Overview

What are the types of headache?

The most common types of headache aremigraines  and tension headaches. Other types of headaches include cluster and rebound headaches.

What are tension headaches?

Most people describe a tension headache as a constant, dull, achy feeling on both sides of the head, or like a band around the head. Some people who have tension headaches also have a tight feeling in their jaw or neck muscles. Tension headaches usually begin slowly and gradually. They often start in the middle of the day.Another name for this type of headache is “stress headache.” When people say they have a stress headache, they usually mean they have a tension headache. Tension headaches may be mild or severe.

What is a cluster headache?

A cluster headache is a rare type of headache. Cluster headaches typically occur once or more daily at the same times each day for up to 12 weeks, until the “cluster period” is over.Cluster headaches are more common in men and usually start very suddenly. The pain is usually located behind or around one eye and is very severe. The eye and nose on the same side as the pain may become red, swollen and runny. Cluster headaches also cause restlessness. These headaches can be frightening for the sufferer and the people around him or her.A cluster headache can last a few minutes or several hours, but it usually lasts for 45 to 90 minutes. The most common times for cluster headaches seem to be between 1:00 a.m. and 2:00 a.m., 1:00 p.m. and 3:00 p.m. and around 9:00 p.m. Cluster periods usually last 4 to 8 weeks and may occur seasonally, such as in spring or fall. Then, no cluster headaches will occur for weeks, months or even years.

What are rebound headaches?

Also known as medication-overuse headache, rebound headaches happen every day or almost every day. They may be caused by using too much pain medicine. Rebound headaches usually begin early in the morning. The pain can be different each day. People who have rebound headaches also may have nausea, anxiety, irritability, depression or problems sleeping.

Causes & Risk Factors

What causes tension headaches?

Tension headaches may be caused by the following:

• Stress
• Certain foods and beverages
• Sleep problems
• Sinus and allergy problems
• Muscle tension, which can be caused by jaw clenching and poor posture
• Depression
• Anxiety
• Hormonal changes in women
• Certain medicines

What causes cluster headaches?

Cluster headaches do not appear to be related to other illnesses or to diseases of the brain. Some of the triggers of cluster headaches include:

• Taking certain medications (such as nitroglycerin)
• Heavy smoking
• Drinking alcohol
• An interruption in your normal sleep pattern
• Abnormal levels of certain hormones
• Problems with the hypothalamus, which controls your body’s “biological clock”

What causes rebound headache?

Prescription and over-the-counter medicine for migraines (such as aspirin and acetaminophen) can cause rebound headaches if you take them too often. If you get rebound headaches, these medicines should not be taken more than 2 days per week. Sedatives, tranquilizers and ergotamine medicines also can cause rebound headaches. Talk with your doctor to find out if you should stop taking these medicines or should take less of them.

Diagnosis & Tests

How are headaches diagnosed?

Your doctor often can tell what kind of headache you have by examining you and hearing your description of the pain. Your description of your headaches will help your doctor make the diagnosis. The time and pattern of attacks are important, so keep a diary of your pain. A headache diary can help you and your doctor know exactly when you are getting headaches, what might be triggering them, and what helps relieve the pain.

Family members or others who see you during a headache can also help by telling the doctor how you look and act. Don’t be embarrassed to tell your doctor about your attempts to relieve the pain (such as banging your head against furniture). These attempts are common, and talking about them will help your doctor judge how severe the headaches are.

Blood tests, X-rays or brain scans–such as computed tomography (CT) or magnetic resonance imaging (MRI)–usually are not needed to diagnose headaches.

Treatment

How are headaches treated?

The most common treatments for headaches are rest and over-the-counter pain relievers. These include aspirin, acetaminophen (one brand name: Tylenol), ibuprofen (one brand name: Motrin) and naproxen (one brand name: Aleve).

When choosing an over-the-counter pain reliever, check the label for possible side effects or interactions with other medicines you are taking. Always read and follow the directions on the label carefully. If you have any questions, ask your doctor or pharmacist. Keep in mind that children should not take aspirin. Aspirin can cause a serious illness called Reye’s syndrome in children younger than 18 years of age.

It’s best to treat headaches when they begin and are still mild–before they get more painful. If these common treatments don’t work, talk to your family doctor. He or she can prescribe medicine that might help relieve your headaches.

What types of prescription medicine are used to treat headaches?

There are several prescription medicines that can be used to prevent headaches. They have to be taken every day. These medicines include the following:

These medicines can help you get fewer headaches. They will not stop every headache. It can take 6 weeks or more for the medicine to start working. Talk to your doctor about whether one of these medicines is right for you. It is important to follow your doctor’s instructions when you take these medicines. Always carry your medicine with you in case you get a headache.

