Headache Care

Healing Headaches: A look at the types, triggers and treatments
By Anurag Bansal and Kathleen Hanley

Virtually every one of us experiences them with varying frequency and severity over the course of our lives. Whether it’s a dull throbbing, a piercing pain or a nauseating head pounder, headaches are a universal phenomenon that can strike suddenly and fiercely in many different forms. There are many different types of headaches, each with its own triggers, symptoms and treatments. So when it comes to managing and preventing headaches, it’s important to consult your primary care doctor – who may refer you to a neurology headache expert – to identify the right course of therapy.

Here’s a look at the four leading types of headaches:

Tension Headaches. These are the most common form of headache, occurring with some regularity, though usually not with chronic frequency, in about three of every four adults. Typical tension headaches produce a dull, mild to moderate squeezing pain on both sides of the head. Some describe it as a vice-like grip. Tension headaches are triggered by fatigue, emotional stress or problems involving the muscles or joints of the neck or jaw. Most last for 30 minutes to a few hours but some can last for days. Unlike migraines, they are not aggravated by routine physical activity like walking or climbing stairs.  Over-the-counter pain relievers like aspirin, acetaminophen, ibuprofen and naproxen are usually the first line of treatment.  However, these medications should be used cautiously to avoid rebound and medication-overuse headaches. Preventive treatment is recommended if headaches increase in frequency or duration.  Massage, physical therapy and acupuncture may provide relief.

Migraine Headaches. Though not as common as tension headaches, migraines are a highly prevalent neurological disease affecting 39 million men, women and children in the U.S.  Nearly a quarter of households include someone who experiences migraines. Pain is usually restricted to one side of the head and worsens over time. Pain behind the eyes and in the back of the head is also common. Many experience sensitivity to light and noise, nausea and vomiting. Some migraines are preceded by a visual aura that may include flashes of light or blurred vision. Migraines can last from a few hours to a few days, once or twice a year in some and up to several times a month in others. There are multiple triggers, including stress, changes in or an irregular sleep schedule, hormonal changes, caffeine and alcohol, changes in weather, diet, dehydration, light, smell and medication overuse. Treatments include both pharmacologic and non-pharmacologic options, including preventive and rescue medications, physical therapy, osteopathy, acupuncture, lidocaine and Botox injections.  

Sinus Headaches. If you feel pressure and pain in the face and forehead, particularly behind the eyes or either side of the nose, it’s possible you’re experiencing a sinus headache. They most often are a symptom of sinusitis, an inflammation caused by infection or seasonal allergies. If you have a runny or congested nose, watery eyes and a headache, you may need a decongestant or allergy medicine to relieve the underlying sinus pressure. Antibiotics also may be prescribed to treat the root infection.

Cluster Headaches. A far less common type of headache, these usually occur around the eye and can cause severe pain very quickly. Sufferers typically experience them in periodic clusters, with one to eight headaches a day during a one- to three-month time frame, relatively short-lived, followed by a remission that can last for several months or years. They are the only type of headache more common in men than women. Unlike migraine and tension headache, cluster headache patients are restless and may pace about or sit and rock back and forth.  The goal of treatments, which include prescription drugs and oxygen therapy, is to decrease severity, shorten duration and prevent recurrence.

Anurag Bansal is an Adult Nurse Practitioner and Kathleen Hanley is a Family Nurse Practitioner, both specializing in headache management in the Neurology Department of Berkshire Medical Center.