Dr. Z.

What causes headaches and what can I do about them?

There are two basic types of headaches, primary and secondary. Primary headaches have various causes and include tension headaches, migraine headaches, and cluster headaches. Secondary headaches occur as a result of some medical condition. These can range from mild conditions such as headaches associated with sinus infections, pregnancy, and caffeine withdrawal, to more serious life-threatening conditions such as brain tumors, strokes, meningitis, and bleeding within the brain.

Primary headaches are by far the most common form and include the following:


The most common form of headache in the United States. Patients report diffuse pain, described as a rubberband-like tension around the base of the skull.


Generally speaking, migraines are the most debilitating form of primary headaches and the second most common. Along with pain in the head, migraines can also be associated with nausea, vomiting, visual changes, and extreme sensitivity to light and sound.


Much more common in men, cluster headaches typically occur on one side of the head and may be associated with vision and/or eye complaints such as tearing, eye pain, or even a runny nose.

What causes it?

Researchers aren’t sure what causes these headaches. Some believe that vascular changes are behind migraine and cluster headaches. It is believed that blood vessels contract and expand inappropriately causing the associated pain. This theory was believed to be the main cause of migraines until more recent evidence shows that the problem may related to nerves within the brain. Scientists believe that certain areas of nerve activity become decreased which causes the release of certain inflammatory chemicals that cause irritation of nerve roots. This irritation is what causes the painful sensation to that area of the head. Today, most researchers believe that cluster headaches are a result of inappropriate blood vessel dilation nd migraines are a result of both vascular blood vessel changes as well as neurological irritation.

Who gets it? Are there risk factors?

Tension headaches are the most common form of primary headache and affect nearly 90% of all adults at some point in their lives. Women are affected more than men and children can suffer from tension headaches as well, experiencing symptoms similar to those in adults. The most common risk factor for the development of tension headaches is emotional stress.
Migraines are the second most common form of primary headache and affect about 12% of the population. Before puberty, boys and girls are affected equally, whereas after puberty, migraines are significantly more common in women than men. There are some documented factors that may trigger a migraine including hormonal changes during menstruation, changes in sleeping or eating patterns, exposure to carbon monoxide, certain foods such as red wine, cheese, chocolate, or caffeine, medications like birth control, and emotional stress.
Unlike tension and migraine headaches, cluster headaches are much more common in men. About 85% of all diagnosed cluster headaches occur in men during the average age of 28 to 30 years. Other risk factors for cluster headaches include men with hazel eyes, a history of significant tobacco or alcohol abuse, type A personalities, a taller than average height, and a history of peptic ulcer disease.

What are the signs and symptoms?

Tension headaches are typically mild in nature and bilateral in location. many report a band-like tension or pressure wrapping around the head with the worst pain over the eyebrows. These headaches usually occur episodically but can occur more frequently, and even daily in some people. Most people do not have any associated nausea, vomiting or other migraine like complaints such as sensitivity to lights or noise and these headaches are not affected by physical activity. Many people report that the pain is worse is the morning or late in the day and may be associated with an increased stress level.

Common symptoms of migraines include unilateral head pain that is moderate to severe in nature. Most people report a pulsating or throbbing pain that can significantly affect activities of daily living. An aura of flashing lights or a tingling sensation may precede some migraines whereas as others occur without warning. Severe migraines can be associated with nausea, vomiting, dizziness, visual disturbances and increased sensitivity to light and/or noise. Migraine headaches are made worse with physical activity and most people feel the need to lie down in a quiet, dark room. Most migraine attacks last between 4 and 72 hours.

Cluster headaches typically occur in “clusters,” occuring several times a day for weeks to months. Most headaches last approximately 30 minutes but can last for up to an hour and a half. The pain is usually described as unilateral and around or behind one eye. The eye may become red, watery, and inflamed and nostril on that side can become stuffy or runny. These headaches are much more common in men and many report excruciating pain causing extreme restlessness. Many pace the floor and can be driven to desperate measures to reduce the pain.

How is it diagnosed?

Your primary care physician can help in diagnosing your headache. During the exam, they will ask you a number of questions relating to the symptoms of your headaches. Your physician will want to know when and where they occur, how often, if anything makes them better or worse, as well as any medications or other medical conditions you may have.
If your doctor questions the description of your headaches, they may order a CT scan or MRI of your brain to rule out other possible conditions. They may also recommend the use of a “headache calendar” in which they ask you to document when your headaches occur, how long they last, and a brief description of the pain itself.

Are there any complications?

The majority of complications arise from self-medicating your headaches. If you feel you have any of the above signs or symptoms of these headaches, talk to your doctor today. There are a number of treatment options for the various forms of primary headaches.

How is it treated?

Treatment of your headaches will depend on the type of primary headache that you have. Most tension headaches can be relieved with over the counter analgesics such as Ibuprofen. Severe pain may warrant the use of stronger prescription medication. Other preventative measures include minimizing your stress level, maintaining good posture, and exercising regularly. There are also preventative medications that may help including certain anti-depressants.

Medications for migraine headaches are used for either acute treatment, preventative treatment, or both. There are several new prescription medications that are taken as soon as symptoms occur and are designed to relieve acute attacks. Other medications, such as certain anti-depressant, cardiac, and seizure drugs can be prescribed to be taken preventatively on a daily basis or when a potential trigger, such as menstruation, is occurring. People who suffer from migraines are encouraged to identify and therefore avoid any potential triggers that may lead to a migraine.

Cluster headaches are treated similarly to migraines. Acute treatment includes the inhalation of pure oxygen as well as prescription medication. Men with cluster headaches are encouraged to avoid tobacco and alcohol and to seek treatment as soon as the first attack occurs.

If you have any further questions or any concerns, please don’t hesitate to visit your “Medical Home” for further evaluation and treatment.

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