What are Headaches

Headache is a common medical problem affecting nearly 50 million people in the U.S. It is a term for pain experienced in the head or upper neck area that can be acute, chronic, or episodic. Different types of headache can be attributed to different nerves in the head or the spine. Headaches can be the result of inflammation or injury to the nerves in question, or a side-effect of an even more serious condition. Newer theories may suggest that some headaches originate from damage to or disorders of the neck.

Headaches are a very common ailment. They are most often described as pain in the head or upper neck, and can be felt in specific areas of the head or face, or at the base of the skull. Headaches can be chronic, a constant source of pain and discomfort, or acute, with a sudden onset, causing sharp, stabbing pains. Some types of headache occur consistently at certain times of day (“episodic” headaches). It is estimated that 45 million people in the U.S. suffer from recurrent headaches. Acute headaches are classified as pain or discomfort experienced anywhere within the head or neck that has a very sudden onset, and rapidly gets worse afterwards

Many types of headache may feel as though they are coming from, or are driving deep into, the brain. However, the brain itself does not actually feel pain (i.e. it does not have the specific biological receptors for pain). Headaches are caused by an irritation (chemical or physical damage) of the many structures surrounding the brain, including the skull, muscles, nerves, arteries, veins, subcutaneous tissue, eyes, ears, sinuses, and mucous membranes. This is usually the result of inflammation, injury, or disease. Certain major nerves transmit this information, i.e. the fact that something is causing pain, back into the brain, which is the basis of this effect.
Headaches can be a source of distraction and irritability at best, and at worst a source of serious pain that can significantly impact normal daily life. Headaches do cause a significant cost to healthcare systems. They are also a leading reason for over-the-counter pain medication (i.e. mild analgesics such as pseudoephedrine and acetaminophen) consumption. Chronic or episodic headache is often resistant to this method of treatment, however. Headaches can cause a significant decrease in concentration, cognition, and the capacity to function normally.

Classification of Headaches

Some common types of headaches are considered separate conditions in their own right. They are referred to as primary headaches if there is no underlying condition or illness causing them.

Migraine Headaches

Migrain Headache DiagramMigraine headaches are common. They are considered the most common of all primary (i.e. arising from a singular condition or explanation) headaches by researchers. The number of new cases per year is reported to be as high as 12% of the U.S. population. Women are three times more likely to experience migraine pain across the course of their lifetime than men. Some experience chronic migraine pain associated with their menstrual cycle. Migraine headaches are considered a recurrent, episodic disorder and are typically characterized by intense episodes of severe, throbbing pain within the head.  Migraines are usually felt just behind or above one eye. Over time, the pain may spread to other areas of the face, especially if left untreated. They may also be accompanied by sensitivity to light, sound, or odors, as well as nausea or vomiting.
Migraine symptoms can last from several hours to several days. Furthermore, some have described the symptoms associated with migraines as progressing through four separate stages:
  1. The prodromal phase, occurring up to 24 hours prior to the onset of acute migraine pain. During this phase, individuals may notice a change in energy levels or mood, irritability, excessive thirst, unusual food cravings, frequent yawning, feelings of drowsiness, and frequent urges to use the restroom.
  2. The aura phase, in which many individuals will experience neurological symptoms, or an aura, which are linked to an imminent migraine episode. These symptoms typically occur twenty minutes to an hour before the pain of the migraine begins. Not all migraine sufferers report auras prior to the onset of a migraine episode.
  3. The attack phase is the point at which individuals may experience intense and severe symptoms as described above, possibly accompanied by light-headedness and even fainting. Without treatment, this phase typically lasts four to 72 hours.
  4. The postdrome phase occurs after the migraine episode has passed. Individuals in this phase report feeling fatigued and drained. Some individuals have reported mild feelings of euphoria. While most episodes of migraine pain are not related to a more serious disease or illness it is important that you monitor your symptoms closely, especially in cases of sudden exacerbation or increased intensity of pain.

Cluster-Type Headaches

HeadacheCluster headaches are typically experienced as severe, migraine-like pain over an eye and/or the temple, again often on just one side of the head. This type of headache frequently occurs at night and is reported to frequently wake the individual up from sleep. The pain may last between thirty minutes and two hours. They can also be characterized as a succession of headaches, occurring as often as eight times in one day. This type of headache can be accompanied by light sensitivity, watering of the eyes, and nasal congestion.
Cluster headaches are most common in men of between 20 and 40 years of age. They are thought to affect 0.01% of the world’s population. Based on patient reports, they are regarded as the worst pain a human can experience.

