There are many different types and causes of headaches, such as migraine, tension-type, cluster, sinus, and hypnic headaches. Medication overuse can also lead to a headache when a person stops using pain relief or other drugs after using them for some time.
Headaches are a common complaint — the World Health Organization (WHO) estimates that almost half of all adults will have experienced at least one headache within the last year.
While they can sometimes be painful and debilitating, a person can treat most of them with simple pain relievers, and they will go away within several hours. However, repeated attacks or certain types of headaches could indicate a more serious health condition.
The International Classification of Headache Disorders defines more than 150 different types of headaches, which it divides into two main categories: primary and secondary.
A primary headache is not due to another condition — it is the condition itself. Examples include migraine and tension headaches. In contrast, a secondary headache has a separate underlying cause, such as a head injury or sudden caffeine withdrawal.
This article explores some of the most common types of headaches, along with their causes, treatment, prevention, and when to speak with a doctor.
A headache with migraine often involves intense throbbing pain on one side of the head.
A person may experience a heightened sensitivity to light, sound, and smell. Nausea and vomiting are also common.
Around 25% of people with migraine experience an aura before the headache starts. These are visual and sensory disturbances that typically last 5–60 minutes and include:
- seeing zig-zagging lines, flickering lights, or spots
- partial loss of vision
- numbness
- tingling
- muscle weakness
- difficulty speaking or finding words
Be aware that aura symptoms could also indicate stroke or meningitis. Anyone experiencing these for the first time should seek immediate medical attention.
Migraine headaches tend to be recurrent, and each attack can last from a few hours to several days. For many, it is a lifelong condition.
Health experts do not understand the causes of migraine fully. However, it often runs in families and is more common in people with certain preexisting conditions, such as depression and epilepsy.
Triggers of migraine could include:
- stress and anxiety
- sleep disruption
- hormonal changes
- skipping meals
- dehydration
- Some foods and medications
- bright lights and loud noise
Treatment
Treatment will depend on various factors, including how severe the symptoms are, how often they occur, and whether the person experiences nausea and vomiting.
Treatment options include:
- non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, aspirin, or acetaminophen
- triptans, such as sumatriptan, which need a prescription
- antiemetics, such as metoclopramide, to manage nausea and vomiting
Neurostimulation techniques, such as transcranial magnetic stimulation, may also help.
A person can also ease attacks by:
- resting in a dark, quiet place
- placing an ice pack or a cold cloth on the forehead
- drinking water
People with chronic migraines should speak with a doctor about preventive treatment. A healthcare professional may diagnose chronic migraine if a person has an episode on more than 15 days per month or if symptoms occur on at least 8 days a month for 3 months.
Drug options for migraine prevention include:
- topiramate (Topamax)
- propranolol
- amitriptyline
Other management choices to consider are dietary changes, stress management, and acupuncture.
Tension-type headaches affect most people at some time. They present as a dull, constant pain on both sides of the head. Other symptoms can include:
- tenderness of the face, head, neck, and shoulders
- a feeling of pressure behind the eyes
- sensitivity to light and sound
These headaches can last from 30 minutes to several hours.
What causes tension headaches is unclear, but stress, anxiety, and depression are common triggers. Other potential triggers include:
- dehydration
- loud noise
- lack of exercise
- insufficient quality sleep
- posture
- skipped meals
- eye strain
Treatment
Over-the-counter (OTC) painkillers, such as ibuprofen, acetaminophen, and aspirin, are usually very effective in stopping or reducing pain. Individuals experiencing headaches on more than 15 days per month over 90 days should consult a doctor.
Lifestyle changes and some treatments may help prevent tension headaches. These can include:
- getting enough sleep
- regular exercise and stretching
- improving sitting and standing posture
- having an eye test
- management of stress, anxiety, or depression
- acupuncture
Cluster headaches are severe and recurrent headaches. They are six times more likely to affect males than females. People describe an intense burning or piercing pain behind or around one eye.
Other symptoms can include:
- watering eyes
- swollen eyelid
- a blocked or a runny nose
- sensitivity to light and sound
- restlessness or agitation
Cluster headaches usually come on suddenly and without warning and last between 15 minutes and 3 hours. People can experience up to eight attacks a day.
