Headache definition and facts

Headache definition and facts

• The head is one of the most common sites of pain in the body.
• Headache or head pain sometimes can be difficult to describe, but some common symptoms include throbbing, squeezing, constant, unrelenting, or intermittent. The location may be in one part of the face or skull, or may be generalized involving the whole head.
• Headache may arise spontaneously or may be associated with activity or exercise. It may have an acute onset or it may be chronic in nature with or without episodes of increasing severity.
• Headache is often associated with nausea and vomiting. This is especially true with migraine headaches.
• Head pain can be classified as being one of three types: 1) primary headache, 2) secondary headache, and 3) cranial neuralgias, facial pain, and other headaches.

• Common primary headaches include tension, migraine, and cluster headaches.
• Home remedies for tension headaches, the most common type of primary headache, include rest and over-the-counter (OTC) medications for pain.
• Secondary headaches are usually a symptom of an injury or an underlying illness. For example, sinus headaches are considered a secondary headache due to increased pressure or infection in the sinuses.
• Medication overuse headache (rebound headache) is a condition where frequent use of pain medications can lead to persistent head pain. The headache may improve for a short time after medication is taken and then recur (The term "rebound headache" has been replaced by the term "medication overuse headache")
• Individuals. should seek medical care for new onset headaches or if headaches are associated with fever, stiff neck, weakness, change in sensation on one side of the body, change in vision, vomiting or change in behavior that may be caused by the development of serious infections.

What is a headache?

Headache is defined as a pain arising from the head or upper neck of the body. The pain originates from the tissues and structures that surround the skull or the brain because the brain itself has no nerves that give rise to the sensation of pain (pain fibers). The thin layer of tissue (periosteum) that surrounds bones, muscles that encase the skull, sinuses, eyes, and ears, as well as thin tissues that cover the surface of the brain and spinal cord (meninges), arteries, veins, and nerves, all can become inflamed or irritated and cause headache. The pain may be a dull ache, sharp, throbbing, constant, intermittent, mild, or intense.

How are headaches classified?

In 2013, the International Headache Society released its latest classification system for headache. Because so many people suffer from headaches, and because treatment is difficult sometimes, it was hoped that the new classification system would help health-care professionals make a more specific diagnosis as to the type of headache a patient has, and allow better and more effective options for treatment.

The guidelines are extensive and the Headache Society recommends that health-care professionals consult the guidelines frequently to make certain of the diagnosis.

There are three major categories of headache based upon the source of the pain.

1. Primary headaches
2. Secondary headaches
3. Cranial neuralgias, facial pain, and other headaches

The guidelines also note that a patient may have symptoms that are consistent with more than one type of headache, and that more than one type of headache may be present at the same time.

What are primary headaches?

Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.

• Tension headaches are the most common type of primary headache. Tension headaches occur more commonly among women than men. According to the World Health Organization, 1 in 20 people in the developed world suffer with a daily tension headache.
• Migraine headaches are the second most common type of primary headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected.
• Cluster headaches are a rare type of primary headache. It more commonly affects men in their late 20s though women and children can also suffer from this type of headache.

Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitating. While these headaches are not life threatening, they may be associated with symptoms that can mimic strokes.

Many patients equate severe headache with migraine, but the amount of pain does not determine the diagnosis of migraine. Read our Migraine Headache article for more information about the symptoms, causes, and treatment of migraines.

What are secondary headaches?

Secondary headaches are those that are due to an underlying structural or infectious problem in the head or neck. This is a very broad group of medical conditions ranging from dental pain from infected teeth or pain from an infected sinus, to life-threatening conditions like bleeding in the brain or infections like encephalitis or meningitis.

Traumatic headaches fall into this category including post-concussion headaches.

This group of headaches also includes those headaches associated with substance abuse and excess use of medications used to treat headaches (medication overuse headaches). "Hangover" headaches fall into this category as well. People who drink too much alcohol may waken with a well-established headache due to the effects of alcohol and dehydration.

What are cranial neuralgias, facial pain, and other headaches?

Neuralgia means nerve pain (neur=nerve + algia=pain). Cranial neuralgia describes inflammation of one of the 12 cranial nerves coming from the brain that control the muscles and carry sensory signals (such as pain) to and from the head and neck. Perhaps the most commonly recognized example is trigeminal neuralgia, which affects cranial nerve V (the trigeminal nerve), the sensory nerve that supplies the face and can cause intense facial pain when irritated or inflamed.

