“A headache is a symptom, not a cause,” said Fallon Schloemer, DO, a neurologist and headache specialist with the Froedtert & MCW health network. “There could be a number of causes which 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 something big, bad and ugly,” Dr. Schloemer said. “But, the pain associated with any headache disorder can be severe and disabling, warranting aggressive early treatment.”
Tension headaches typically are bilateral, meaning the pain is felt on both sides of the head. These 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 stress (physical or psychological).
“This is typically what people are referring to when they say they have a ‘normal’ or ‘regular’ headache,” Dr. Schloemer said. “But 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 certainly impact quality of life.”
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 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.
There are several different causes for secondary headache types, but in regards to primary headache disorders, there are a variety of influences.
- Genetic: Often seen in migraine, as they can run in families.
- Environmental: Different triggers include change 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 much 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 certainly impact headaches.
Keeping a Headache Journal
Dr. Schloemer encourages anyone suffering from headaches to keep a “headache journal,” or diary. A headache journal is an important way of gathering information and 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.
When to Be Concerned
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 very unusual for someone who has never had headaches to, later in life, suddenly get headaches,” Dr. Schloemer said. “Even if the symptoms appear to be consistent with a migraine, we need to rule out a secondary cause.”
Headache treatment focuses on addressing the causes of the individual’s triggers. Medication is an option, but it is not always the answer.
“My approach to headache management is multidisciplinary and comprehensive,” Dr. Schloemer said. “We spend a lot of time discussing the headaches and everything else that may be impacting them. It is really about addressing all of the factors that might be contributing to the patient’s headaches. It is not uncommon for me to recommend several treatment modalities, including physical therapy and psychotherapy, to help with the pain specifically, as well as address other stress and mood issues that can be related. We also work on managing underlying sleep issues, smoking cessation, weight loss and work on trigger avoidance. The patient and I work together to restore function, reduce disability and feel better. It truly is a team approach, and there are many options.”
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