Migraine Headaches

Most people hear the word “migraine” and think “headache.” But the headache is just one symptom of this inherited neurological condition that affects about 28 million Americans over age 12.  

Symptoms 
Common migraine symptoms include:

• Moderate to severe headaches lasting from four to 72 hours.
• Throbbing or pulsing pain, usually on just one side of the head. 
• Dizziness, nausea and vomiting.
• Sensitivity to lights, sounds and sometimes smells.
• Pain made worse by activity, even walking or climbing stairs. 

Migraine With Aura

Some people who have migraine headaches also experience what doctors call “aura,” sensory (usually visual) distortions that come on before head pain begins. “Migraine with aura affects about 25% of migraine sufferers,” says Nelli Boykoff Perkins, M.D., a Sutter neurologist with subspecialty training in headache medicine. “It’s important to understand your migraine type because migraine with aura is associated with an increased risk of stroke. The risk is higher in women who smoke or take estrogen-containing oral contraceptives.” 

Treatment 
Treatment for migraine is very specific and includes treatments that prevent and interrupt attacks. Visit a neurologist who specializes in migraine to find what works for you.  

Tension Headaches

According to the World Health Organization, up to 70% of people experience episodic tension headaches. Many people have an occasional tension headache lasting a short time. Others experience frequent headaches lasting for hours or days. And a small percentage of people have almost constant tension headache pain. 

Symptoms 
“Tension headache pain is very different from migraine pain,” Dr. Boykoff Perkins says. Tension headache symptoms include: 

• Mild to moderate pain on both sides of the head.
• Pain in your temple.
• Pressing or tightening pain.

“Unlike migraine pain, routine physical activity doesn’t worsen tension headache pain,” says Dr. Boykoff Perkins. 

Causes 
Doctors once thought muscle tightness caused tension headaches. They now think that muscles may tighten as a reaction to the pain and that tension headaches have underlying genetic roots and involve central nervous system sensitivity and brain chemicals. Triggers most often connected with tension headaches include stress, anxiety, depression, fatigue and hunger. 

Treatments 
Most people treat occasional tension headaches on their own with a combination of over-the-counter medications and relaxation techniques, including massage, exercise and meditation. See a doctor if your headaches become more frequent, more painful or longer lasting to explore other treatment options and rule out other medical conditions that can cause headache pain.  

Combined Migraine and Tension Headaches

A study by the World Health Organization found that about 17% of people who see a neurologist for headache pain have combined migraine and tension headaches. The condition was once called mixed migraine or mixed headaches, but doctors now use the more descriptive name. People with this condition may experience some or all of the symptoms of both types, which can make diagnosis and treatment more challenging. Make an appointment with a headache specialist if you identify with the symptoms listed for both migraine and tension headaches to establish a management strategy that works for you. 

Cluster Headaches

People who experience them and doctors who treat them place cluster headaches at the top of the pain chart. “If migraine headache pain is severe — and it is — cluster headache pain is excruciating,” Dr. Boykoff Perkins says. Cluster headaches also have other distinct symptoms:

• Sharp pain comes on with little warning above or around one eye.
• Headaches last from 15 minutes to three hours.
• The affected eye begins tearing or becomes bloodshot. Your pupil may get smaller.
• The eyelid of the affected eye may swell or droop.
• Your nose becomes congested and runny.
• Restlessness and agitation.
• Headache pain disappears as suddenly as it appeared.
• Headaches may happen once every other day or up to eight times a day, often around the same time each day.
• Attacks appear in clustered patterns. Clusters typically last for a few weeks. They usually go away for several months before starting again. Some people experience a single cluster in their lifetimes, while others experience them daily. 
  Cluster headaches are rare, striking only about one in 1,000 people. They often begin between ages 20 and 40 and are three to four times more common in men than women. 

Causes 
“Cluster headaches seem to be connected to the body’s circadian rhythm, though the exact mechanism is unclear,” Dr. Boykoff says. “We began to suspect the connection because attacks can occur so predictably and often at night.”

Treatments 
You can treat an oncoming attack with inhaled oxygen and injectable medications to reduce the headache’s severity. 

Treatments that stimulate nerves, including deep brain stimulation and vagus nerve stimulation, also bring relief to some. Headache specialists can prescribe medications that help prevent attacks. 

Treatments for this rare and debilitating condition continue to evolve. If you experience cluster headaches, contact a neurologist experienced in treating headaches for the most current and knowledgeable care. 

Medication Overuse Headaches

Also called rebound headaches, medication overuse headaches are chronic headaches caused by the very medications people take to relieve head pain. They happen when people take medications more than a couple of times a week to treat frequent headaches or out of fear that a headache might start. Just about any headache medication taken too often can bring on a medication overuse headache. 

Symptoms 
According to the American Headache Society, telltale signs of medication overuse headaches include:

• Headaches become more intense, more frequent and more difficult to treat.
• Preventive medication is not working.
• Higher medication doses are needed to treat pain.
• Patients are making trips to the emergency room and requiring hospitalizations.

While most headache types have identifying symptoms, rebound headache pain varies. It can shift back and forth from migraine-like pain to tension-like pain in the same day. 

Treatments 
Treating medication overuse headaches requires a special understanding of how to undo the rebound effect. Preventive measures are especially important with this condition. Talk to a specialist if you take headache medications frequently and are experiencing headaches more than 15 days a month.  

Chronic Daily Headaches

Chronic headaches can be what doctors call “new daily persistent headache” (NDPH) if the headache comes on suddenly and remains continuous from onset. NDPH is a headache that essentially comes on one day and doesn’t go away. The pain can have either tension-type or migraine features. Most people who have NDPH have no history of headaches and can recall the exact day, and sometimes the exact moment, the headache began. No one knows what causes NDPH, but it’s wise to see a headache specialist for treatment and to rule out any underlying causes. 

Getting Care

“If headaches of any type are interfering with your life, it’s reasonable to get an evaluation,” Dr. Boykoff Perkins says. “I meet so many people who suffer for years because they don’t find the appropriate care. Why lose days of your life to headaches when you don’t have to?”