17 types of headaches

The different types of headaches depend upon the class to which they belong. Some common types include:

1. Primary tension headaches that are episodic
2. Primary tension headaches that are chromic
3. Primary muscle contraction headaches
4. Primary migraine headaches with aura
5. Primary migraine headaches without aura
6. Primary cluster headache
7. Primary paroxysmal hemicrania (a type of cluster headache)
8. Primary cough headache
9. Primary stabbing headache
10. Primary headache associated with sexual intercourse
11. Primary thunderclap headache
12. Hypnic headache (headaches that awaken a person from sleep)
13. Hemicrania continua (headaches that are persistently on one side only. right or left [unilateral])
14. New daily-persistent headache (NDPH) (a type of chronic headache)
15. Headache from exertion
16. Trigeminal neuralgia and other cranial nerve inflammation
17. Secondary headaches due to:
    • Trauma
    • Disorders
    • Infection
    • Structural problems with the bones of the face, teeth, eyes, ears, nose, sinuses or other structures
    • Substance abuse or withdrawal

What causes headaches?

Migraine headache is caused by inflammation or irritation of structures that surround the brain or affect its function. While the brain itself has no pain nerve fibers, everything else above the shoulders, from the neck, skull, and face, can cause a person to have of head pain. Systemic illnesses, including infection or dehydration, can have associated headache. These are known as toxic headache. Changes in circulation and blood flow or trauma can also cause headache.

Changes in brain chemistry may also be associated with headache: medication reactions, drug abuse and drug withdrawal can all cause pain.

Every person is different so the history of the headache is important. Recognizing patterns or precipitating (foods eaten, stress, etc.) factors, in combination with the physical examination and associated symptoms, can help identify the cause for each individual's specific headache.

What causes tension headaches?

While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may become inflamed, go into spasm, and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck insert, the temples where muscles that move the jaw are located, and the forehead.

There is little research to confirm the exact cause of tension headaches. It is believed that tension headaches occur because of physical stress on the muscles of the head. For example, these stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm. Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer concentrating for long periods. Emotional stress also might cause tension headaches by causing the muscles surrounding the skull to contract.

What are the signs and symptoms of tension headaches?

Common signs and of tension headaches include:

• Pain that begins in the back of the head and upper neck and is often described as a band-like tightness or pressure. It may spread to encircle the head.
• The most intense pressure may be felt at the temples or over the eyebrows where the temporalis and frontal muscles are located.
• The pain may vary in intensity but usually is not disabling, meaning that the sufferer may continue with daily activities. The pain usually is bilateral (affecting both sides of the head).
• The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to light and sound.
• The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people.
• The pain allows most people to function normally, despite the headache.

How are tension headaches diagnosed?

The key to making the diagnosis of any headache is the history given by the patient. The health-care professional will ask questions about the headache to try to help make the diagnosis. Those questions will try to define the quality, quantity, and duration of the pain, as well as any associated symptoms. The person with a tension headache will usually complain of mild-to-moderate pain that is located on both sides of the head. People with tension headaches describe the pain as a non-throbbing tightness, that is not made worse with activity. There usually are no associated symptoms like nausea, vomiting, or light sensitivity.

The physical examination, particularly the neurologic portion of the examination, is important in tension headaches because to make the diagnosis, it should be normal. However, there may be some tenderness of the scalp or neck muscles. If the health-care professional finds an abnormality on neurologic exam, then the diagnosis of tension headache should be put on hold until the potential for other causes of headaches has been investigated.

How are tension headaches treated?

Tension headaches are painful, and patients may be upset that the diagnosis is "only" a tension headache. Even though it is not life threatening, a tension headache can make daily activities more difficult to accomplish. Most people successfully treat themselves with over-the-counter (OTC) pain medications to control tension headaches. The following work well for most people:

• aspirin,
• ibuprofen (Motrin, Advil),
• acetaminophen (Tylenol, Panadol) and
• naproxen (Aleve).

If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Physical therapy, massage, biofeedback, and stress management can all be used as adjuncts to help with control of tension headaches.

It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It always is wise to ask a health care professional or pharmacist if one has questions about OTC medications and their use. This is especially important with OTC pain medications, because they are used so frequently.

It is important to read the listing of ingredients in OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third listed ingredient may have the potential interfering with the action of other drugs based upon a patient's other medical issues For example:

• Some OTC medications include caffeine, which may trigger rapid heartbeats in some patients.
• In nighttime preparations, diphenhydramine (Benadryl) may be added. This may cause sedation, and driving or using heavy machinery may not be appropriate when taking a sedative medication.
• Some OTC cold medications have pseudoephedrine mixed in with the pain medication. This drug can cause elevated blood pressure and palpitations.

