December 13, 2017
What Type of Headache Do You Have?

What Type of Headache Do You Have?

by Leslie Goldman  

Nearly everybody gets headaches. Annoying and painful at best, debilitating at worst, headaches are among the top 10 causes of disability worldwide, robbing Americans of more than 157 million work and school days every year, according to the National Headache Foundation.

Knowing what type of headache you’re experiencing is critical to properly diagnosing and treating it. Here are the basics on the four main types to help you plan your best counterattack. See your health care provider if you experience any of them more than occasionally.

Tension headache

What it is: The most common type of headache, tension headaches are typically the result of tight shoulder or neck muscles. Common triggers include poor posture—for example, hunching over a computer—as well as stress, eyestrain, and fatigue.

Key symptoms: Sufferers tend to describe the pain as mild to moderate and bilateral, as if something is squeezing their head or neck.

How it’s treated: Over-the-counter pain medicines like aspirin, ibuprofen, or acetaminophen are the first line of treatment but may lead to rebound headaches if used too often. So if you have regular tension headaches, try to correct their underlying cause by, for instance, improving your posture or managing stress (e.g. with biofeedback or meditation). If none of these steps help, see your physician to get a definitive diagnosis and a treatment plan.

Migraine

What it is: The second most common type of headache, migraines typically cause intense pain and nausea and are often so debilitating that sufferers miss work or family activities. Three times more women than men suffer migraines.

Key symptoms: A migraine attack consists of four distinct phases. Not everyone experiences all four phases, but it’s important to understand them because the earlier you recognize the attack, the better your chance of cutting it short.

  • Phase 1: Prodrome. 
About 30 percent to 40 percent of migraineurs experience some kind of prodrome hours or even days before an attack. Symptoms include difficulty concentrating, fatigue, food cravings, sensitivity to light and sound, and restlessness.
  • Phase 2: Aura. Classic aura symptoms are most often visual—flashing lights, wavy lines, blurry vision, or partial loss of sight—but some people have other sensory symptoms such as auditory hallucinations or motor weakness. The aura typically lasts around 15 minutes, but only 20 to 25 percent of migraineurs experience it.
  • Phase 3: Headache. The headache itself can range in intensity from mild to completely incapacitating. It typically is limited to one side of the head, and may be accompanied by nausea, dizziness, vomiting, tingling or numbness in the extremities or face, and sensitivity to noise, light, touch, and odor.
  • Phase 4: Postdrome. The migraine’s final phase. Sufferers typically feel drained and “hung over.”

How it’s treated: Early in an attack, nonprescription painkillers such as aspirin, ibuprofen, and acetaminophen taken with a caffeinated beverage may be enough to stop a milder migraine. If not, or if migraines are moderate to severe in intensity, prescription options include triptan drugs (sumatriptan, zolmitriptan, and others) and, less commonly, the drug ergotamine, which is administered in combination with caffeine to prevent blood vessels in the head from expanding and causing pain. Ergotamine has more side effects than triptans so is usually used only if those drugs haven’t worked.

Sinus headache

What it is: What many people call a “sinus headache” is actually a migraine accompanied by sinus symptoms such as nasal congestion or pain and pressure in the cheeks or forehead. Much less often, it’s a symptom of sinusitis, an acute or chronic inflammation of the sinus cavities. Patients frequently misdiagnose themselves with a sinus headache when they really have a classic migraine, according to the American Headache Society Committee on Headache Education (ACHE).

Key symptoms: If your headache is accompanied by a cold or other viral upper respiratory infection, you may be experiencing sinusitis.

To determine for sure whether you’re having a true sinus headache or a migraine, you can ask yourself the three questions below. If you answer “yes” to at least two of them, the odds are 93 percent that it’s a migraine, according to the American Headache Society:

  • In the last three months, have your headaches interfered with work, school, or family activities?
  • Does nausea accompany your headaches?
  • Do you experience sensitivity to light along with your headaches?

How it’s treated: If your “sinus headache” is actually a migraine with sinus symptoms, treat it as you would any migraine. Treatments for sinusitis include OTC and prescription decongestants, nasal corticosteroid sprays, and saline nasal irrigation. Infrequently, antibiotics are also needed.

Cluster headache

What it is: The “headache from hell,” thankfully uncommon. Cluster headaches arrive in groups of one to three a day, last anywhere from 15 minutes to three hours apiece, and recur every day or two for weeks or months, often during the same season of the year. Men are about twice as likely to experience cluster headaches as women.

Key symptoms: Sufferers tend to describe the pain as "boring," “burning," and “like an icepick in my eye.”

How it’s treated: OTC medications can’t touch cluster pain. To be effective, short-term therapies must be given within minutes of symptoms appearing. Inhaling pure oxygen can shorten or stop an attack. Triptans administered by nasal spray or injection also are often effective. A person with cluster headaches should see a doctor very experienced in treating headaches, usually a neurologist. He or she may prescribe medication to help prevent the attacks; in rare cases, patients may need surgery.

When to get immediate help for a headache

If your headache is accompanied by dizziness, vomiting, a stiff neck, or progressive neurological symptoms, call your doctor immediately. If you ever feel you are having "the worst headache of your life," or develop speech, vision, or movement difficulties along with the headache, call 9-1-1. These can be symptoms of a more serious condition such as a brain hemorrhage.