Headache causes, symptoms, diagnosis & treatments

What are headaches?

A headache is pain in any part of your head. Just about everyone has had a headache, but the types, causes and symptoms of headaches vary widely. They can happen to one or both sides of your head, be in one location, radiate across your head from one point, or have a viselike quality. The level of pain can vary from mild to a sharp throbbing sensation, and last for less than an hour to several days. Some headaches develop slowly; others can quickly feel like a knife has been thrust into your brain. While most headaches go away on their own, some signal a serious health condition. Always take seriously any new headache or severe headache that lasts more than two weeks. It may be a warning sign of a serious health problem.

What are the different types of headaches?

Of the more than 150 types of headaches, the most common types include:

Tension headaches are the most common type and cause mild to moderate pain. They come and go as stress and tension build and then dissipate.
Migraines cause pounding throbbing pain, and can last from four hours to three days, and occur one to four times a month. Other symptoms are sensitivity to light, sound or smells; nausea or vomiting; loss of appetite; and stomach pain.
Cluster headaches are the most severe, causing intense piercing or burning pain around one eye that can be constant or throbbing. On the affected side, the eyelid droops, the eye reddens and the pupil gets smaller. Tears may form, and the nostril either runs with clear discharge or is stuffy. Patients often pace during a cluster headache due to the pain. Lasting 15 minutes to three hours, cluster headaches occur during cluster periods lasting two weeks to three months. During the cluster period, there may be two or three headaches a day. Men are more likely to have cluster headaches than women.
Sinus headaches cause a deep and constant pain across the cheekbones, forehead or bridge of the nose. Caused by inflamed sinuses or a sinus infection, they often include a fever, swollen face, fullness in the ears, and a runny nose with yellow or green nasal discharge.
Posttraumatic headaches result from a head injury and may not start until two or three days after the injury. They can last for months. Symptoms include dull ache, vertigo, lightheadedness, irritability, tiring quickly, trouble concentrating and memory problems.
Chronic daily headaches can be caused by migraines, tension headaches, or hemicrania continua. They’re considered chronic if they occur 15 or more times a month for longer than three months.

Less common headaches include:

Exercise headaches occur when you’re active. The muscles in your head, scalp and neck need more blood and blood vessels swell to supply it. The pulsing pain can last from five minutes to 48 hours. It can also happen after sex or other intensive activity.
Hemicrania continua is a chronic headache that always affects one side of your face and head, and worsens when drinking alcohol or exercising. Other symptoms include red teary eyes, drooping eyelid, smaller pupils, runny or stuffy nose, and changes in pain intensity. Some people also have nausea and vomiting, and sensitivity to light or sound. These headaches can occur daily, lasting for about six months, stop for several weeks or months and then recur.
Hormone headaches are the result of changing hormones during menstrual periods, pregnancy, or menopause. Birth control pills and hormone replacement therapy can also cause them.
Daily persistent headaches can happen for three months or more, causing moderate to severe pain. Other symptoms are similar to a tension or migraine headache. They usually start suddenly and the cause is unknown, making them hard to treat. In some people they’re linked to an infection, flu, surgery or stressful event.
Rebound headaches, also called medication overuse headaches, cause a dull, constant head pain that’s often worse in the morning. Using prescription or over-the-counter pain relievers more than two or three times a week, or more than 10 days a month, can cause more pain when the medication wears off.

Headaches that are rarer include:

“Ice pick” headaches are short but intense headaches that usually last a few seconds. The stabbing pain can happen a few times a day. See your doctor because they can be a symptom of another condition that needs medical attention.
Spinal headaches can occur after a spinal tap, spinal block or an epidural shot for pain. A spinal or puncture headache can result If spinal fluid leaks through the puncture site.
“Thunderclap” headache happens suddenly, peaks quickly, and people say it’s the worst headache of their life. It can be caused by a blood vessel tear, rupture or blockage; head injury; stroke; narrowed blood vessels that surround the brain; inflamed blood vessels; or blood pressure changes in late pregnancy.

What causes headaches

Headache pain can come from mixed signals between your brain, blood vessels, and nerves. Although it’s not known why, certain nerves in blood vessels and muscles in your head start sending pain signals to your brain. The most common causes of headaches are illness, head injury, stress, or family history of a specific type of headaches such as migraines.

Headaches can have primary or secondary causes.

Primary headaches include cluster headaches, migraines, and tension headaches. They are caused by overactivity or problems with pain-sensitive structures in your head. They can be caused by chemical activity in the brain, the nerves or blood vessels surrounding the skull, muscles in the head and neck, or a combination of any of these.

They can also be triggered by:

Drinking alcohol, especially red wine
Eating processed meats that contain nitrates or MSG
Stress or anxiety
Poor lifestyle choices such as skipping meals or insufficient sleep
Poor posture
Rapid weather changes
Strong smells from chemicals, perfumes or certain foods

Some primary headaches have specific features such as pain associated with a certain activity, such as coughing or exercise. These headaches can also be a symptom of an underlying disease.

