Headaches Explained: Relief, Types and Causes

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Today, we're gonna talk about headaches. Now, headaches are very common and they can be quite debilitating. They can keep you from being able to work, from being able to go to school, from being able to function. The good news is that most headaches are not life-threatening, but some of them are. So today, I'm going to give you headaches explained.  I'll cover headache relief, types of headaches, and causes. Plus, how to know if your headache is a matter of life or death.


Headache Categories

Primary and Secondary Headaches

Headaches can be divided into two main categories, primary headaches, and secondary headaches. Secondary headaches are caused by an underlying illness or an underlying condition. For example, a secondary headache could be caused by sinus infections, dehydration, a brain bleed, or even a brain tumor. So, a secondary headache has an underlying illness or condition as a cause. With primary headaches, there is no underlying illness that's causing the headache.

The primary headache is the illness. Primary headaches account for about 50% of all headaches and they include tension headaches, migraine headaches, and cluster headaches.




Primary Headaches

Tension Headaches

So let's start with tension headaches. Tension headaches are actually the most common cause of people buying over the counter analgesics or pain medicines for headaches. They are bilateral, meaning they happen on both sides of your head. They tend to feel like someone has a band that is wrapped around your forehead and exerting constant pressure. The pain of tension headaches is mild to moderate, usually not very severe. And that pain is constant. It's not typically a pounding or a throbbing pain.

Tension headaches are not typically worsened by activity, and they are typically not associated with flashing lights or change in vision. They do tend to be preceded by stress and tension.


Migraine Headaches

Another type of primary headache, migraine headaches. Now whether you have them or not, you have all heard of migraine headaches. Unlike tension headaches, which are mild to moderate, migraine headaches tend to be moderate to severe. Very severe as in very debilitating and they can really, really keep you from functioning properly.

Migraine headaches occur in about 12% of adults and women are more affected by migraines than men.

Migraine headaches tend to be unilateral, meaning they happen on one side of the head and they are a pounding or a throbbing headache as opposed to the more constant headache of a tension headache. I mentioned that tension headaches don't tend to be bothered by activity, well, migraine headaches do.

People with migraines don't like a lot of activity, even things as simple as walking or climbing can worsen or exacerbate a migraine headache. Bright lights tend to worsen migraine headaches as well as loud noises. There are different phases to migraine headaches. There can be a prodrome that consists of certain symptoms that occur 24 or up to 48 hours before the actual migraine headache even starts. Some prodrome symptoms may include yawning, irritability, and depression.

headaches explained

Aura Migraine Symptoms

And for people who have recurrent migraines, many of them can time when the actual headache will hit just based on when their prodrome started. About 25% of patients with migraine headaches will get an aura. An aura is a set of symptoms, which can be like hallucinations which occur right before the migraine headache begins.

An aura can be flashing lights or bright spots. In an aura, you can have a change in vision or actually have zigzag patterns or geometrical shapes that show up in your vision. An aura can also include tingling or numbness of the fingers, of the hand, or even a tingling or numbness in the face. In other words, the symptoms of an aura before a migraine headache can be very similar to symptoms of a stroke. For some migraine patients, within a matter of minutes of the aura stopping, the migraine headache begins.

And then remember the migraine headaches can be moderate to severe, pounding, and debilitating. And most patients with migraine headaches are soothed by being in a dark room where it's very quiet and where they're not moving. Some migraine headaches are associated with hormonal changes. Many young girls first develop migraines during puberty and some menopausal women note a change in their migraine headaches. Migraine headaches can last anywhere from three hours to three days.


Cluster Headaches

Cluster headaches are another type of primary headache. Unlike tension headaches and migraine headaches, cluster headaches are actually not very common. In fact, they occur in less than 1% of the population, and cluster headaches tend to affect men more than they affect women.

With cluster headaches, there's not a lot of warning. The onset is sudden and severe. So, you may be sitting there minding your own business one minute, and then boom! You have a deep, severe, excruciating, debilitating headache. Cluster headaches are always unilateral. They always affect one side and they tend to start in the eye. So you will get eye pain, you may even get eye redness. Your eye may begin to tear or you may have lacrimation from the eye. You can also get a droopy eyelid and a change in the pupil size of the affected eye.