These attacks tend to occur in daily clusters and can persist for weeks or months. They also tend to start at consistent times, often a couple of hours after falling asleep at night.
Any person experiencing these symptoms, which can sometimes resemble hay fever, should consult their doctor.
The cause of cluster headaches is unclear, but they are more likely to occur in smokers. People should avoid alcohol during attack periods.
Treatment
Treatment aims to reduce the severity and frequency of the attacks. Options include:
- oxygen therapy
- sumatriptan
- verapamil
- steroids
- melatonin
- lithium
Deep-brain stimulation and vagus nerve stimulation also show promise in treating cluster headaches that do not respond to medication.
Exertional headaches are due to strenuous physical exercise, with the following triggers:
- running
- jumping
- weight lifting
- sexual intercourse
- bouts of coughing or sneezing
These headaches are usually very short-lived but can sometimes last up to 2 days. They present as throbbing pain throughout the head and are more common in those with a family history of migraine.
Individuals experiencing cluster headaches for the first time should speak with a doctor, as they could be a sign of something serious.
Treatment
Treatment for exertional headaches includes using:
- OTC pain relief
- beta-blockers, such as propranolol
- indomethacin
Sometimes, exertional headaches may result from cardiovascular problems. If so, a doctor may recommend tests to check a person’s cardiovascular and cerebrovascular health.
A hypnic headache is a rare condition that usually begins when people are in their 50s, but it can start sooner. People also refer to them as “alarm clock” headaches, and they wake individuals during the night.
A hypnic headache consists of mild-to-moderate throbbing pain, usually on both sides of the head. It can last for up to 3 hours, while other symptoms may include nausea and sensitivity to light and sound.
People can experience several attacks each week. The cause of hypnic headaches is not clear, and there are no known triggers.
Although hypnic headaches are harmless, an older adult who experiences any unusual headaches for the first time should seek medical advice. A doctor may wish to rule out migraine and cluster headaches.
Treatment
Treatment options for hypnic headaches include:
- caffeine
- indomethacin
- lithium
6. Medication-overuse headache
A medication-overuse headache (MOH) — sometimes known as a rebound headache — is the most common type of secondary headache. A MOH features frequent or daily headaches with symptoms similar to those of tension headaches or migraines.
These headaches initially respond to painkillers but then reoccur sometime later.
A doctor may diagnose MOH if a person has a headache disorder and has also taken pain relief medication for at least 15 days a month.
Drugs that can cause MOH include:
- opioids
- acetaminophen
- triptans, such as sumatriptan
- NSAIDs, such as aspirin and ibuprofen
A MOH can still occur despite taking these medications. However, a MOH mainly seems to develop in people taking painkillers specifically to treat a headache.
Treatment
The only treatment for MOH is to stop taking the medication causing the headaches. However, anyone stopping medication should only do so under the supervision of a doctor. The doctor can help devise a plan and may prescribe alternative medicines to ease the withdrawal process.
After stopping the drug, a person is likely to experience:
- worsened headaches
- nausea and vomiting
- increased heart rate
- low blood pressure
- sleep disturbance
- restlessness, anxiety, and nervousness
A doctor may prescribe medication, such as antiemetics, to help relieve these symptoms to manage nausea and vomiting. The symptoms usually last for 2–10 days but can persist for up to 4 weeks.
A doctor will advise on suitable pain relief medication to use after resolving an MOH.
The following steps can help prevent MOH:
- avoiding the use of codeine and opioids
- limiting the use of pain relief medication for headaches
- using preventive medications for a chronic migraine
Sinus headaches occur with sinusitis — an inflammation of the sinuses. It usually results from an infection or an allergy.
The symptoms consist of a dull, throbbing ache around the eyes, cheeks, and forehead. The pain may worsen with movement or straining and can sometimes spread to the teeth and jaw.
Other possible symptoms include:
- facial pressure or pain
- reduced sense of smell
- nasal discharge
- a blocked nose
- fever
- fatigue
- ear pain
- bad breath
- cough
- dental pain
- a general feeling of being unwell
Sinus headaches are quite rare. If there are no nasal symptoms, a headache of this nature is more likely to be a migraine attack.
