Multidisciplinary team takes new approach to headaches.

How common are headaches in adults?

According to the National Headache Foundation, more than 45 million Americans suffer from chronic (long-term), recurring (repeating) headaches; of these, 28 million suffer from migraines. About 20 percent of children and adolescents also have significant headaches. About 70% of headache sufferers are women.

Headaches are the most common cause of absenteeism from work and school. Migraine sufferers lose more than 157 million work and school days every year because of headache pain.

What are the types of headaches?

A comprehensive headache classification guide was established by the International Headache Society and includes more than 150 headache categories.

Based on research, a practical headache classification includes primary and secondary headaches.

Primary headaches

Primary headaches are those that are not the result of another medical condition. The category includes tension-type, migraine, and cluster headaches.

  • Tension-type headaches: The most common type of headache. Tension-type headaches tend to be mild to moderate, non-throbbing, and bilateral (on both sides of the head). They usually do not get worse during routine activities (bending over, walking stairs, etc.) Because tension-type headaches tend to be mild, patients usually treat them successfully with over-the-counter medications. Patients should be aware that using over-the-counter medications too often can lead to chronic (long-term) daily headache.
  • Migraines: the second most common type of primary headaches. The exact cause of migraines is unknown, although they are caused by changes in the nerves and blood vessels. Migraines are also related to changes in the brain and inherited abnormalities in certain areas of the brain. Migraine pain is moderate to severe, often described as pounding or throbbing. Migraines can last from 4 hours to 3 days and usually occur 1 to 4 times per month. Migraine symptoms include sensitivity to light, noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain.
  • Cluster headaches: the least common, but most severe, type of primary headache. The pain of a cluster headache is intense and has a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term "cluster headache" refers to headaches that come in a group, or cluster. Cluster headaches occur one to three times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to recur.
  • New daily persistent headaches (NDPH): A form of primary headache; in other words, a headache that is not associated with a physical disease. An NDPH starts abruptly as a headache that is new to the patient. The patient should be able to pinpoint the brief (72 hour) period of time when the headache appeared. While these headaches may not be related to other diseases, they tend to be constant or persistent, bilateral (located on both sides of the head), and don’t respond to many medications.

Secondary headaches

Secondary headaches, or those that result from another medical or neurological condition, include sinus headaches, medication overuse headaches, or headaches that occur because of a head injury, trauma, or more serious condition such as a tumor.

  • Sinus headaches: headaches associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually gets worse with sudden head movement or straining and occurs with other acute sinus symptoms, such as nasal discharge, foul taste in the mouth, feeling of fullness in the ears, fever, facial swelling, and pain over the involved sinus.
  • Medication overuse headaches: headaches that occur as a result of the overuse of either readily available over-the-counter analgesics or prescribed painkillers such as opiates and sedative hypnotic tablets designed for headache management (butalbital-containing headache remedies). This is the most common type of chronic headache seen in specialty headache centers and is referred to as a “transformed” headache. Tension-type or migraine headaches that are intermittent can transform into a chronic headache from the inappropriate “overuse” of medications. These headaches can also happen without the overuse of analgesics. It is felt that worldwide, 4% of the population has chronic daily headaches of some sort, and a good percentage of this population includes medication overuse headaches.

Are headaches hereditary?

Yes, headaches, especially migraines, have a tendency to run in families. Children who have migraines usually have at least one parent who also suffers from the condition. Headaches also can be triggered by certain environmental factors that are shared in a family’s household, such as:

  • second-hand tobacco smoke
  • strong odors from household chemicals or perfumes
  • exposure to certain allergens
  • eating certain foods.

Stress, pollution, noise, lighting, and weather changes are other environmental factors that can trigger headaches for some people.

People with migraines may inherit abnormalities in certain areas of the brain, as well as the tendency to be affected by certain migraine triggers, such as fatigue, bright lights, weather changes, and others.

What causes headaches?