Other examples where caution should be used include the following:

• Aspirin should not be used in children and teenagers because of the risk of Reye's syndrome, a life threatening complication that may occur when a viral infection is present and aspirin is taken.
• Aspirin, ibuprofen, and naproxen are anti-inflammatory medications that can be irritating to the stomach and may cause intestinal bleeding. They should be used with caution in patients who have peptic ulcer disease.
• Most anti-inflammatory medicines also cause the potential for bleeding elsewhere in the body, and you should not take them if you also take blood thinners. Talk with your doctor or other health care professional about the benefits and risks of anti-inflamatory drugs. Blood thinners include warfarin (Coumadin), heparin (Lovenox), dabigatran (Pradaxa), apixaban(Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa), clopidogrel bisulfate (Plavix), ticagrelor (Brilinta), and prasugrel (Effient).
• Overuse of aspirin, ibuprofen, and naproxen also may cause kidney damage.
• Acetaminophen, if used in amounts greater than recommended, can cause liver damage or failure. It also should be used with caution in patients who drink significant amounts of alcohol or who have liver disease because even lesser doses than are normally recommended may be dangerous.
• Medication overuse headache can be mistaken for chronic tension headaches. When pain medications are used for a prolonged period headaches may recur because the effects of the medication wear off. (This type of headache was referred to as a "rebound headache," and is classified as a secondary headache.)

What causes cluster headaches?

Cluster headaches are so named because they tend to occur daily for periods of a week or more followed by long periods of time -- months to years -- with no headaches. They occur at the same time of day, often waking the patient in the middle of the night.

The cause of cluster headaches is uncertain but may be due to a sudden release of the chemicals histamine and serotonin in the brain. The hypothalamus, an area located at the base of the brain, is responsible for the body's biologic clock and may be the source for this type of headache. When brain scans are performed on patients who are in the midst of a cluster headache, abnormal activity has been found in the hypothalamus.

Cluster headaches also:

• tend to run in families and this suggests that there may be a role for genetics;
• may be triggered by changes in sleep patterns; and
• may be triggered by medications (for example, nitroglycerin, used for heart disease)

If an individual is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate, and foods high in nitrites like smoked meats) also are potential causes for headache.

What are the symptoms of cluster headaches?

Cluster headaches are headaches that come in groups (clusters) separated by pain-free periods of months or years. A patient may experience a headache on a daily basis for weeks or months and then be pain-free for years. This type of headache affects men more frequently. They often begin in adolescence but can extend into middle age.

• During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some patients may experience pain more than twice daily.
• Each episode of pain lasts from 30 to 90 minutes.
• Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep.
• The pain typically is excruciating and located around or behind one eye.
• Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery.
• The nose on the affected side may become congested and runny.

Unlike people with migraine headaches, those with cluster headaches tend to be restless. They often pace the floor and/or bang their heads against a wall. People with cluster headaches can be driven to desperate measures, including suicidal thoughts.

How are cluster headaches diagnosed?

The diagnosis of cluster headache is made by taking the patient's history. The description of the pain and its clock-like recurrence is usually enough to make the diagnosis.

If examined in the midst of an attack, the patient usually is in a painful crisis and may have the eye and nose watering as described previously. If the patient is seen when the pain is not present, the physical examination is normal and the diagnosis will depend upon the history.

How are cluster headaches treated?

Cluster headaches may be very difficult to treat, and it may take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and the headaches that follow need to be prevented.

Initial treatment options may include one or more of the following:

• inhalation of high concentrations of oxygen (though this will not work if the headache is well established);
• injection of triptan medications, like, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are common migraine medications;
• Spraying or dripping lidocaine, a local anesthetic, into the nostril;
• dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict; and
• caffeine.

Prevention of the next cluster headache may include

• calcium channel blockers, for example, verapamil (Calan, Verelan, Verelan PM, Isoptin, Covera-HS) and diltiazem(Cardizem, Dilacor, Tiazac);
• prednisone (Deltasone, Liquid Pred);
• antidepressant medications;
• lithium (Eskalith, Lithobid); and
• antiseizure medications including valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and topiramate(Topamax).

Can cluster headaches be prevented?

Since cluster headache episodes may be spaced years apart, and since the first headache of a new cluster episode can't be predicted, daily medication may not be warranted.

Lifestyle changes may help minimize the risk of a cluster headache flare. Stopping smoking and minimizing alcohol may prevent future episodes of cluster headache.

What diseases cause secondary headaches?

