Know Your Headache Type

Fri, 4 Nov. 2011 - 9:02 p.m. MT
Credit: ARA Staff - American Running Association

Headaches affect 90 to 95% of us at least once a year, with women generally at the upper part of that range and men at the lower end. It helps to classify them into discernable groups, with the caveat that increasingly physicians are choosing to identify hybrid types known as “mixed” headaches, with characteristics of both migraine and tension headaches that defy easy grouping. In general, though, understanding the basic, common types of headache and who gets them, when, and why can help you figure out what to do—either without worry, or when (rarely) you might need to in fact see a doctor.

Headaches from Illness or Medication
Not included in the basic, common types of headache, for purposes of this article, are those headaches caused by food allergy, illness, or adverse reaction to medication. These are really symptoms of another health problem, worth touching upon separately and briefly now. Many non-life-threatening medical conditions, such as a head cold, the flu, or a sinus infection, can cause headache. Some less common but serious causes include bleeding, infection, or a tumor. A headache can also be the only warning signal of high blood pressure (hypertension). In addition, certain medications—nitroglycerin, prescribed for a heart condition; estrogen, prescribed for menopausal symptoms—are notorious causes of headache.
Because the following symptoms could indicate a significant medical problem, seek medical care promptly if you experience:
a sudden headache that feels like a blow to the head (with or without a stiff neck)
headache with fever
persistent headache following a blow to the head
confusion or loss of consciousness
headache along with pain in the eye or ear
relentless headache when you were previously headache-free
headache that interferes with routine activities
Likewise, always take children who have recurring headaches to the doctor, especially when the pain occurs at night or is present when the child wakes in the morning.
Three Common Headache Types
The three common types of headache are tension, sinus, and migraine. Though these have different root causes, experts now see an advantage to viewing headaches more or less along a continuum. The more intense a tension headache gets, the more it resembles the sharp, throbbing pain of a migraine headache. Likewise, when a migraine headache becomes more frequent, its pain begins to feel like that of a tension headache.
The continuum is ordered by headache characteristics. The occasional tension headache is at one end and the migraine headache is at the other. In between are chronic tension headache and chronic migraine, which are often lumped together as chronic daily headache.
As noted, this doesn’t mean that all headaches share the same mechanisms. Experts still generally believe that tension headaches are stimulated by muscle tightness, while migraine headaches are caused by the dilation and inflammation of blood vessels. However, if you have migraine headaches frequently, you may develop muscle tightness, which can trigger more headaches, creating a vicious cycle.
Headaches are often caused by psychological stressors: stress itself, fatigue, or lack of sleep. They can also be caused by hunger, caffeine withdrawal, and changes in estrogen level or weather.
Feels like
Who gets it
How often and for how long
Mild to moderate steady pain throughout the head, but commonly felt across the forehead or in the back of the head. Generally not accompanied by other symptoms.
Can affect children, but is most common in adults.
Frequency varies. Generally hours in length.
Mild to moderate steady pain that typically occurs in the face, at the bridge of the nose, or in the cheeks. May be accompanied by nasal congestion and postnasal drip.
Affects people of all ages. People with allergies seem most vulnerable.
Frequency varies. Generally hours in length. Often seasonal.
Moderate to severe throbbing pain, often accompanied by nausea and sensitivity to light and sound. The pain may be localized to the temple, eye, or back of the head, often on one side only. In migraine with aura, visual disturbance precedes the pain.
Typically occurs from childhood to middle age. In children, migraine is slightly more common among males, but after puberty, it’s much more common in females.
Attacks last a day or longer. They tend to occur less often during pregnancy and with advancing age.
Headache Treatment Options
If you find yourself coping with three or more headaches a week, there are steps you can take to resolve the issue. In addition to o.t.c pain medication, there are many newer meds that may be effective, including gabapentin, topiramate, amitriptyline, and tizanidine. All of them have a good chance of causing drowsiness, and are many suited for people with chronic daily tension headache or some other debilitating form. The drowsiness may subside with time. There are steroid injection or Botox for more extreme cases of chronic headache. You might try seeing a physiatrist. These are physicians who specialize in diagnosing and treating pain. A neurologist may also be able to help.
Stay physically active and keep a food diary, both to help you make healthier choices and to identify possible dietary triggers. Myotherapy, a kind of deep-tissue massage, can be very helpful if your headache is induced by tight back, neck, or shoulder muscles. Get a consistent eight hours of sleep per night and avoid alcohol. Try for at least 30 minutes of aerobic activity every day, and don’t forget to stretch!
Find the right doctor for you, even if it takes a few tries. One chronic daily headache sufferer recommends finding something to keep you occupied on bad days. “I turned to podcasts and books on tape I could listen to while I lay in bed,” she writes in Harvard’s online publication Health Beat. “I also got a tai chi DVD, so that I could move around a little when I got sick of lying down.”
Health Beat, January 2011, “What Type of Headache Do You Have?",

(RUNNING & FITNEWS® January / February 2011 • Volume 29, Number 1)

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