Headache

Types of Headache

The International Headache Society classifies 67 different types of headache into 13 categories. More broadly, headaches are classified in terms of primary and secondary causes, as well as cranial neuralgias, facial pain, and other causes.

Primary headaches are headaches that occur with no underlying medical cause. The most common are:

• Tension headache

• Migraine

• Cluster headache

• Medication overuse headache (formerly called rebound headache)

• Post-traumatic headache

• Chronic paroxysmal hemicrania

Secondary headaches are headaches caused by other factors. Some causes are trauma, stroke, brain tumors, and infection.

Cranial Neuralgias, facial pain, and other types of headache can be caused by a variety of things. Cranial neuralgias occur when nerves in the head and upper neck become inflamed, leading to headache. Facial pain can have many origins. Other causes of headache are those that do not fall under any other classifications, such as caffeine withdrawal headache, headache associated with exercising, and so-called “ice cream” headaches, which are caused by eating something very cold.

Types of Primary Headache

Tension Headache

Tension headaches are the most common form of headache. They may be episodic – meaning they occur occasionally and are generally relieved by over-the-counter (OTC) analgesics (pain relievers) such as acetaminophen (Tylenol), ibuprofen (Motrin or Advil), or naproxyn (Aleve). Or they may be chronic. Chronic tension headaches are tension-type headaches that occur almost every day, sometimes for months at a time, and are generally not relieved by OTC analgesics. These headaches vary in severity, from mild to moderate, and they can last for hours, days, or even longer.

Tension headaches are generally felt in the forehead, temples or the back of your head and neck. They are generally not associated with any significant changes on exertion. Often, only certain positions seem to provide relief.

Symptoms of tension-type headache include:

• Dull, continuous pain

• Soreness in the temples

• A tight “band-like” sensation around the head (some people describe this as a “vice-like” ache)

• Sensations of pressure

• Contracting head and neck muscles (some physicians refer to tension-type headaches as “muscle contraction” headaches).

• Tightness in the neck.

Tension headaches are thought to occur when muscles in the head and neck tighten, stimulating pain receptors in the blood vessels of the scalp. The underlying cause of tension headache—the reason for muscle tension—is often hard to pinpoint. However, tension headaches are often associated with one or more of the following:

• Physical stress. Standing or sitting with poor posture (or in an unnatural position) can cause tension in the muscles of the neck. Uncomfortable noise or light can also lead to muscle tension, as can abnormalities (such as misalignment) in the structures (muscles, bones, discs) of the face and neck.

• Emotional stress. Problems at work or lack of work, financial worries, noisy neighbors, and domestic unhappiness are just a few causes of stress that can result in tension headache.

• Depression Feelings of sadness, hopelessness, pessimism, and a general loss of interest in life are all parts of the emotional state known as depression. Depression is an important but often overlooked cause of headache.

Migraine

To read more about Migraine go to Migraine

Cluster Headache

Cluster headache is so named because attacks occur in groups. Characterized by severe, sharp, penetrating pain that begins with little or no warning, these headaches typically last for 30 to 45 minutes and recur up to 10 times per day. They are often accompanied by a stuffy or runny nose and tearing of the eye on the side of the head affected by the pain. Cluster headaches occur five times more commonly in men than women.

Cluster headaches most often strike in the morning or late at night, and can continue for months. The pain can disappear for weeks—or even months or years—at a time. In some sufferers, however, the attacks are not clustered and occur continuously. This debilitating headache type is not a symptom of any serious disease but does require expert medical treatment.

Unfortunately, cluster headache can be extremely difficult to treat. The pain is both unexpected and short-lived, so it typically resolves by the time medication has been absorbed. It is sometimes treated with a variety of combination painkillers, steroids, ergotamine compounds and, more recently, sumatriptan, a medication developed for migraine relief. Medications are often administered through the nose or injected, so they work more quickly. Oxygen, used at home with a portable cylinder and mask, may also be used to treat cluster headache. If all other treatments fail in relieving cluster headache, surgical procedures such as the destruction of the active nerve endings may be effective.

Medication Overuse Headache (Previously Called Rebound Headache)

Medication overuse headache, previously called rebound headache, is another common—though often unrecognized—type of headache. Medication overuse headache occurs with long-term use of prescription and/or over-the-counter.