Headache is a symptom associated with many illnesses. While head pain itself is the issue with primary headaches, secondary headaches are due to an underlying disease or injury that needs to be diagnosed and treated. Controlling the headache symptom will need to occur at the same time that diagnostic testing is performed to identify the underlying disease. Some of the causes of secondary headache may be potentially life threatening and deadly. Early diagnosis and treatment is essential if damage is to be limited.

The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (This is not a complete list.).

Head and neck trauma

• Injuries to the head may cause bleeding in the spaces between the meninges, the layers of tissue that surround the brain (subdural, epidural, and subarachnoid spaces) or within the brain tissue itself (intracerebral hemorrhage: intra=within + cerebral=brain, hemorrhage=bleeding).
• Edema or swelling within the brain, not associated with bleeding, may cause pain and a change in mental function.
• Concussions, where head injury occurs without bleeding. Headache is one of the hallmarks of post-concussionsyndrome.
• Whiplash and neck injury also cause head pain.

Blood vessel problems in the head and neck

• Stroke or transient ischemic attack (TIA).
• Arteriovenous malformations (AVM) when they leak.
• Cerebral aneurysm and subarachnoid hemorrhage. An aneurysm, or a weakened area in a blood vessel wall, can expand and leak a small amount of blood causing what is called a sentinel headache. This may be a warning sign of a future catastrophic bleed into the brain.
• Carotid artery inflammation
• Temporal arteritis (inflammation of the temporal artery)

Non-blood vessel problems of the brain

• Brain tumors, either primary, originating in the brain, or metastatic from a cancer that began in another organ
• Seizures
• Idiopathic intracranial hypertension, historically called pseudotumor cerebri, where pressure within the spinal canal increases. The cause is unknown and while it can occur in all ages, it often affects young, obese females. Idiopathic intracranial hypertension can cause significant headache and if left untreated may, on occasion, lead to blindness.

Medications and drugs (including withdrawal from those drugs)

Oral contraceptives, medications used to treat erectile dysfunction, blood pressure or other cardiac medications can all lead to or cause headaches. Medication overuse headache, occurring when pain medications are taken too frequently, can be caused by acetaminophen (Tylenol and others), aspirin, ibuprofen (Advil and others), OTC analgesics with caffeine (Excedrin®, etc.), as well as narcotic analgesics and other prescription pain medications.

Infection

• Meningitis
• Encephalitis
• HIV/AIDS
• Systemic infections (for example, pneumonia or influenza)

Changes in the body's environment

• High blood pressure (hypertension)
• Dehydration
• Hypothyroidism
• Kidney dialysis

Problems with the eyes, ears, nose throat, teeth, sinuses, and neck

• Sinus infection
• Dental pain
• Glaucoma
• Iritis

How are secondary headaches diagnosed?

If there is time, the diagnosis of secondary headache begins with a complete patient history followed by a physical examination and laboratory and radiology tests as appropriate.

However, some patients present in crisis with a decreased level of consciousness or unstable vital signs due to the underlying cause of the headache. In these situations, the health-care professional may decide to treat a specific cause without waiting for tests to confirm the diagnosis.

For example, a patient with headache, fever, stiff neck, and confusion may have meningitis. Since meningitis can be rapidly fatal, antibiotic therapy may be started before blood tests and a lumbar puncture are performed to confirm the diagnosis. It may be that another diagnosis ultimately is found, for example, a brain tumor or subarachnoid hemorrhage, but the benefit of early antibiotics outweighs the risk of not giving them promptly.

What are the exams and tests for secondary headaches?

The patient history and physical examination provide the initial direction for determining the cause of secondary headaches. Therefore, it is extremely important that a patient with new, severe headache seeks medical care and gives their health-care professional an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing the headaches will depend upon the doctor's evaluation and what specific disease, illness, or injury is being considered as the cause of the headaches (the differential diagnosis). Common tests that are considered include the following:

• blood tests;
• computerized tomography (CT scan) of the neck;
• magnetic resonance imaging (MRI) scans of the head; and
• lumbar puncture (spinal tap).

Specific tests will depend upon what potential issues the health-care professional and patient want to address.

Blood tests

Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate(ESR), or C-reactive protein (CRP). These two tests are very nonspecific; that is, they may be abnormal with any infection or inflammation, and abnormalities do not point to a specific diagnosis of the cause of the infection or inflammation. The ESR is often used to make the tentative diagnosis of temporal arteritis, a condition that affects an older patient, usually over the age of 65, who presents with a sharp, stabbing temporal headache, due to inflammation of the arteries on one side of the head.

Blood tests may be used to assess electrolyte imbalance, and a variety of other potential problems involving organs like the liver, kidney, and thyroid.

