by Dr. C.H. Weaver M.D. updated 1/2021
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.
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).
The Four Stages of a Migraine Attack
- Prodrome: the warning signs of a migraine, which vary but can include either fatigue or bursts of energy, yawning, frequent urination, and mood changes.
- Aura: nervous system symptoms that can be visual (such as flashes of light or blind spots) or involve other senses (such as tingling and numbness).
- Headache: the attack phase, which can also include nausea, vomiting, and sensitivity to light, sounds, and smells.
- Postdrome: the migraine “hangover,” which can include residual low-grade headache and continued sight, sound, and smell sensitivity.
Not all migraine attacks include all four stages. Only about 25 percent of migraineurs will ever experience aura. Some migraines even skip the headache phase, a phenomenon called acephalgic or silent migraine.
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)
- 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.
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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.
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.
- Novel medications can prevent Migraines
You may find that certain foods trigger your headaches or migraines. Pay attention to the types of foods that seem to trigger a headache. If, for example, you often get a headache when you eat chocolate, it’s likely that chocolate is a trigger for you. Other foods that are thought to set off a headache or migraine include aged cheeses, cured meats, and citrus fruits. Naturally, avoiding food triggers is an important step in prevention.
Nutrition and headache prevention may be about more than avoiding suspected triggers—a balanced eating plan may also help to prevent headaches. Aim to eat regular meals, as the low blood sugar levels that can result from missed meals can set off a headache. Meals should be balanced, providing protein, carbohydrates, and vitamins and minerals. Further keep blood sugar levels stable by avoiding excess sugar. As well, consume caffeine or alcohol in moderation amounts (if at all), as excess amounts of either substance may trigger a headache.
There are several different options for preventing and treating headaches and migraines with medication. Ask your doctor about options—both prescription and over-the-counter—that may be appropriate for you. Your doctor will consider factors including the nature of your symptoms, your overall health, any other medications you are taking, as well as the type of headaches you experience when choosing medication options.
Some people find that over-the-counter pain relievers such as aspirin, ibuprofen, and acetaminophen (Tylenol®) help control headache pain. There are also FDA-approved over-the-counter medications formulated specifically to treat migraines; these include Excedrin® Migraine and Advil® Migraine.
Over the Counter Medications: These need to be used in limited quantities or they can trigger more headaches. It is best to limit the use of medications to 8-10 days a month, and if you need to use over the counter pain medication more often, speak to your health care provider.
- Acetamenophen, Ibuprofen, and Naproxen can all be helpful during a migraine
- Combination medications such as Excedrin can be helpful.
- NSAIDS: Anti-inflammatory medications that can help with migraine attacks. Examples include diclofenac, cambia, nabumetone, ketorolac, and indomethacin
- Anti-emetics: Some medications used for nausea can help both nausea and migraines. Examples include metochlopramide, prochloperazine, and promethazine.
- Triptans: Migraine specific medications that reduce certain chemicals in and around the brain during migraines. Examples include almotriptan, eletriptan, frovatriptan, naritriptan, rizatriptan, sumatriptan, and zolmitriptan.
- Ergots: Migraine specific medications that reduce certain chemicals in and round the brain during migraines. Examples include dihydroergotamine.
Preventive Treatment for Migraine Headaches
Prescription medications: Certain types of medications have been found to be effective to reduce the frequency of migraines when taken as prescribed.
- Aimovig (erenumab-aooe) treatment is given by once-monthly self-injections. Aimovig is the first FDA-approved preventive migraine treatment in a new class of drugs that work by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks.
- Tricyclic Anti-depressants and seratonin neurepinephrine reuptake inhibitors can help reduce migraine frequency.
- Anti-hypertensive medication: Certain beta blockers, calcium channel blockers, ACE inhibitors, and ARB medications can reduce migraine frequency. Propranolol, and Timolol have been FDA approved to treat migraine.
- Anti-seizure medication: Certain anti-seizure medications, such as topiramate and divalproex sodium, have been FDA approved to treat migraine
- Botox - Onabotulinum toxin A: Botox has been FDA approved to treat chronic migraine. For more information about the use of botulinum neurotoxin in the treatment of chronic migraine and other health conditions, see the article “Beyond Botox” available online at awomanshealth.com/beyond-botox.
Living with Migraines
With a combination of lifestyle measures and medication to prevent migraines and treat their symptoms, it’s possible to control the frequency and severity of attacks. As well, some people affected by migraines find that alternative therapies like acupuncture, acupressure, and yoga help to control frequency of attacks and symptoms and contribute to an improved quality of life. Biofeedback is also used to help people manage migraine attacks; this self-help treatment involves the monitoring of breathing, pulse, heart rate, temperature, muscle tension, and brain activity—all involuntary physical responses to stimuli like stress (a potential migraine trigger). The goal is that by learning how to identify and control these responses, individuals can learn to control their body’s response to stress and thus prevent some migraines.
- NINDS Headache Information Page. National Institute of Neurologic Disorders and Stroke Web site. Available at: http://www.ninds.nih.gov/disorders/headache/headache.htm. Accessed July 2020.
- NINDS Migraine Information Page. National Institute of Neurologic Disorders and Stroke Web site. Available at: http://www.ninds.nih.gov/disorders/migraine/migraine.htm. Accessed July 2020.
- Tools for Sufferers. National Headache Foundation Web site. Available at: http://www.headaches.org/education/Tools_for_Sufferers. Accessed July 2020.
- Trigger Avoidance Information. American Headache Society Web site. Available at: http://www.achenet.org/tools/TriggerAvoidanceInformation.asp. Accessed July 2020.