Headaches

This is part two in a series on medical conditions treated by health psychologists.

There are several types of different headaches.  Tension-type, Migraine, and Cluster are the most common.

The International Headache Society describes tension-type headache as infrequent episodes of headache that last minutes to days. The pain is usually occurs on both sides of the head and has a pressing or tightening quality. Tension-type headache  usually does not worsen with physical activity. Nausea is usually not a symptom.   Sensitivity to light (photophobia) or sensitivity to sound (phonophobia) may be present.  Tension-type headaches are the most common type of headache and 30% to 78% of people may experience them in their lifetime.  Some people have frequent tension-type headaches causing them to become disabled.  Most people with this type of headache have the headache infrequently.  Infrequent tension-type headaches occur once a month or so and are mild to moderate in severity.


Migraine headaches are less common than tension-type headaches.  They effect 6% of men and 18% of women.  Most people who have migraines are women.  Most women start having migraines after they start menstruating.  Up to 10% of children can have migraines as well.  Migraine is described as a recurrent headache lasting 4-72 hours and often has unilateral pulsating or throbbing pain, moderate to severe intensity pain, nausea or photophobia. The pain of migraine can be made worse by routine physical activity.  Migraines are often preceded by neurological symptoms called an "aura" with changes in speech, movement, vision, sense of taste or smell.  The auras can change from one migraine attack to another.  The headaches last from 4 to 72 hours without treatment.


Cluster headaches occur in about 1% of the population and are distinct from migraine and tension-type headaches on several levels. Most of the cluster headache sufferers are men with onset between ages of 20-40.  Cluster headaches are characterized by severe, unilateral pain that is around the eye or along the side of the head.  The headaches last from 15 to 180 minutes and occur once every other day to up to 8 times daily.  Attacks are associated with eyes watering on the same side of the head that the pain is located. Patients may also experience nasal congestion, runny nose, forehead and facial sweating, dropping eyelids or eyelid swelling.  Pain from a cluster headache is usually severe and people may be restless or agitated due to the pain.  This type of headache may be hereditary.  Headaches may be provoked or triggered by alcohol, histimines, nitroglycerine, or other medications.  The headaches occur in clusters often daily or several times a day and then cease for weeks, months or years, between attacks.

Other causes of headaches are less common.

Medication overuse headache or rebound headache is often a daily chronic headache that occurs with medications used to treat headaches in about 1.4% of the population.  Ergot, triptan, opioid or butalbital analgesics and non-steroidal antiinflammatory agents (NSAIDS).


New daily persisting headache is a chronic daily headache that continues without remission for more than 3 months.  These headaches are usually evaluated by CT, MRI, or MRA scans.


Hemicrania Continua is a daily continuous headache that remits only with treatment by indomethicin.  There are eye symptoms with tearing and swelling and the nose may run or be congested.  It impacts one side of the face and head only.


Post-concussive headache follows head or head and neck injuries in conditions like whiplash and concussion.  These headaches start off severe and may involve sensitivity to light and sound, dizziness, loss of balance, nausea and vomiting.  Over time they remit.  The headaches can recur up to about 5 years post injury.  Headaches may last longer when there is a history of multiple concussions.


Dental problems like temporomandibular joint disease (TMJ) can cause headaches.  The headache pain in precipitated by jaw movements.  When the jaw disorder is treated the headaches remit within 3 months and does not recur.


Sexual headaches or orgasmic headaches occur with sexual activity or orgasm.  These headaches may be the result of vascular changes or hormonal changes or they may be benign headaches related to movement and stretching of muscles.  The headache pain can be severe and there is sensitivity to light and movement.  Because these types of headaches can be associated with problems with blood vessels or high blood pressure it's important to have them evaluated by a physician.


Thunder clap headaches are severe sudden excruciating painful headaches.  These start suddenly and represent a torn blood vessel.  These headaches represent medical emergencies and need to be evaluated in an emergency room.  People will describe these as feeling like they were kicked in the head.  They may have a stiff neck.  The headache peaks within 60 seconds it may improve over the next hour or may worsen with signs of loss of consciousness.  There may be nausea and vomiting.


Ice cream headaches also known as cold induced headaches are triggered by anything cold like ice cream in the back of the mouth or roof of the mouth.  The headache is intense and goes away as the cold sensation stops.


Hot dog headache is also known as nitrate headache.  It's cause by nitrates in foods like cured meats such as hot dogs.  Again as soon as the food is digested the headache stops.


Migraine equivalents are episodic pain conditions without headache pain.  This type of headache can feature neurological symptoms or non-neurological symptoms, such as abdominal pain, vertigo, even emotional outbursts, depression or panic. The word "equivalent" suggests that sufferers instead of a headache, are having some other equivalent troubling symptom. This condition is much more common in children and can resemble stroke-like symptoms which are a numbness or tingling on the arm - absent of any headache. Also younger children often complain of an upset stomach without any headache. This can often also be a migraine equivalent. Once the child has  thrown up, there is often an easing up and relief of the headache symptoms. This headache type is experienced in the stomach where there are a lot of receptor sites for the neurotransmitter serotonin.

 
Health and medical psychologists can help patients understand their type of headache.  Help them classify symptoms for diagnosis.  Help them manage medications.  Help them understand the distinctions between classes of medications.  Set up food lists to avoid triggers.  And help them with pain management techniques.

If you have a new type of headache or a severe headache you should seek medical advice.