Toxicology tests may be helpful if the patient is suspected of abusing alcohol, prescription, or other drugs of abuse.

Computerized tomography of the head

Computerized tomography (CT scan) is able to detect bleeding, swelling, and some tumors within the skull and brain. It also can show evidence of a previous stroke. With intravenous contrast injection, (angiogram) it may also be used to look at the arteries of the brain for aneurysms.

Magnetic resonance imaging (MRI) of the head

MRI is able to show the anatomy of the brain and the layers that cover the brain and the spinal cord (meninges). It is more precise than computerized tomography. This type of scan is not available at all hospitals. Moreover, it takes much longer to perform, requires the patient to cooperate by holding still, and requires that the patient have no metal in their body (for example, a heart pacemaker or metal foreign objects in the eye).

Lumbar puncture

Cerebrospinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid looks for infection (such as meningitis due to bacteria, virus, fungus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor within the brain. Pressure within the space can be measured when the lumbar puncture needle is inserted. Elevated pressures may make the diagnosis of idiopathic intracranial hypertension (previously known as pseudotumor cerebri) in combination with the appropriate history and physical examination.

When should I seek medical care for a headache?

A patient should seek medical care if their headache is:

• The "worst headache of your life." This is the wording often used in textbooks as a cue for medical practitioners to consider the diagnosis of a subarachnoid hemorrhage due to a ruptured cerebral aneurysm. The amount of pain will often be taken in context with the appearance of the patient and other associated signs and symptoms. Too often, patients are prompted to use this expression by a health-care professional and do not routinely volunteer the phrase.
• Different than their usual headaches
• Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity
• Associated with persistent nausea and vomiting
• Associated with fever or stiff neck. A stiff neck may be due to meningitis or blood from a ruptured aneurysm. However, most patients who complain of a stiff neck have muscle spasm and inflammation as the cause.
• Associated with seizures
• Associated with recent head trauma or a fall
• Associated with changes in vision, speech, or behavior
• Associated with weakness or change in sensation on one side of their body that may be a sign of stroke.
• Not responding to treatment or is getting worse
• Requires more than the recommended dose of over-the-counter medications for pain
• Disabling and interfering with work and quality of life

How do you get rid of a headache? Are home remedies effective for headaches?

It is important to consider that an unusual headache may need to be evaluated by a health-care professional, but in most instances, primary tension headaches may be initially treated at home.

• First steps include maximizing rest and staying well hydrated.
• Recognizing and minimizing stressful situations may be of help, if that is one of the contributing causes of the headache.
• If there has been a cold or runny nose recently, humidifying air may be helpful in allowing sinuses to drain.
• Rubbing or massaging the temples or the muscles at the back of the neck may be soothing, as might warm compresses.
• Over-the-counter pain medication may be helpful, in moderation.

Those with migraine headaches often have a treatment plan that will allow treatment at home. Prescription medications are available to abort or stop the headache. Other medications are available to treat the nausea and vomiting. Most patients with migraine headaches get much relief after resting in a dark room and falling asleep.

12 Surprising Headache Triggers Tips

Your Boss

Anything (or anyone) that boosts your stress level can make you more vulnerable to tension headaches or migraines. Doctors don’t know exactly how it happens. Many things may be involved, including certain nerves in the brain that relay pain messages and may be extra sensitive. Changes within the brain itself may also be involved in migraine headaches.

Weather

When the temperature changes, it can make a migraine more likely. Whether it's a heat wave or a cold snap, the change can trigger a headache. Sunny, hot days can do that, too. Rain or changes in barometric pressure also may lead to headaches. While you can't change the weather, you can wear sunglasses on a bright day, stay hydrated, and avoid midday sun.

Strong Scents

Strong smells, even nice ones, trigger migraines in many people. Why this happens is unclear. The most common offenders are paint, perfume, and certain types of flowers.

Hair Accessories

Ouch! How you wear your hair can take a toll on your head. A too-tight ponytail may strain the connective tissue in the scalp, leading to a hairdo headache. Headbands, braids, and tight-fitting hats can do that, too. If this is the cause of your headache, you’ll usually get fast relief if you let your hair down.

Exercise

Strenuous activity can sometimes lead to headaches. Examples include jogger’s headache and even a sex headache. These types of headaches are most common in people who are likely to get migraines. Though rare, this type of headache can also be a sign of a very serious problem such as bleeding in the brain. Call 911 if you get a bad headache after doing something that’s physically hard.