Tension-Type Headaches

Tension-type headaches are experienced in the forehead or the back of the head. They usually follow a regular pattern, so that they may regularly begin in the late afternoon, remit by evening, and can occur every day. Tension headaches can also be chronic, i.e. experienced chronically for most of the day or even several days on end.
Patients often describe tension-type headaches as extreme pressure around the forehead or head. They can also be associated with throbbing, stabbing, or grinding pain in the facial muscles. Sufferers may also experience light and sound sensitivities. Episodic tension headaches can last from half an hour to several days. They occur for up to fifteen days a month. More frequent pain episodes are termed chronic tension-type headaches.
Tension headaches are the most common type of headache, affecting approximately 3% of the total population. They may be milder than other types, such as migraines, but they can be disruptive and distressing nonetheless. They are associated with a loss of concentration, irritability, and increased sensitivity to external stimuli, which can act as triggers of tension headaches.

Secondary Headaches

A secondary headache can take the form of any of the headache types described above, but as a symptom of an underlying condition or a side-effect of a medical treatment. Secondary headaches can be caused by conditions such as arthritis and fibromyalgia. Generally, the source of secondary headache pain is not serious or life threatening. In fact, patients who have had a headache in the past and who do not also meet any of the following criteria are considered at a low risk for a serious underlying problem. It is important to monitor symptoms closely however, and to make an appointment with your physician’s office to rule out any more severe conditions. However, if you experience symptoms such as very unusual headache pain or a much more severe headache than usual, for example, this may be a cause for concern.
If the headache is accompanied by a heretofore-unexperienced aura (described as visual disturbances such as metallic lines within one’s field of vision, or unusual sensory, motor, or speech disturbances), it may be a sign of a serious underlying condition. If it is triggered by coughing, exertion, or while engaged in sexual intercourse, this may indicate a vascular condition such as an embolism or stroke. Pain along with a change in personality or mental status, or with loss of consciousness, should also be taken seriously. A headache also accompanied by stiffness in the neck, a fever, or rash may be a symptom of meningitis. A headache accompanied by tenderness in or around the temples is also a sign of possible serious illness, such as an aneurysm. If alarming symptoms occur, please consider seeking immediate medical attention. It may be a false alarm, but it is better to be safe than sorry.

Causes of Headaches

Headache pain is transmitted by nerves in the membranes inside the skull, or major nerves radiating out of the brain. These nerves may have incurred injuries or damage from inflammation or irritation. This is mostly linked to headaches that are chronic or recurrent. Headaches are divided into primary and secondary categories. Secondary headaches result from damage to nerves or other tissues anywhere in the body as a result of another condition or illness, whereas primary headaches are a condition caused by direct damage to the nerves in the brain or skull. Some headaches arise for no diagnosable reason at all, however. These are called idiopathic headaches.
Headaches centered at the base of the skull or top of the neck can be traced to the occipital nerve. Migraine headaches can be attributed to a number of important nerves in a network called the trigemino-cervical complex. Other migraine symptoms, such as photophobia (aversion to light), sonophobia (aversion to sound), and extreme episodic pain can originate from this complex. Episodic migraines are associated with damage to the trigeminal nerve, a major nerve in the brain. Some cluster headaches can also be traced to this nerve, though they are thought to result from a different mechanism of damage to that associated with migraines. Other cluster headaches can also be attributed to a group of nerve endings in the skull called the sphenopalatine ganglion (SPG). Some headaches in or around the nasal area (often called sinus headaches) can also be traced to the SPG.
Tension headaches are associated with physiological factors such as eyestrain, stress, anxiety, and hunger. They are also known to be a side-effect of sleep deprivation. Tension headaches are also associated with jaw problems, such as teeth grinding or clenching. Unlike migraine and other types of pain, tension headaches are not (currently) strongly associated with one specific major nerve group. It is associated more with extreme muscle strain in the jaws or temples, transmitted to the brain by a variety of nerves in the skull or brain. These include the SPG, occipital, and trigeminal nerves.

Treatment for Headaches

Nerve blocks, if successful, are also effective medium-term treatments for headaches. Occipital, trigeminal, and SPG blocks are often indicated for cluster and chronic migraine headaches. They can achieve pain relief lasting from weeks to months between treatments. Trigemino-cervical blocks are applied to the upper neck. SPG blocks must be applied by inserting a thin needle into the nasal or oral passages, and onward into its location in the skull. The anesthetic will then be injected through this needle.

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Acute headaches are sudden onset headaches in which pain is located anywhere in the head and neck, and severity worsens rapidly. There are two types of headaches: primary and secondary. Primary headaches result from a disturbance in the pain-sensing tissue within the head and neck. Secondary headaches are associated with other medical conditions within the body. A number of treatment options are available and are determined based on the specific characteristics of the headache. It is recommended that you speak with your physician to develop an appropriate course of treatment.

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