

The approach to headache management within the Froedtert & the Medical College of Wisconsin health network is multidisciplinary and comprehensive. Your team will spend a lot of time discussing the headaches and factors that may influence them. The treatment team may recommend several treatment modalities, including physical therapy and psychotherapy, to address pain, as well as to address stress and mood issues that can be related. 

Your team will also work with you to manage underlying sleep issues, smoking cessation, weight loss and trigger avoidance. The goal is to restore function, reduce disability and help you feel better. It truly is a team approach, and there are many options.

Learn more about headache treatment and relief.

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