Poor Posture

Slouching builds up pressure in the head and neck muscles. Do you hunch your shoulders, use a chair with no lower-back support, or stare at a monitor that is too low or too high? If you have frequent tension headaches, these simple lifestyle changes could help.

Cheese

A migraine trigger for some people is aged cheese, including blue cheese, cheddar, parmesan, and Swiss. The problem may be a substance called tyramine. The longer a food ages, the more tyramine it has.

Red Wine

Tyramine is also found in red wine and other alcoholic drinks. Other ingredients in wine can contribute to headaches as well. Because alcohol boosts blood flow to the brain, the effects may be even more intense. Try sipping sparkling water or another non-alcoholic drink.

Cold Cuts

Cold cuts and other processed meats often contain tyramine and food additives such as nitrites, which may trigger headaches in some people. If you think this could be a trigger for you, try taking these foods out of your diet for a while to see if it makes a difference.

Skipping Meals

Hunger headaches aren’t always obvious. If you don’t eat, your head could start to ache before you realize you’re hungry. The trouble is likely a dip in blood sugar. But don’t try to cure a hunger headache with a candy bar. Sweets cause blood sugar to spike and then drop even lower.

Smoking

Smoking is known to trigger headaches, and not just in the person holding the cigarette. Secondhand smoke contains nicotine, which causes blood vessels in the brain to narrow. Giving up cigarettes or staying away from secondhand smoke helps a lot if you get cluster headaches. These are extremely painful, one-sided headaches that can also cause eye and nose symptoms.

Caffeine

If you get a lot of headaches, too much caffeine may be why. In moderation, caffeine often helps. In fact, it’s found in many headache medications. But chain-chugging coffee or sodas can cause headaches. If you want to stop caffeine, ease off gradually. Quitting suddenly can make things worse: Caffeine withdrawal is another headache trigger.

Identify Triggers

By doing this you may be able to stop headaches before they start. The best strategy is to keep a headache diary. Every day, note the foods you eat, stressful events, weather changes, and physical activity. Whenever you have a headache, jot down the time it starts and stops. This will help you find patterns so you can avoid your triggers.

Manage Stress

Many people find that they’re more prepared to manage migraines or tension headaches by taming stress. You can’t control everything, but you can change how you respond to the things that concern you. Look into classes or read a book on stress management, meditation, or massage. Anything healthy that helps you relax, problem-solve, and recharge is worth a try.

Stretch Your Legs

Exercise is a powerful stress reliever. You can do anything you like. Walking is a great choice. When you walk, the swinging motion of your arms tends to relax the muscles in your neck and shoulders. Breaking up those knots gets at the root of some headaches.

Eat Regular Meals

No more hunger headaches! Eating good-for-you meals throughout the day (with smaller portions, so you don’t eat too much) will keep your blood sugar on an even keel. Try to pair a protein with a complex carbohydrate, such as peanut butter on whole-grain bread or a chicken breast with brown rice. Also, sip enough fluids, since dehydration can also give you a headache.

Physical Therapy

This combines exercise and education to reduce pain and improve range of motion. If you get tension headaches, physical therapy may help relax your neck muscles and teach you to form new habits that lead to better posture.

Medicine's Role

Over-the counter pain relievers such as acetaminophen, aspirin, ibuprofen, and naproxen are effective against many types of headaches. But using these medicines daily, or nearly every day, can result in medication overuse headaches or rebound headaches -- headache pain that returns as soon as the pills have worn off. For frequent or severe headaches, ask your doctor what would help.

When to See a Doctor

If you get a new headache that is unusually severe or lasts longer than usual, see a doctor. Tell her if your headache pattern changes, such as if they happen more often or if you have new triggers. Call 911 if you have a severe, sudden headache (out of the blue or after an accident or head injury), or if you also have vision changes, trouble talking, movement problems, confusion, seizure, a fever, or a stiff neck.

Pain: Why Does My Head Ache?

Your Vision's Blurry

You may get a headache when you try to focus on something near your face. If you're farsighted, things look fuzzy as you get closer to them. It could be because your eyeball is too short or the clear covering on your eye, called the cornea, is too flat. You might be born with it, but it starts to happen to most folks after age 40. Your doctor can help with eyeglasses, contact lenses, or surgery that corrects the shape of your cornea.

You Tense Your Neck and Shoulders

Do you hunch over your computer for hours or hold your phone to your ear with your shoulder? Or maybe stress makes you tense the muscles in your jaw. Any of these may cause "tension headaches." A hot shower, warming pad, and over-the-counter meds can help. Regular exercise along with meditation and other relaxation approaches might stop it before it starts.

