Headaches can be more complicated than most people realize. Different kinds can have their own set of symptoms, happen for unique reasons, and need different kinds of treatment.
Once you know the type of headache you have, you and your doctor can find the treatment that’s most likely to help and even try to prevent them.
What Are the Types of Headaches?
There are 150 different types of headaches. The most common ones are:
Tension headaches: Also called stress headaches, chronic daily headaches, or chronic non-progressive headaches, they are the most common type among adults and teens. They cause mild to moderate pain and come and go over time.
Migraines: These headaches are often described as pounding, throbbing pain. They can last from 4 hours to 3 days and usually happen one to four times per month. Along with the pain, people have other symptoms, such as sensitivity to light, noise, or smells; nausea or vomiting; loss of appetite; and upset stomach or belly pain. When a child has a migraine, she often looks pale, feels dizzy, and has blurry vision, fever, and an upset stomach.
Mixed headache syndrome: Also called transformed migraines, this condition is a mix of migraine and tension headaches. Both adults and children can have it.
Cluster headaches: This type is intense and feels like a burning or piercing pain behind the eyes, either throbbing or constant. It’s the least common but the most severe type of headache. The pain can be so bad that most people with cluster headaches can’t sit still and will often pace during an attack.
They’re called “cluster headaches” because they tend to happen in groups. You might get them one to three times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to come back again.
Sinus headaches: With these, you feel a deep and constant pain in your cheekbones, forehead, or bridge of your nose. They happen when cavities in your head, called sinuses, get inflamed. The pain usually comes along with other sinus symptoms, such as a runny nose, feeling of fullness in the ears, fever, and swelling in your face.
Acute headaches: Kids get these headaches that start suddenly and go away after a short time. If there are no symptoms of other nerve problems, the most common cause is a respiratory or sinus infection.
Hormone headaches: Women can get headaches from changing hormone levels during their periods, pregnancy, and menopause. The hormone changes from birth control pills also trigger headaches in some women.
Chronic progressive headaches: Also called traction or inflammatory headaches, these get worse and happen more often over time. They make up less than 5% of all headaches in adults and less than 2% of all headaches in kids. They may be the result of an illness or disorder of the brain or skull.
What Causes Headaches?
The pain you feel during a headache comes from a mix of signals between your brain, blood vessels, and nearby nerves. Specific nerves of the blood vessels and head muscles switch on and send pain signals to your brain. But it's not clear why these signals turn on in the first place.
People often get headaches because of:
Illness: such as an infection, cold, or fever. They’re also common with conditions like sinusitis (inflammation of the sinuses), a throat infection, or an ear infection. In some cases, the headaches may be the result of a blow to the head or rarely, a sign of a more serious medical problem.
Stress: Common causes of tension headaches include emotional stress and depression as well as alcohol use, skipping meals, changes in sleep patterns, and taking too much medication. Other causes include eyestrain and neck or back strain due to poor posture.
Your environment, including secondhand tobacco smoke, strong smells from household chemicals or perfumes, allergens, and certain foods. Stress, pollution, noise, lighting, and weather changes are other possible triggers.
Headaches, especially migraines, tend to run in families. Most children and teens (90%) who have migraines have other family members who get them. When both parents have a history of migraines, there is a 70% chance that their child will also have them. If only one parent has a history of these headaches, the risk drops to 25%-50%.
Doctors don’t know exactly what causes migraines. A popular theory is that triggers cause unusual brain activity, which causes changes in the blood vessels there. Some forms of migraines are linked to genetic problems in certain parts of the brain.
Too much physical activity can also trigger a migraine in adults and children.
Getting a Diagnosis
Once you get your headaches diagnosed correctly, you can start the right treatment plan for your symptoms.
The first step is to talk to your doctor about your headaches. She’ll give you a physical exam and ask you about the symptoms you have and how often they happen. It’s important to be as complete as possible with these descriptions. Give your doctor a list of things that cause your headaches, make them worse, and what helps you feel better. You can track details in a headache diary to help your doctor diagnose your problem.
Most people don’t need special diagnostic tests. But sometimes, doctors suggest a CT scan or MRI to look for problems inside your brain that might cause your headaches. Skull X-rays are not helpful. An EEG (electroencephalogram) is also unnecessary unless you have passed out when you had a headache.
If your headache symptoms get worse or happen more often despite treatment, ask your doctor to refer you to a headache specialist. If you need more information, contact one of the organizations in the resource list for a list of member doctors in your state.
How Are Headaches Treated?
Your doctor may recommend different types of treatment to try. She also might recommend more testing or refer you to a headache specialist.
The treatment you need will depend on a lot of things, including the type of headache you get, how often, and its cause. Some people don’t need medical help at all. But those who do might get medications, counseling, stress management, and biofeedback. Your doctor will make a treatment plan to meet your specific needs.
What Happens After I Start Treatment?
Once you start a treatment program, keep track of how well it’s working. A headache diary can help you note any patterns or changes in how you feel. Know that it may take some time for you and your doctor to find the best treatment plan, so try to be patient. Be honest with her about what is and isn’t working for you.
Even though you’re getting treatment, you should still steer clear of the things you know can trigger your problem, like foods or smells. And it’s important to stick to healthy habits that will keep you feeling good, like regular exercise, enough sleep, and a healthy diet. Also, make your scheduled follow-up appointments so your doctor can see how you’re doing and make changes in the treatment program if you need them.