Headaches and Migraines

More than 40% of people, at some point in their lives, will get headaches that are bad enough to see a healthcare provider. And if you’re one of them, you’ll quickly learn there’s a lot more to it than pain in your head, neck or behind your eyes.

With more than 150 kinds of headaches falling into two categories — primary and secondary — it can be tricky to figure out what’s going on.

Primary headaches

Primary headaches start because something isn’t working right in your head. Things like poor posture, alcohol, stress or even coughing or sneezing can also trigger them. Primary headaches aren’t related to another (underlying) health condition. When we talk about primary headaches, we mean ones like:

• Common tension-type headaches.
• Cluster headaches.
• Hemicrania continua.
• New daily persistent headaches (NDPH).
• Exertion headaches.
• Food-triggered headaches.
• Nicotine headaches.
• Hunger headaches.
• Primary cough headaches.

Most primary headaches aren’t dangerous. But the pain can interrupt your life, particularly if you get headaches regularly.

Secondary headaches

Secondary headaches are symptoms of another medical condition. Some aren’t typically dangerous if treated, like:

• Dehydration headaches.
• Medication overuse headaches.
• Sinus headaches.
• Cervicogenic headaches (neck problems that cause headaches).

There are also more serious secondary headaches that need care right away. Spinal headaches happen when spinal fluid leaks out of the membrane that protects your spinal cord. This often happens after a spinal tap.

Sudden, excruciating thunderclap headaches can come out of nowhere. They usually last at least five minutes. While some are harmless, others can be a sign of bleeding in the brain, another injury or a condition called reversible cerebral vasoconstriction syndrome.

Migraines

Migraines, which include a very distinct headache, are part of a common neurological condition. A throbbing headache on one side of your head is common.

But you can have other another symptom called a migraine aura. Auras act like a migraine warning system and often last between 10 minutes and an hour. You might see sparks or zigzags. You might feel dizzy or not be able to speak clearly. These symptoms happen before you have head pain. They’re red flags that a migraine is coming on.

A migraine attack can last for hours, or even days. And there’s more than one kind of migraine, like:

• Migraine with aura (complicated migraine).
• Migraine without aura (common migraine).
• Migraine without head pain (silent or acephalgic migraine).
• Hemiplegic migraine with temporary paralysis or sensory changes on one side of your body.
• Migraine with brainstem aura that causes vertigo, slurred speech, ringing in your ears (tinnitus) and loss of balance.
• Status migrainosus, which can last up to 72 hours (three days) and causes extreme pain and nausea.

Many people who get migraines have them regularly. If you have them at least 15 days a month, you have chronic migraines. And sometimes, if you use headache pain medications for more than 10 to 15 days each month, you might get headaches that happen more often (rebound headaches).

What to expect at your first visit

When you have painful headaches, you may not be sure what’s causing them. You may think you have a sinus headache, but it might be a migraine. Or you’re convinced it’s a migraine, but it’s really a tension headache.

That’s why it’s important to sit down with experienced healthcare providers who know how to find out what’s really going on. Your provider will kick off your first appointment by getting to know you and understanding your symptoms. They’ll want to know:

• How long have you had headaches?
• How often do you get headaches?
• How long do your headaches last?
• What kind of symptoms do you get with your headaches?
• Have you noticed certain things seem to trigger your headaches?
• Are you under a lot of stress?
• What are your sleep habits like?
• How are you treating your headaches at home?
• How do your headaches affect your life?
• Have you been diagnosed with other health conditions?
• What medications do you take?
• Does anyone else in your family have problems with headaches?

During your visit, your provider will do a physical exam. They’ll look for signs of other conditions like fever, infection, high blood pressure and fatigue. You may also have a neurological exam to check your muscle strength, balance and thinking abilities.

Your provider may order other tests to help find out what’s causing your headaches — and to rule out other conditions. You may have imaging tests like a CT scan or MRI to help our team see if there are any problems in your brain or nervous system. You may also have an electroencephalogram (EEG) to measure brain activity.

You might also be asked to keep a headache journal. You’ll use this diary to keep track of your headaches and symptoms. You’ll also list what you ate and did that day so our team can help you find possible triggers.

Meet Our Headache and Migraine Team

When you come to Cleveland Clinic, you’ll get a personalized care team of providers. These experts work together to figure out what kind of headaches you’re having and the best way to treat them. Your team could include:

• Neurologists.
• Radiologists.
• Pain management specialists.
• Psychiatrists.
• Psychologists.
• Physical therapists.

We build your treatment plan based on what kind of headaches you have and what triggers them. That’s why a headache journal is so important during diagnosis. It lets us personalize treatment to your needs. Not every headache requires medication. We’ll consider your headache type, how often you have headaches and what’s causing them.

Prevention and lifestyle changes

For primary headaches, we may try things like stress management, avoiding triggers and biofeedback. This therapy helps you learn to recognize the early signs of tension and respond better to stressful situations.

If you have migraines, we’ll learn what triggers your migraines. Preventing an attack by understanding triggers can help. We often try this before we start medication.

Avoiding heavily scented products or red wine. Adjusting your exercise routine. Getting more sleep. Not eating certain foods. All may keep that pounding headache or debilitating migraine attack at bay.

Applying heat or cold packs to your head and stretching or massaging your head, neck and back can help reduce pain from some types of headaches. So can resting in a dark, quiet place. And sometimes, even taking a walk can help.

Treating underlying medical conditions

For secondary headaches, your care team treats the medical condition that’s causing your pain. It could be high blood pressure or diabetes, dehydration or sinus problems. No matter the reason, your care plan will include focusing on treating the underlying condition.

Headache medications

For occasional tension headaches, we may recommend you take over-the-counter pain relievers. For really bad, frequent headaches or migraine attacks, our team may prescribe stronger headache medicines. We can recommend ones to help prevent episodes. Or ones that can help stop them when they start.

If you have secondary headaches, you may also need to take medications for underlying causes, like prescriptions for high blood pressure, seizures, diabetes or depression.

Infusions

You may receive intravenous (IV) infusions (through your vein) that deliver medication directly into the bloodstream — for faster relief. Infusions are often used for headaches that fail to respond to other treatments (refractory or intractable headaches).

Other treatments

Depending on the type of headache you have, you may be able to have pain-relieving treatments in your provider’s office. These include:

• Botox^® (botulinum toxin) injections.
• Occipital nerve blocks.
• Trigger point injections (TPI).
• Intranasal (through your nose) sphenopalatine ganglion (SPG) blocks.

Taking the Next Step

You don’t have to let headaches or migraines control your life. Even having one or more episodes each week is reason enough to reach out for help. Our providers will uncover what type of headache you have, pinpoint the triggers and guide you through different ways to prevent them. And when one does flare up, we’ll teach you how to stop it in its tracks