• Tricyclic antidepressants, such as amitriptyline, and nortriptyline
• Antiepileptic drugs, such as valproic acid, gabapentin and topiramate
• Beta blockers, such as propranolol

What else can I do to help my headaches?

Besides taking medicine, following a regular daily routine can also help. For instance, eat meals at regular hours. Other things you can do to ease the pain of a headache include the following:

• Put a heat pack or an ice pack on your head or neck.
• Take a hot shower. Go to bed and get up at the same time every day.
• Get enough rest or sleep.
• Take time away from things that are stressful. This could mean doing anything from taking a brief walk to taking a vacation.
• Do not skip breakfast. Fasting is a common cause of headache.
• Get regular exercise of all types. Work up to exercising for 30 to 60 minutes, 4 to 6 times a week. Yoga, meditation and relaxation therapy can also relieve headaches.

What about alternative therapies and herbal health products?

Some patients try alternative therapies (such as acupuncture or chiropractic treatments) for headache relief. If you are considering an alternative therapy, talk to your doctor about the potential risks and benefits of these treatments. If you are considering taking an herbal health product for headache relief, keep in mind that these products aren’t tested to be sure they’re safe. You should check with your doctor before taking any herbal health product, especially if you take any prescription medicines.

What is mind-body therapy?

Mind-body therapy focuses on the connections between your mind, body and behaviors. Problems with any one of these things can affect your health. Examples of mind-body therapy are meditation, muscle relaxation, hypnosis, biofeedback and a type of counseling called cognitive (say: kog-na-tiv) behavior therapy. Biofeedback is a technique where you use your thoughts to control your body. Biofeedback can help you treat physical and mental health problems. Cognitive behavior therapy is also called talk therapy. This kind of therapy helps you identify negative thoughts so you can stop them before they cause problems. Cognitive behavior therapy is often used to treat low self-esteem and depression, but it can also help ease stress in general.

Does mind-body therapy really work?

Yes. Studies show that mind-body therapy works just as well as medicine for certain kinds of headaches.

How can I learn to do mind-body therapies?

You can do certain types of mind-body therapy yourself:

You might need help from a professional for other types of mind-body therapy, such as hypnosis and biofeedback. Talk to your doctor if you want to try mind-body therapy. He or she can recommend someone who specializes in this kind of therapy. Your doctor can also offer suggestions to help you cope with stress.

• Meditateby taking a few deep breaths, closing your eyes and focusing on your breath or a positive thought.
• Relaxyour muscles by applying either heat or cold to the tense area. If heat works for you, try taking a hot shower or bath. Or try a heating pad (set on a low setting) or a hot water bottle. If cold works for you, try a cold pack wrapped in a thin towel (to protect your skin).
• Massageyour temples and the muscles in your neck and shoulders. Massages can also help relax muscles.

What treatments are available for cluster headaches?

Several treatments are available for cluster headaches. It is important to work with your doctor to pick the right treatment for you, talk about side effects of different medicines and set up a schedule for taking the medicines your doctor prescribes. At the start of a cluster headache, inhaling pure oxygen through a mask can help prevent the attack. Because the headaches come on so quickly however, this is not always practical. Your doctor will probably prescribe 2 medicines. One medicine is taken regularly during the entire cluster period to reduce the number of headaches. In order for the medicine to work, the level of the drug in your blood must be high at the time your attacks usually start. Preventive medicines work well to reduce the number of headaches during cluster periods. The second medicine is taken to relieve the pain as a cluster headache occurs. These medicines can greatly shorten the headache and reduce its severity. Attacks begin too quickly for you to reach medical help. You must be ready to take this medicine as soon as an attack begins. You may want to teach family members about your headaches and medicines so that they will be able to help you when you have an attack. Medicines taken by mouth work too slowly to give relief for cluster headaches. For this reason, your doctor may prescribe a medicine that is taken by nasal spray, by injection (a “shot”) or taken as a rectal suppository. Another treatment that works for some people is using a local anesthetic (numbing medicine) in the nose.

Although cluster headaches are very painful, with the right treatment most people cope very well. It is important that you work with your doctor to find the right treatment for you.

Questions to Ask Your Doctor

• What can I do to prevent headaches? Can exercise or other lifestyle habits help?
• What type of headaches do I get, and what causes them?
• What are the differences between tension, cluster, rebound and migraine headaches?
• What types of medicines are used to treat headaches? Can I take something to prevent them from occurring?
• What should I be recording in my headache journal?
• Can medicines or herbal supplements cause headaches? Are there herbal supplements that can help a headache?

Citations

• Mind-Body Therapies for Headache by Victor Sierpina, M.D., John Astin, PhD, James Giordano, PhD ( 11/15/07,http://www.aafp.org/afp/20071115/1518.html  )
• The Patient with Daily Headaches by M Maizels ( 12/15/04,http://www.aafp.org/afp/2004/1215/p2299.html  l)

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.