You're Hungry

Maybe you haven't had a meal in a while. It could give you low blood sugar, which triggers a headache. It might help to have several small meals instead of three big ones and keep healthy snacks like nuts or veggies on hand for emergencies.

You Skipped Your Morning Coffee

Your body gets used to the caffeine and reminds you with a throbbing head if you forget to drink your regular cup. When coffee isn't at hand, green or black tea or even dark chocolate will do. If you want to quit your caffeine habit, don't do it all at once. Cut down by about 25% a week to get used to it.

You Had Sex

You may have a dull ache in your neck or head that worsens as you get more sexually excited. Or it might be a throbbing headache that arrives quickly just as you climax. Some people feel both. Most last minutes, but it can be hours. It's usually nothing to worry about, but tell your doctor right away if you get a headache during or after sex, especially if it never happened before or it's sudden, which could be signs of something serious.

Your Sinuses Are Swollen

A simple cold can inflame hollow areas behind your cheekbones and forehead. The swelling could cause pain there that worsens when you bend over. It might be hard to breathe because mucus, which can get thick and yellow or green, doesn't drain properly. Over-the-counter drugs can often help you manage it. There's no need to call your doctor unless the symptoms are bad, don't go away, or get worse.

You Drank Too Much Last Night

Today you pay with a hangover that includes a throbbing head. That's because alcohol disturbs your sleep and rids your body of liquid. You may feel tired and nauseous, too. About five to eight drinks for men and three to five for women is enough to cause it. Rehydrate with water, broth, or sports drinks. Anti-inflammatory drugs can help, but avoid acetaminophen, which is too hard on your liver when you've been drinking.

You Just Ate Ice Cream

Sometimes called an "ice cream headache" or "brain freeze," it happens when you eat something very cold, especially if you do it fast. Doctors aren't sure what causes it, but it could be that the icy temperature makes the blood vessels in your mouth shrink, which triggers pain signals to your brain. It's nothing to worry about and is usually gone in a minute or so. Prevention is simple: Eat frosty foods more slowly.

You Hit Your Head

Headaches can start right away or months after an injury. They might be at the site of the blow or all over your skull and may get worse when you're stressed. The cause isn't always clear, but sometimes too much blood builds up in one spot. This is called a hematoma. In serious cases, you may feel weak, confused, nauseous, and forgetful. See your doctor if you have any of these symptoms or if you have a headache after hitting your head.

You Have an Ear Infection

Bacteria or a virus may infect the air-filled middle ear, where tiny bones vibrate to make the sounds you hear. It usually happens fast. Fluid buildup could cause ear and head pain along with drainage of liquid, blood, or pus. If you notice any of these symptoms, call your doctor, who will want to watch the infection and can help you manage pain and swelling. Most cases get better without treatment in 1-2 weeks.

You Overdo Your Pain Relievers

Even common over-the-counter medications like aspirin, ibuprofen, and acetaminophen may cause headaches if you use them more than 15 days a month. Prescription opioids or drugs with caffeine might do it in just 10 days. People who get migraines are more likely to have this problem. Your doctor can help you change your meds and give you other strategies to make you feel better.

You Ate a Headache "Trigger"

Everyone is different, but foods that are more likely to cause a throbbing head include:

• Aged cheese
• Some fruits and nuts
• Alcohol
• Foods with nitrates, like hot dogs, sausage, or bacon
• Fermented or pickled foods like sauerkraut or relish
• A flavor enhancer called MSG

You can figure out your triggers if you track what and when you eat in a food journal and notice what leads to a headache.

You Just Worked Out

You might hurt on both sides of your head while you exercise hard or after you're done. Running, swimming, or weightlifting can bring it on. It's usually nothing to worry about, but it's best to check with your doctor to be sure it's not something serious. Get medical help right away if you also throw up, pass out, or have double vision.

You've Got the Wrong Pillow

It may give you a headache if it puts your body in the wrong posture all night. And if you toss and turn, the lack of sleep might also lead to a pounding head. Look for a pillow that keeps your head and neck in line with the rest of your body, as if you are standing up. Talk to your doctor or a physical therapist if you can't get comfortable.

When to Call 911

In rare cases, a headache might be a sign of something more serious. It could be a condition that develops slowly, such as a brain tumor. Or it could be a medical emergency, like a stroke. Call 911 if the pain is sudden and severe or you notice any of these symptoms along with it:

• Numbness or weakness on one side of your face or body
• Garbled speech or confusion
• Trouble seeing
• Dizziness, loss of balance

Migraine or Headache? Migraine Symptoms, Triggers, Treatment

What Is a Migraine?

