Headaches can be classified as either primary or secondary headache disorders. Primary headache disorders are those which the cause of the headache is unknown and the headache is the condition and symptom that is treated. Secondary headaches refer to those conditions in which the headache is a symptom of an underlying condition, such as a tumor or bleeding.
Primary headache types include Tension-type headache, Migraine (with or without aura), and Cluster headaches. Cervicogenic headache will also be discussed briefly.
Tension Type Headaches
Tension type headaches are the most common, affecting upwards of 75% of all headache sufferers. As many as 90% of adults have experienced tension-type headache at some point in their life. The symptoms of a tension headache include a throbbing sensation that may affect one or both sides of the head. The frequency of tension headaches are quite variable and can even occur on a daily basis. Tension headaches can occur as a response to stressful event or lifestyle, although psychological stress has been somewhat overemphasized as a cause of headaches.
Treatment of Tension headaches should include development of stress-coping mechanisms, medication management which often involves acetaminophen and anti-inflammatory medications, and the occasional minimally invasive interventional procedures.
Migraine Headaches
Migraine headaches are less common than tension-type headaches. As many as 6% of all men and up to 18% of all women have experienced a migraine headache. The symptoms of a migraine headache can include a throbbing sensation that can be on one side of the head or both. Nausea, sensitivity to light and sound are common symptoms as well. The pain associated with migraine headaches can be debilitating. About 20% of migraine sufferers experience an aura that precedes the onset of the migraine headache. The aura is usually visual in nature and is described as bright blinking lights that move across the field of vision. Migraine headaches usually occur on an occasional basis (as often as once or twice per week).
Treatment of migraine headaches are usually aimed at the prevention as well as the treatment of the actual headaches. Many medication types are used as preventative measures including medications classically used to treat blood pressure, depression, and seizure disorders. Newer medications to address an existing migraine headache have been introduced over the past several years. These medications are commonly referred to as “tryptans”. Lifestyle changes including avoidance of migraine “triggers” is certainly as important as medication management. More recently, surgical procedures have been developed to address those migraine sufferers whose headaches are not responsive to traditional treatments. These procedures are offered at University Hospitals.
Cluster Headaches
Cluster headaches affect about 1% of the population. They are distinct from migraine and tension-type headaches in that males are mostly affected. These headaches occur in groups (or clusters) lasting up to one month. The pain from a cluster headache is usually centered around one eye which may become inflamed and watery. Nasal congestion is also common on the same side as the headache. The pain is usually severe and lasts one to two hours. Cluster headaches can be exacerbated by a smoking and alcohol intake.
Treatment of cluster headaches usually includes preventative and abortive types of medications. Oxygen administration during a headache may help to achieve relief as well. Injections of the sphenopalatine ganglion and peripheral nerve stimulation can be effective treatments in refractory cases.
Cervicogenic Headaches
Cervicogenic headache refers to a type of secondary headache where the underlying cause is dysfunction or irritation to nerves that supply the neck and back of the head travel. Cervicogenic headache manifests itself as neck and back-of-the-head pain that is aching and shooting in nature.
The treatment of these types of headaches is focused on the underlying cause, specifically the areas where the nerves are being irritated. Simple injections like trigger point injections, occipital nerve blocks or cervical facet blocks may produce profound pain relief. There are other interventional techniques that have been used with great success such as radiofrequency ablation and occipital nerve stimulation to produce long term relief.
Summary
As with many other medical conditions, when conservative treatments for headaches do not provide adequate relief, it is time for a medical evaluation. Primary care physicians, Neurologists, and Pain Specialists are usually the appropriate types of physicians to evaluate your headache. If you do experience a sudden onset of the “worst headache of your life” or have other symptoms such as loss of balance or consciousness, please go directly to an emergency room for evaluation.