A secondary headache can be a symptom of a disease, condition or situation that activates the pain-sensitive nerves in the head. A great many conditions can cause secondary headaches, and they vary widely in severity. Secondary headaches can be caused by:

Nasal or sinus infection (sinusitis)
COVID-19 infection
Middle ear infection
Toxoplasmosis (infection caused by a parasite)
Flu and fever-causing illnesses
Brain tumor
Stroke
Carbon monoxide poisoning
Concussion and long-term post-concussion symptoms
High blood pressure (hypertension)
Hypertension inside the skull
Swelling of a blood vessel in the brain (aneurysm)
Glaucoma
Panic attacks, panic disorder
Artery tear
Malformation of an artery or vein
Structural problem at the base of the skull
Inflammation in the brain (encephalitis)
Inflammation of the lining of arteries (arteritis)
Inflammation of the lining of the brain and spinal cord (meningitis)
Irritation of nerves that connect the face and brain (trigeminal neuralgia)
Hematoma (swelling containing clotted blood) inside the skull
Medications including overuse of pain medications
Monosodium glutamate (MSG)
Dental problems
Pressure from tight headgear like a helmet or goggles
Dehydration
Alcohol hangover
“Brain freeze” from ingesting cold foods like ice cream

What are the symptoms of headaches?

Headache pain can vary from mild to severe. A very painful headache or frequent headaches can be a symptom of a stroke, meningitis, encephalitis or other serious condition or disease.

If you have the worst headache of your life, or a sudden and severe headache, go to an emergency room or call 9-1-1. Seek immediate medical attention If you develop a headache that also causes:

Confusion or trouble understanding speech
Fainting
High fever, greater than 102 F to 104 F
Numbness, weakness or paralysis on one side of your body
Stiff neck
Trouble seeing or speaking
Trouble walking
Nausea or vomiting that are not related to the flu or a hangover

See your doctor if you have headaches that:

Occur more often than usual
Are more severe than usual
Worsen or don't improve with appropriate use of over-the-counter drugs
Keep you from working, sleeping or participating in normal activities

How are headaches diagnosed?

It’s important to be able to tell your doctor what causes your headaches, how they feel, how long they last, and what makes them better. If your doctor has a clear understanding of all your symptoms, he or she can better pinpoint the cause and develop a treatment plan to help you stay headache free.

Your doctor will do a physical exam and may recommend:

CT scan or MRI to look for possible causes inside your brain
A blood test that can detect inflammation, (erythrocyte sedimentation rate or ESR)
Digital subtraction angiography, which uses X-ray with a contrast dye to view the blood vessels in the brain
Spinal tap to look for bleeding in the brain, or an infection

Your doctor may suggest a headache specialist if treatment recommendations don’t provide relief.

What are the treatment options for headaches?

Treatment will depend on the type of headache you have, how often you get headaches, and the cause. Your treatment plan may include medications, counseling, learning to manage stress, or biofeedback. Modifying your lifestyle can help you eliminate headache triggers.

Once you start treatment, track how well it’s working. You and your doctor may have to try several treatments before finding what works best for you. During treatment, remember to stay away from the events or substances that have triggered headaches in the past.

Mayo Clinic. (June 2020). Headache. Retrieved 11-29-21, {https://www.mayoclinic.org/symptoms/headache/basics/definition/sym-20050800}

WebMD. (Sept. 2020). Headache Basics. Retrieved 11-30-21, {https://www.webmd.com/migraines-headaches/migraines-headaches-basics}

Cleveland Clinic. (N.d.) Headaches. Retrieved 12-1-21, {https://my.clevelandclinic.org/health/diseases/9639-headaches}

Stanford Health Care. (N.d.). Diagnosing Headaches. Retrieved 12-1-21, {https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/headache/diagnosis.html}

Medically reviewed by:

Dr. Desiree Levyim

Dr. Desiree Levyim is a board eligible neurologist in practice since 2020. She joins TeleMed2U in our mission to provide increased access to healthcare.

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References

Mayo Clinic. (June 2020). Headache. Retrieved 11-29-21, {https://www.mayoclinic.org/symptoms/headache/basics/definition/sym-20050800}

WebMD. (Sept. 2020). Headache Basics. Retrieved 11-30-21, {https://www.webmd.com/migraines-headaches/migraines-headaches-basics}

Cleveland Clinic. (N.d.) Headaches. Retrieved 12-1-21, {https://my.clevelandclinic.org/health/diseases/9639-headaches}

Stanford Health Care. (N.d.). Diagnosing Headaches. Retrieved 12-1-21, {https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/headache/diagnosis.html}

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