Every week patients are walking into my clinic complaining of headaches and most don’t realize that there are many different types of headaches, each of which has a different cause and different symptoms.
The International Headache Society has identified 14 different types and sub classifications of headaches. There are 2 basic categories of headaches, primary and secondary. Primary headaches include those of vascular origin (cluster and migraine headaches) as well as those of muscular origin (tension-type headaches). Secondary headaches result from another source including inflammation or head and neck injuries.
For the purpose of this blog I am going to focus on the more common types of headaches. Hopefully after reading this, you will have a better understanding of what type of headache you may be suffering from.
Migraines can run in families and are diagnosed using certain criteria.
- At least five previous episodes of headaches
- Lasting between 4–72 hours
- At least two out of these four: one-sided pain, throbbing pain, moderate-to-severe pain, and pain that interferes with, is worsened by, or prohibits routine activity
- At least one associated feature: nausea and/or vomiting, or, if those are not present, then sensitivity to light and sound
Sensitivity to light and noise are also associated with migraines. A migraine may be foreshadowed by aura, such as visual distortions or hand numbness. (About 15% to 20% of people with migraines experience these.)
Tension Type Headaches
Tension headaches, the most common type, feel like a constant ache or pressure around the head, especially at the temples or back of the head and neck. Some patients describe a band-like pressure along their head. Not as severe as migraines, they don’t usually cause nausea or vomiting, and they rarely halt daily activities.
Over-the-counter treatments, such as aspirin, ibuprofen, or acetaminophen (Tylenol), are usually sufficient to treat them. Experts believe these may be caused by the contraction of neck and scalp muscles (including in response to stress), and possibly changes in brain chemicals. Lifestyle changes including stress management, improving sleep and hydration can also help to reduce the incidence of these types of headaches. Acupuncture and laser therapy have also been shown to be effective in treating tension type headaches.
Cluster headaches, which affect more men than women, are recurring headaches that occur in groups or cycles. They appear suddenly and are characterized by severe, debilitating pain on one side of the head, and are often accompanied by a watery eye and nasal congestion or a runny nose on the same side of the face.
During an attack, people often feel restless and unable to get comfortable; they are unlikely to lie down, as someone with a migraine might. The cause of cluster headaches is unknown, but there may be a genetic component. There is no cure, but medication can decrease the frequency and duration.
Cervicogenic headache, as the diagnosis suggests, refers to a headache of cervical origin, in other words headaches which stem from the neck. Cervicogenic headaches usually occur on one side of the head. They start one side of the back of the head and neck, and then travel to the front/forehead region. They may also be associated with arm discomfort. These types of headaches are very effectively treated with chiropractic care. Treatment for this types of headaches include acupuncture, muscle release techniques and spinal manipulation.
When a sinus becomes inflamed, often due to an infection, it can cause pain. It usually comes with a fever and can be diagnosed by symptoms or the presence of pus viewed through a fiber-optic scope. Headaches due to sinus infection can be treated with antibiotics, as well as antihistamines or decongestants.
Overuse of painkillers for headaches can, ironically, lead to rebound headaches. Culprits include over-the-counter medications like aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin, Advil), as well as prescription drugs. One theory is that too much medication can cause the brain to shift into an excited state, triggering more headaches. Another is that rebound headaches are a symptom of withdrawal as the level of medicine drops in the bloodstream.
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