People who experience frequent headaches or other chronic pain may take more than the recommended dose of a medication or take it more frequently than directed. They may even take these medications preemptively, to “ward off” a potential headache.

When medications are overused in this way, the body develops a tolerance to these drugs. Eventually, the person may become dependent on them. At the point of drug dependence, not only is more of the drug required to achieve the desired effect (pain relief), but the body actually “asks” for the drug by signaling “pain.” Eventually, the drug is no longer effective in controlling pain, but the body still requires it.

Symptoms of medication overuse headache include pain that:

• Occurs in headache sufferers who take pain relievers very frequently (more than two days per week), often in excessive amounts

• Occurs daily or nearly daily.

• Varies in severity, type and location

• Is accompanied by fatigue, nausea, stomach distress, restlessness, anxiety, irritability, memory problems, difficulty in intellectual concentration, and/or depression

• Tends to occur in the early morning hours, between 2 and 5 a.m.

• Worsens over time, so larger and more frequent doses of drugs are needed

• Occurs when medication is discontinued abruptly

This tolerance and dependency can develop with any pain reliever, and caffeine can make it worse. Treatment consists of discontinuing use of the medication. However, that may be difficult to do.

Those dependent on over-the-counter drugs may be able to gradually stop using the drugs by themselves, but withdrawal symptoms may interfere. A physician can design a program to help the patient through this period.

Post-Traumatic Headache

This chronic headache condition is caused by an injury to the head or neck that affects the nerves. The description of the pain varies, but it is often felt at the back of the head and can be present daily. In some cases, these headaches may take on the characteristics of migraine.

Chronic Paroxysmal Hemicrania

Chronic paroxysmal hemicrania is a rare type of headache that bears similarities to cluster headaches. Once reported mainly in women (at a ratio of 7:1), more recent studies show that men and women may be affected about equally. Pain occurs in one side of the head, on or around the eye and is often severe and debilitating. Some patients have described the pain as throbbing or claw-like.

Individual attacks may last from 2 minutes to an hour. People with chronic paroxysmal hemicrania typically experience 10 to 20 attacks per day, although some people have reported experiencing as many as 45 attacks in one day.

Like cluster headaches, the attacks of chronic paroxysmal hemicrania are associated with red and tearing eyes and nasal congestion or runny nose, which is generally more severe on the affected side. The pain always occurs on the same side.

This type of headache responds to the prescription pain reliever indomethacin (Indocin) and occasionally to calcium channel blockers, a type of drug that causes a widening of the blood vessels. Oxygen is ineffective.

Secondary Headaches

Secondary headaches are symptoms of some other medical condition. The most common causes of secondary headaches are:

• Stroke Stroke occurs when blood flow to the brain is suddenly interrupted, causing massive damage or death of cells in a particular area of the brain. During a stroke, a sudden, severe headache may occur.

• Subarachnoid Hemorrhage: A subarachnoid hemorrhage occurs when an artery ruptures and blood leaks into the fluid surrounding the brain, called the subarachnoid space .

Subarachnoid hemorrhages usually occur when a distended and weakened segment of artery, known as an aneurysm, gives way. Trauma, such hitting the head during a fall from a bicycle, can also cause subarachnoid hemorrhage. Although this type of bleeding can lead to stroke (i.e. brain cell death), the two are not the same.

The sudden rupture of the artery causes intense, severe pain. People who have experienced it have likened it to having been hit across the back of the head with a hammer. The bleeding often leads to changes in consciousness ranging from confusion, disorientation, or belligerence to coma. Weakness on one side of the body is also common.

Subarachnoid hemorrhage is a life-threatening medical emergency. Anyone who experiences a sudden onset of intense, severe head pain should seek emergency medical care immediately. Call 9-1-1 in the United States.

• Brain Tumors. Commonly, people who suffer with severe headaches fear that they have a brain tumor. In most cases, their fears are unfounded. Less than five percent of headaches are caused by brain tumors. It is true, however, that headache is one of the most common symptoms of a brain tumor.

• Infection Headache often accompanies the flu or other causes of fever. The pain does not indicate that the brain is infected; infection in any part of the body can cause a fever and headache.