Treatment
Sinusitis usually goes away within 2–3 weeks.
Treatment options include:
- rest
- drinking fluids
- OTC pain relief
- nasal decongestants
- saltwater nasal sprays or solutions from the pharmacy
- antihistamines
- steroid nasal sprays, available on prescription
- antibiotics, if a doctor finds there is a bacterial infection
People should speak with a doctor if symptoms do not improve within a week or become severe.
To diagnose the underlying cause of sinusitis, a doctor may refer an individual to an ear, nose, and throat specialist. In some cases, minor surgery may be necessary to drain the sinuses.
Tips for preventing sinusitis include avoiding smoking and known triggers.
A high caffeine intake — more than 400 milligrams (mg), or around 4 cups of coffee per day — can sometimes lead to headaches.
In people consuming more than 200 mg of caffeine daily for over 2 weeks, withdrawal may result in migraine-like headaches. These typically develop 12–24 hours after stopping abruptly. They peak at 20–51 hours and can last 2–9 days.
Other possible symptoms include:
- tiredness
- difficulty concentrating
- reduced mood or irritability
- nausea
The effects of caffeine vary from person to person, but reducing intake could decrease the risk of getting headaches. Limiting caffeine consumption may help people who have chronic migraines.
Sometimes, a person develops a headache immediately or soon after a head injury.
OTC pain relief often resolves this. However, if symptoms are severe or get worse over time, an individual should seek immediate medical attention.
Always call an ambulance for a serious head injury or if the following symptoms occur after a head injury:
- unconsciousness
- seizures
- vomiting
- memory loss
- confusion
- vision or hearing problems
Post-traumatic headaches can also develop months after the original head injury, making them difficult to diagnose. They can sometimes occur daily and persist for up to 12 months.
Headaches are often due to changes in hormone levels. Migraine may occur around menstruation from changes in estrogen levels.
Hormone-related headaches often develop 2 days before or 3 days after a period or during ovulation. Symptoms are similar to migraine without aura, but they can last longer.
Hormone-related headaches can also result from:
- oral contraceptives
- menopause
- pregnancy
Treatment
Treatment for a menstrual headache is the same as the treatment for a migraine without aura. Doctors can advise about possible preventive measures, such as:
- hormonal therapy
- taking a triptan or NSAID around the periods
- alternative oral contraception plans, such as omitting the pill-free break
- hormone replacement therapy for those undergoing menopause
Consuming excessive alcohol can lead to a throbbing headache the following day or even later that day. These migraine-like headaches usually occur on both sides of the head and can worsen from movement.
Someone with a hangover headache may also experience nausea and sensitivity to light.
Treatment
There are no cures for hangovers, but it is possible to relieve symptoms by drinking plenty of water and eating sugary foods. OTC painkillers may help reduce or stop the headache.
Symptoms of hangovers tend to go away within 72 hours.
Ways of reducing the risk of a hangover include:
- drinking in moderation
- not drinking on an empty stomach
- drinking water between alcoholic beverages and before going to bed
Headaches are a common problem, but most people can manage them with OTC pain relief, such as acetaminophen.
However, anyone who experiences severe, persistent, recurrent, or worsening headaches should consult a doctor. An individual should seek immediate medical assistance if they have a headache:
- that starts suddenly and is extremely painful
- following a significant blow to the head
- with confusion or disturbed vision, balance, or speech
- with numbness or weakness
- with fever, seizures, or unconsciousness
- with a stiff neck or rash
- with persistent vomiting
Children who have recurring headaches should also speak with a doctor as soon as possible.
Headaches can affect many people. Often, taking OTC pain relief, such as NSAIDs, will resolve them. However, in some cases, headaches may indicate a medical issue.
Cluster, migraine, and medication-overuse headaches are all types of headaches that may benefit from medical help and possibly prescription medication.
Anyone with concerns about persistent headaches should seek medical advice, as they can sometimes indicate an underlying disorder.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens, and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888 or (516) 419-4480 for the Long Island office to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.