Headache pain results from signals interacting among the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels are activated and send pain signals to the brain. It’s not clear, however, why these signals are activated in the first place.

There is a migraine “pain center,” or generator, in the mid-brain area. A migraine begins when overactive nerve cells send out impulses to the blood vessels. This causes the release of prostaglandins, serotonin, and other substances that cause swelling of the blood vessels in the vicinity of the nerve endings, resulting in pain.

Headaches that occur suddenly (acute onset) are usually caused by an illness, infection, cold, or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat), or otitis (ear infection or inflammation).

In some cases, the headaches may be the result of a blow to the head (trauma) or, rarely, a sign of a more serious medical condition.

Common triggers of tension-type headaches or migraine headaches include:

  • emotional stress related to family and friends, work, or school
  • alcohol use
  • skipping meals
  • changes in sleep patterns
  • excessive medication use
  • tension
  • depression

Other causes of headaches include eye strain and neck or back strain caused by poor posture.

When headaches become progressive and occur along with other neurological symptoms, they can be the sign of a disease process in the brain, such as:

  • hydrocephalus (abnormal buildup of fluid in the brain)
  • meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
  • encephalitis (infection/inflammation of the brain)
  • hemorrhage (bleeding within the brain)
  • tumor
  • blood clots along the surface of the brain
  • head trauma
  • abscess
  • toxins (overexposure to chemicals, including certain medications)

How are headaches evaluated and diagnosed?

The good news for headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started.If you have headache symptoms, the first step is to go to your family physician. He or she will perform a complete physical examination and a headache evaluation. During the headache evaluation, the doctor will consider your headache history and the description of the headaches. You will be asked to describe your headache symptoms and characteristics as completely as possible.

A headache evaluation may include a CT scan or MRI if the doctor thinks there might be a problem with the central nervous system. Both of these tests produce cross-sectional images of the brain that can reveal abnormal areas or problems. Skull x-rays are not helpful. An EEG (electroencephalogram) is also unnecessary unless you have ever passed out during a headache.

If your headache symptoms become worse or become more frequent despite treatment, ask your family physician for a referral to a specialist. Your family physician should be able to provide the names of headache specialists.

How are headaches treated?

Your family physician may recommend different types of treatment, or may recommend further testing or refer you to a headache specialist. You should establish a reasonable time frame with your family physician to evaluate your headache symptoms.

The proper treatment will depend on several factors, including the type and frequency of the headache and its cause. Not all headaches require medical attention. Treatment may include education, counseling, stress management, biofeedback, and medications. The treatment prescribed for you will be tailored to meet your specific needs.

  • Headache education includes identifying and recording what triggers your headache, such as lack of sleep, not eating at regular times, eating certain foods or additives, caffeine, environment, or stress. Avoiding headache triggers is an important step in successfully treating the headaches.
  • Counseling in the form of one-on-one sessions, group therapy, or support groups can help you identify your headache triggers and teach you useful coping techniques.
  • Stress management: To successfully treat headaches, it is important for you to identify what causes or triggers the headaches. Then you can learn ways to cope or remove the stressful activities or events. Relaxation techniques are helpful in managing stress and include deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, or relaxation to music. Ask your health care provider for more information about these techniques.
  • Biofeedback: Biofeedback equipment includes sensors connected to your body to examine your involuntary physical responses to headaches, such as breathing, pulse, heart rate, temperature, muscle tension, and brain activity. By learning to recognize these physical reactions and how the body responds in stressful situations, biofeedback can help you learn how to release and control tension that causes headaches.
  • Medications: There are three types of headache medications, including symptomatic relief, abortive, and preventive medications.

What happens after I start treatment?

When your doctor starts a treatment program, keep track of the results and how the treatment program is working. Keep your scheduled follow-up appointments so that your doctor can check your progress and make changes in the treatment program as needed. Keeping a headache diary can be extremely helpful to measure progress, or the lack of progress.


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