Patients with cluster headaches tend to pace and move around. So this is quite different from patients with migraine headaches. Remember I told you that patients with migraine headaches like to be in a dark room and to be very still. But patients with cluster headaches tend to pace. Cluster headaches tend to be more short-lived than migraine headaches.  They will last for a matter of minutes, like 15 to 30 minutes or up to around three hours.


Secondary Headaches

Now let's talk about the secondary headaches. Unlike the primary headaches which are the illnesses, the secondary headaches are caused by an underlying condition or an underlying illness, such as a brain bleed, a sinus infection, trauma, or injury to the head. They can also be caused by a brain tumor. There are many secondary causes of headaches so I'll just give you a few more examples.


Causes of Secondary Headaches

Dehydration - Yes, something as simple as dehydration.

Caffeine Withdrawal -  If you are a person who is used to drinking your cups of coffee every day, and then you go a day with no coffee, you may have a caffeine withdrawal headache.

Now, some very important and potentially life-threatening secondary causes of headaches include:

  • Intracranial Hemorrhages or Brain Bleeds - With some intracranial hemorrhages, the headache can present as a thunderclap. And the patient may describe it as the worst headache of his or her life.
  • Subarachnoid Hemorrhage
  • Epidural Hematomas
  • Subdural Hematomas
  • Internal Carotid Artery Dissection - can cause a potentially life-threatening headache.
  • Giant Cell arteritis or Temporal Arteritis - this usually tends to occur in older patients and around the temple.
  • Underlying Heart Disease
  • High Blood Pressure


headache relief


Headache Relief and Treatment

Now, what are the treatments or the relief for headaches? Well, certainly you will want to consult your physician. And if your headache is severe, you'll need to go to the emergency department. But some common reliefs or treatments are as follows.

Tension Headache Treatment:

For tension headaches, many patients are relieved with over the counter analgesics like acetaminophen.

Migraine Headache Treatment:

For migraines, you may also try some over the counter analgesics and then rest, being in a dark room, being in a quiet room, or a room without bright lights. And if your migraines are recurrent or severe, then certainly you want to see your doctor or even your neurologist.

Cluster Headache Treatment:

For cluster headaches, sumatriptan or certain triptans tend to work,  as well as oxygen.

Now, you must consult your physician especially if you are an older patient or a patient with underlying heart disease because, for many patients, the triptans are contraindicated. Triptans should NOT be used in patients with heart disease, uncontrolled hypertension, or peripheral artery disease.


Life-Threatening Headache Symptoms

I've explained all of these headaches, but how in the world will you know if your headache is a matter of life or death?  How do you know when you should actually go to the emergency room or consult your physician?

Well, if your headache is severe and if you would describe it as the worst headache of your life, you definitely want to activate the emergency medical system. If you have a seizure or confusion, or a change in mental status, you should certainly consult your doctor. Or if you actually pass out, if you have a syncopal episode with your headache, you should consult your physician.

Also, if your headache is associated with a fever or a stiff neck, you should consult your doctor because these can be symptoms of meningitis as a secondary cause of the headache. If you are pregnant and have new-onset headaches, you should consult your physician. And if you are over the age of 40 and all of a sudden you're getting new headaches, you should consult your doctor.

If you have neurological symptoms like numbness or weakness or tingling, you should also consult your doctor. Now, these could be signs of migraine headaches but if these symptoms are new for you with your migraines, you should still see your physician. And if the headaches are just constant and recurrent and severe and certainly if they're debilitating, or you're just not sure, still see your doctor. Any of these symptoms I just described could be symptoms of a life-threatening cause of a headache.

Conclusion: Headaches Explained

This is headaches explained: if you found this information to be helpful, please be sure to share this with those you love and care about.  Also, subscribe to my YouTube channel if you have not done so already. Be sure to click the notification bell so you'll be among the first to see when I release new medical content. Also, please follow me on Instagram.   Have you ever experienced debilitating headaches?  Please comment down below and let me know what type of headaches you experienced and what you used for relief.

Dr. Frita - Frita McRae Fisher, M.D.
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