Headaches / migraines

Causes | Symptoms | Diagnosis | Treatment
Headaches are the most common form of pain.  It’s one of the most common reasons people miss work or school.   There are two types of headaches:

  • Primary – not caused by another disorder – includes migraines, cluster headaches, and tension headaches.
  • Secondary – caused by another disorder – includes those associated with head injuries, stroke, infection, substance abuse or withdrawal, and disorders of the eyes, sinuses, neck, and teeth.

There are differences in a regular headache and a migraine.  Headaches associated with stress, tension, hangovers, and illnesses usually go away within a few hours and get better when pain relievers are taken.  Migraines on the other hand are usually more severe than regular headaches and have associated symptoms such as sensitivity to light and noise, nausea and vomiting and can be debilitating to where a person is not able to get up out of bed.

Causes

Primary Headaches
There are numerous factors that can contribute to why people get headaches including chemical activity in the brain, a mix of signals between the brain, blood vessels and nerves.  Primary headaches are caused by dysfunction or overactivity in pain-sensitive structures in the head.  Common relatable causes are:
Tension Headaches

  • Muscle tightness – tightened muscles in the neck, shoulders, scalp and jaw
  • Stress – a common cause of tension headaches.  This can include emotional stress, anxiety and depression.  Skipping meals, alcohol use or change in sleep patterns can also cause tension headaches.
  • Environmental – some everyday triggers such as allergens, strong perfume, tobacco smoke, smells from cleaners, pollution and weather changes can cause headaches.
  • Illness – headaches are common when someone has an infection, a cold or fever.  Illnesses such as sinusitis, ear or throat infection can also cause headaches.

Cluster Headaches

The cause of cluster headaches is relatively unknown.  These headaches occur when a nerve pathway (trigeminal autonomic reflex pathway) is the base of the brain is activated.  The trigeminal nerve is responsible for sensations such as heat and pain.  When this nerve is activated it causes eye pain associated with cluster headaches.  The activation of the trigeminal nerve is believed to come from the hypothalamus, a deep part of the brain that regulates our sleep and wake cycles.
Migraines
Researchers are still investigating the causes of migraines however genetics and environmental factors are believed to have a major role.  Mayo researchers believe that migraines may be caused by changes in the brainstem and interaction with the trigeminal nerve as well as imbalances in brain chemicals.  Triggers that may cause migraines include:

  • Stress or anxiety
  • Beverages – such as alcohol or caffeinated drinks
  • Foods – foods high in salt or processed foods may trigger migraines
  • Food Additives – artificial sweeteners such as aspartame and preservatives such as monosodium glutamate (MSG)
  • Hormonal changes – women who experience hormonal fluctuations are more likely to get migraines
  • External stimuli – strong smells such as secondhand smoke, perfume as well as visual stimuli such as bright lights and glare may cause migraines
  • Physical – intense physical activity may increase chances of migraines
  • Sleep changes – changes in sleep patterns may trigger migraines
  • Environmental – weather changes may effect some people who are prone to migraines
  • Medications – oral contraceptives and vasodilators can aggravate migraines

Secondary Headaches
Secondary headaches are those that are caused by another disorder or condition.  These conditions range in severity and can activate the pain-sensitive nerves in the head.
Common causes:

  • Illnesses – sinusitis, ear infection, flu
  • Injuries – concussion, post-concussion syndrome,
  • Medical conditions – dehydration, glaucoma, high blood pressure, meningitis, panic disorder
  • External causes – hangover, overly tight headgear/helmet, carbon monoxide poisoning, reaction to medication

Other more serious causes can include:

  • Blood clots
  • Brain aneurysm
  • Brain tumor
  • Chiari malformation
  • Encephalitis
  • Intracranial hematoma
  • Meningitis
  • Stroke
  • Trigeminal Neuralgia

Symptoms

Different types of headaches have different symptoms.  It is important to be able to explain the type of symptoms you are having to your doctor so that you can get the correct treatment for your headache pain.
Symptoms of tension headaches:

  • Tight band of pain around the head
  • Dull aching pain
  • Tenderness to the head and neck, as well as shoulder muscles

Symptoms of cluster headaches:

  • Begin and evolve quickly
  • Intensity increases within minutes
  • Usually felt behind the eye on one side of the head
  • Usually happens at the same time of day or night
  • May happen several times per day
  • Can cause tearing or redness of the eye

Symptoms of migraines:

  • Pain that can range from moderate to severe
  • Pulsating pain
  • May affect only one side of the head
  • Can cause nausea and vomiting
  • Can cause sensitivity to light and sound

Diagnosis

It is important to get a proper diagnosis in order for proper treatment to be given.  Most headaches are diagnosed using a patient’s description of their headache (severity, location, other symptoms) in conjunction with a physical examination and collection of medical history.  If your provider feels that there may be an underlying cause to the headache, they may order additional diagnostic tests including X-rays, CT scan or MRI.
It is important for people to be aware of headache warning signs that would warrant a patient seeking immediate medical attention.  If a headache has any of the following signs, seek immediate medical attention:

  • Comes on suddenly or becomes severe within seconds or a few minutes
  • Can be described as the “worst headache of your life”
  • Severe and accompanied by a stiff neck and fever
  • Is accompanied by a seizure, confusion, personality changes, fainting
  • Begins immediately after strenuous exercise
  • Causes weakness, numbness or visual impairment

Treatment

Treatment options will depend on the type and severity of the headache.  Many people will not seek medical attention for occasional headaches and will use over-the-counter pain relievers.  Unfortunately sometimes repeated use of these medications can cause overuse headaches.
Over-the-counter headache medications include:

  • Pain relievers: Aspirin, Ibuprofen (Advil, Motrin), acetaminophen (Tylenol), and naproxen (Aleve).
  • Combined Medications:  Over-the-counter medications such as Exedrin Migraine often combine pain relievers with caffeine to treat severe headaches.
    Other medications:
  • Prescribed medications:  For some people who experience frequent migraines, a doctor may prescribe triptan or narcotics to relieve severe headache pain.
  • Antidepressants: Tricyclic antidepressants are commonly used to prevent tension headaches.
    Alternative treatments:
    Many people are now seeking alternative treatments to treat and prevent tension headaches.  These alternative treatments include:
  • Acupuncture:  may relieve temporary relief from chronic tension headaches.
  • Massage:  frequent massages can help reduce stress and tightness of the muscles in the neck, shoulders and back that can attribute to tension headaches.
  • Breathing techniques:  an alternative relaxation therapy that may help people cope with the pain from tension headaches.
    SCU is proud to offer all three of these alternative treatment options in their University Health Center.  Our patient centric philosophy lets us treat the patient as a whole person for total wellbeing.

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