Headaches and Migraines

Overview

Headaches—discomfort that may be described as pain, pressure, or tension affecting the head and face—are grouped into four types: vascular, muscle contraction (tension), traction, and inflammatory.

  • Vascular headaches include migraines (the most common type of vascular headache), toxic headache produced by fever, “cluster” headaches (repeated episodes of intense pain), and headaches related to high blood pressure.
  • Muscle contraction headaches are characterized by tight or tense facial and neck muscles.
  • Traction and inflammatory headaches are symptoms of other medical conditions, such as stroke or sinus infection. These types of headaches may be signs of a more serious disorder, so—as with any unusual changes to your health—it’s important that you consult a doctor.

Migraines

Migraine headaches are the most common type of vascular headache. They involve intense pulsing or throbbing pain on one or both sides of the head and may be accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Women experience more migraines than men, and onset may be associated with hormonal changes during the menstrual cycle. Some people who experience migraines report having an aura, or visual disturbance (flashing lights, zig-zag lines, or temporary loss of vision) before the headache begins.

Symptoms and Diagnosis

The symptoms of headaches generally include different levels and types of pain affecting various regions of the head. Diagnosis—based on the nature you discomfort—of the specific type of headache may be an important step in getting effective treatment. As well, diagnosis is also important if your headache may be an indication of a more serious health concern (such as is possible with a traction or tension headache).

Although headaches are a common complaint and many people don’t seek medical treatment for them, there are certain headache characteristics that do indicate the need to medical attention. Consult your doctor if your experience any of the following:

  • Headaches that get worse—meaning they cause more pain and last longer—over a period of days or weeks
  • If you’ve never had headaches and suddenly begin to experience them (a particular concern in people over 50 years of age)
  • A feeling a weakness, numbness, or changes in vision or hearing
  • Persistent pain—even after taking over-the-counter analgesics (pain killers)
  • Changes to your memory, personality, and cognitive abilities
  • A stiff neck, rash, nausea, vomiting, fever, breathing problems, or head injury

Your primary care physician may be to help treat your headache or diagnose another medical condition that is causing it. Some people affected by headaches also consult headache specialists or visit headache clinics for diagnosis and treatment. You may want to discuss this option with your healthcare team.

To help you and your doctor diagnose and treat your headache, it may be helpful to keep a headache diary. This diary will include headache frequency, characteristics of the pain, and circumstance of substances (certain foods, for example) that seem to bring on a headache (known as triggers).

Symptoms and Diagnosis of Migraines

Symptoms that can help differentiate a migraine from other types of headaches include:

  • Pain concentrated on one side of the head (typically around the eye or temple and sometimes in the face, sinus, jaw, or neck)
  • Pulsating or throbbing pain
  • A level of pain that affects normal activities
  • Nausea or vomiting
  • Increased sensitivity to light and sound
  • Attacks that last for 72 hours or more
  • Visual disturbances (an aura, wavy lines, dots, flashing lights, or blind spots) that begin about 20 minutes to an hour before the headache
  • Tingling in arm or face
  • Difficulty speaking

To determine whether your headaches are migraines, your doctor will consider the history and nature of your symptoms as well as family history of similar headaches. Although there is no medical test to confirm a migraine, tests such as CT scan and MRI can be used to rule out other medical causes of the headache.

Triggers and Prevention Measures

Understanding what triggers your headaches goes hand-in-hand with taking measures to prevent them. As you identify the situations and behaviors that set off a headache, you can make efforts to avoid these things while also making other lifestyle changes to control or prevent headaches.

Triggers can differ from person to person and by type of headache. Examples of circumstances and exposures that may bring on a headache or migraine include:

  • Stress and anxiety
  • Irregular sleep patterns
  • Certain foods (foods high in sugar and cured meats, for example)
  • Missing meals (low blood sugar can trigger a headache)
  • Dehydration
  • Excessive caffeine intake
  • Excessive alcohol intake
  • Drug use

A number of people who suffer from migraines find that environmental and physical factors, such as changes in climate or weather, can trigger their headaches. These factors include changes in humidity, temperature, or barometric pressure, or high winds. Travel and changes in routine may also trigger a migraine, and so may a change in altitude. Some people report flickering light (such as that produced fluorescent light, television, and movies); glare; intense light reflection; extremes in heat or sound; and fumes and vapors (such as in poorly ventilated spaces) can set off a migraine. People affected by migraines can be particularly sensitive to light.

Hormones and Migraines

More women than men suffer from migraines, a fact that may be attributable to changes in hormones during a woman’s menstrual cycle. Pregnancy may also affect migraine incidence—increasing attacks for some and decreasing them for others.

Prevention Measures

Once you recognize the circumstance or factors that may trigger a headache or migraine, you can take steps to prevent them, often by making adjustments to your everyday life. Examples of measures you can take include:

  • Get regular sleep. Aim for six to eight hours per night and go to bed and wake up at regular times each day—even on the weekends.
  • Stay physically active. Control stress and improve well-being by staying active. Moderate exercise on a regular basis (three to five days per week) can be beneficial.
  • Stay hydrated. Sip water throughout the day, as dehydration may trigger a headache.
  • Reduce stress. Find a stress-management technique that’s effective and that you enjoy. Consider yoga, meditation, massage, or a warm bath.

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