Definition
There are four types of headaches: vascular, muscle contraction (tension), traction, and inflammatory.
- The most common type of vascular headache is a migraine. Migraine headaches are usually characterized by severe pain on one or both sides of the head, an upset stomach, and, at times, disturbed vision.
- After migraine, the most common type of vascular headache is the toxic headache produced by fever.
- Other kinds of vascular headaches include “cluster” headaches, which cause repeated episodes of intense pain, and headaches resulting from high blood pressure.
- Muscle contraction headaches appear to involve the tightening or tensing of facial and neck muscles.
- Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection.
Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by inflammation, including those related to meningitis as well as those resulting from diseases of the sinuses, spine, neck, ears, and teeth.
Causes
Tension headaches are one of the most common forms of headaches. They may occur at any age, but are most common in adults and adolescents. If a headache occurs two or more times a week for several months or longer, the condition is considered chronic. Chronic daily headaches can result from the under- or over-treatment of a primary headache. For example, patients who take pain medication more than 3 days a week on a regular basis can develop rebound headaches.
Tension headaches can occur when the patient also has a migraine. A migraine is caused by abnormal brain activity, which is triggered by stress, certain foods, environmental factors, or something else. However, the exact chain of events remains unclear. Today, most medical experts believe the attack begins in the brain, and involves various nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues.
Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Such activities include typing or other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache.
Other triggers of tension headaches include:
- Alcohol use
- Caffeine (too much or withdrawal)
- Colds and the flu
- Dental problems such as jaw clenching or teeth grinding
- Eye strain
- Excessive smoking
- Fatigue
- Nasal congestion
- Overexertion
- Sinus infection
Symptoms
The pain symptoms of headaches and migraines are:
- The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure.
- Often is described as pressure encircling the head with the most intense pressure over the eyebrows.
- The pain usually is mild (not disabling) and bilateral (affecting both sides of the head).
- The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to light and sound.
- The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people.
- The pain allows most people to function normally, despite the headache.
Exams and Tests
A headache that is mild to moderate, not accompanied by other symptoms, and responds to home treatment within a few hours may not need further examination or testing, especially if it has occurred in the past. A tension headache reveals no abnormal findings on a neurological exam. However, tender points (trigger points) in the muscles are often seen in the neck and shoulder areas.
The health care provider should be consulted — to rule out other disorders that can cause headaches — if the headache is severe, persistent (does not go away), or if other symptoms are present with the headache.
Headaches that disturb sleep, occur whenever you are active, or that are recurrent or chronic may require examination and treatment by a health care provider.
Treatments
Understanding your headache triggers can help you avoid situations that cause your headaches. A headache diary can help you identify