What Different Types of Headaches are There?

Generally headaches can be separated into either primary or secondary headaches. Examples of primary headaches include migraines, tension type headaches, and cluster headaches, and examples of secondary headaches include head trauma, neck trauma or injury (following whiplash injury), occipital neuralgia, cranial masses, post dural puncture headaches, and others.

Migraines and Tension headaches are the most common primary headaches and these are discussed below.

What are Migraines Headaches?

Migraine headaches are extremely common and can be present with or without an aura. An Aura is a phenomenon which occurs prior to the onset of the headache such as: flashing lights, altered vision, weakness, altered smell or other phenomenon. In a typical migraine an Aura usually occurs up to one hour prior to the onset of the headache. About half of migraine sufferers also experience a prodrome which occurs up to 24 hours prior to the onset of the headache, which can include altered perception, irritability or withdrawal, and food craving. Common features of a migraine headache include symptoms affecting one side of the head, a pulsating feature to the headache, the severity is moderate or severe and the headache is exacerbated by routine physical activity. Generally the headache will last between 4-72 hours and is associated with nausea and vomiting, photophobia (sensitivity to light) and/or phonophobia (sensitivity to sound).

The complete cause of migraines is still not clearly understood. There does appear to be a genetically with migraine headaches

What is the Treatment of Migraine Headaches?

Generally headaches are treated initially with acetaminophen, aspirin, nonsteroidal anti-inflammatories and various combination products, which generally include accommodation of the previous medications sometimes with a caffeine product. Antinausea agents can also be used to treat the associated nausea and vomiting symptoms. Generally narcotic medications are not used in the treatment of headaches.

Education is also extremely important. Avoid triggers such as tobacco products, certain foods and drinks (red wine, chocolate) and medication overuse. Exercise can also be helpful.

Specific migraine treatments include ergot derivatives, various combination products (such as Midrin) and triptans (examples include Imitrex, Maxalt, etc.).

Preventative Therapy (prophylactic therapy) is also common to prevent the migraine headaches from occurring or decreasing the frequency and intensity of migraine headaches. Generally, preventative treatment is used if the headaches are more frequent than twice a week, there is significant interference with daily activities when the Headaches occur or treatment is not effective or cannot be tolerated due to side effects. Preventative medications include blood pressure, anti-seizure, or antidepressants medications.

What are Tension Headaches?

Tension Headaches are the most common form of Primary Headache. They are characterized by mild to moderate tightness or pressure around the head in a headband distribution, but also involving the upper back and neck. The headaches are usually on both sides of the head and usually lack a throbbing or pulsating component or significant nausea/vomiting or light or sound sensitivity.

What is the Treatment of Tension Headaches?

Treatment of Tension Headaches starts with relaxation training, cognitive behavior therapy, heat, massage, and ice. Medications for mild to moderate headaches include Tylenol and Aspirin. For more severe headaches Nonsteriodal anti-inflammatories (NSAIDs) or caffeine containing analgesics can be very helpful. Opioid medications are not generally recommended for treatment.

Preventative Therapy (Prophylactic Therapy), similar to Migraine headaches can be used. The most common class of medications includes antidepressants medication, muscle relaxers and intramuscular injections with Botox.

When are Headaches More Concerning?

When the following situations occur the headaches may be more concerning and may be a symptom of a more serious medical condition.

• Headaches which start after the age of 50
• Very intense or severe headache ("worst headache of your life") or progressively worsening headaches
• Headaches in individuals with cancer or AIDS
• A headache associated with a fever or rash
• A headache associated with other neurologic deficits

If these occur consult your physician for further evaluation.

Our Fellowship Trained and Board Certified Pain Management Physicians will guide you through the treatment of your neck pain. Our goal is to help you get your life back so you can enjoy life to the fullest.