• Meningitis is an infection of the meninges (tissues that cover the brain and spinal cord). This potentially fatal infection can be caused by a number of common bacteria. Viral meningitis is much less dangerous and can resolve without treatment. Meningitis is most common in children, but it can occur in adults as well.

• Temporal Arteritis. Temporal Arteritis is an inflammation of the temporal arteries, the medium-size arteries located above and in front of the ears on both sides of the head. One of the most common symptoms of temporal arteritis is headache. Changes in vision are also commonly reported. Temporal arteritis affects one to five out of 10,000 people over 50 in the United States and occurs four to six times more frequently in women than men.

Symptoms of temporal arteritis include:

• A headache with pain centered on one temple, though it can be more diffuse

• Swelling and warmth in the temporal artery

• Tenderness of the scalp over the artery

• Double vision, blurred vision, large blind spots, blindness of one eye or other changes in vision

• Pain upon chewing as the vessels that supply blood to the muscles of the jaw become compressed by the inflammation

• In extreme cases, the temporal artery may be visible as a knobby, hard structure running over the surface of the skull

Temporal arteritis is typically treated with corticosteroids.

Cranial Neuralgias, Facial Pain, and other Types of Headaches

The International Headache Society established a third category of headache in 2005, cranial neuralgias, facial pain, and other types of headache.

Cranial neuralgia or facial pain occur when nerves in the head and neck become irritated or inflamed. Twelve nerves, called cranial nerves, supply the brain with information about the face, upper neck, and head. These nerves also control motion of the face, allowing us to smile, frown, chew, talk, and more.

Underlying causes of cranial neuralgia and facial pain vary widely and include physical and emotional stress, tumors, meningitis, Herpes zoster infections,

Treatment of cranial neuralgia may involve removing the source of the pressure or treating underlying illness. Most of the time, however, treatment is focused on relieving symptoms.

• People who experience spastic pain resembling tic douloureux may benefit from anti-seizure medications.

• People for whom the pain is resembles facial pain may find relief from tricyclic antidepressants and a phenothiazine.

• The physician may perform a procedure called a nerve block, in which she injects a pain-numbing medication into a specific cranial nerve. This helps the doctor determine which nerve is affected and may provide pain relief even after the medication wears off.

Common cranial neuralgias and facial pain include:

• Trigeminal neuralgia. This type of headache is characterized by brief episodes of stabbing pain, often starting in the chin or cheek. It occurs when the fifth cranial nerve, called the trigeminal nerve, becomes irritated or inflamed. The trigeminal nerve controls muscles involved in chewing and conducts sensory impulses to the face, mouth, and sinuses.

• Occipital neuralgia. Pain behind the eye occurs when the second cranial nerve, the occipital nerve, becomes irritated or inflamed. This headache is characterized by a continuous throbbing ache, with occasional shock-like jabs of pain. Pressure can make the pain worse. Physical and emotional tension can trigger an attack.

• Glossopharyngeal neuralgia. Short, sharp spasms of pain in the back of the nose, throat, tongue, or behind the jaw or lower ear suggest glossopharyngeal neuralgia. This type of headache occurs when the ninth cranial nerve, the glossopharyngeal nerve, becomes irritated or inflamed. , Chewing, swallowing, talking, coughing, or yawning can trigger a pain spasm.

• Exertional headache. Also known as a “sports headache,” exertional headache occurs in some people when they exercise. It is most likely caused by dilation of vessels as the blood pressure increases. In most people, the headache is harmless and can often be prevented by taking an over-the-counter pain reliever about an hour or so before exercising.

• Idiopathic stabbing headache. This type of headache occurs more commonly in people who get migraines. These headaches begin without warning and consist of brief, sharp, stabbing, ice-pick like pains in various parts of the head. They are believed to be due to discharges in the sensitive occipital nerve. Although these headaches can be frightening, they are benign.

• “Ice cream” headache. This type of headache occurs briefly in the forehead or temples and is caused by eating ice cream or other cold food too quickly. The headache is caused by a sudden stimulus of cold going over the gullet, which in turn stimulates the glossopharyngeal nerve.

To read more about determining the cause of a headache, go to Finding the cause of your headache.