A migraine is a throbbing painful headache, usually on one side of the head, that is often initiated or "triggered" by specific compounds or situations (environment, stress, hormones, and many others). They occur more often in women (75%, approximately) and may affect a person’s ability to do common tasks.

Migraine Symptoms

Migraine symptoms, throbbing pain, usually on one side of a person's head, can be intense enough to cause a person to be unable to do simple tasks or to work. The headache pain may radiate toward the eyes, forehead, or temple and make a person develop nausea, vomiting, vision problems, and sensitivity to normal light or mild exertion.

Migraine With Aura

"Classic" migraines begin with an aura such as seeing visual field changes (dots, wavy lines, blurriness) about an hour or less before the pain begins. Approximately 20% of people with migraines have this "classic" type.

Migraine Warning Signs

"Classic" auras do not occur in all patients, but about 25% of migraine patients can have a prodromal phase. The prodromal phase occurs as long as 24 hours before migraine pain develops; the prodromal phase consists of mood changes (depressed, excited, irritable) and sensations of odd smells or tastes, while others may feel tired or tense.

What Causes a Migraine?

The neurological causes of migraines are not understood but researchers speculate something may initiate a mix of blood vessel permeation and brain chemicals to interact with brain cells to cause the migraine.

Trigger: Flashing Lights

Migraine headaches are often triggered to occur when the person is exposed to a specific set of circumstances. One of the most common triggers is strong flickering light. For example, faulty fluorescent lights, a television picture rapidly going on and off, or sunlight reflected off of waves in a lake or the ocean are all potential triggers.

Trigger: Anxiety and Stress

As mentioned, stress is sometimes a trigger for migraines. While it is unlikely that people can live stress-free lives, many people can reduce their stress and avoid triggering migraines by using relaxation techniques, deep breathing, and other biofeedback techniques.

Trigger: Lack of Food or Sleep

Regular daily patterns of meals and sleep work well for some individuals to avoid migraines. Sleep interruptions and lack of adequate fluid and/or food intake and even some food binges may trigger a migraine.

Trigger: Hormonal Changes

Many women's migraines are linked to their menstrual cycle. The hormonal increases and decreases are thought to be responsible for triggering migraines in some women. However, patterns differ from person to person so one type of hormonal therapy may benefit one woman, but it may be unhelpful or even increase migraine symptoms in other women.

Trigger: Headache Foods

Although studies have not proven that any food is a migraine trigger, patients often suggest certain foods trigger their migraines. Common food or food ingredients cited by patients are red wine, cheese, chocolate, soy sauce, processed meat, and MSG.

Trigger: Tyramine

Tyramine, produced from the amino acid tyrosine, may be a trigger for migraines because it can cause blood vessel constriction and expansion. Many aged and fermented foods that are associated with migraines like cheeses, soy sauce, pickles, or aged meats like pepperoni contain tyramine.

Caffeine: Help or Hindrance?

The caffeine in coffee may help relieve migraines when used with some medications. However, when the caffeine levels drop, the patient may then be prone to develop headaches. Consequently, it may be both a help and a hindrance for people with migraines.

Tracking Personal Triggers

Individuals should keep a diary or list of things that act as warning signs or triggers of an oncoming migraine. This information may help migraine sufferers to avoid future migraines.

Who Gets Migraines?

Migraines occur in women about three times more often than in men; people with relatives who get migraines are more likely to get them. In addition, migraines more often occur in people with epilepsy, depression, stroke, asthma, anxiety, and in individuals with neurologic and hereditary (genetic) disorders.

Migraines in Children

Migraines occur in children about equally until puberty when migraines become more common in girls. However, in children, migraine symptoms are somewhat different than those in adults; children may experience stomach pains (abdominal migraine), frequent and forceful vomiting, or benign paroxysmal vertigo where the symptoms are unsteady balance, involuntary eye movements, vomiting, and behavioral changes.

Diagnosing Migraines

Migraines are usually diagnosed by the clinical history of symptoms; however, most doctors will do a CT or MRI brain scan to determine if other causes of headaches (brain tumor or bleeding into the brain, for example) are present.

Calculating Your Headache Burden

Some doctors like to estimate how much migraines disrupt normal activities before treatment begins. A questionnaire is given to the patient to estimate how often they miss various functions (school, work, family activities) because of migraines.

Treatment: Over-the-Counter Drugs

There are many types of over-the-counter (OTC) medicines for headache pain. Some of the most common are aspirin, naproxen sodium, ibuprofen, and acetaminophen; some OTCs are marketed as treatments for migraines. Although all of these OTCs may be helpful, people should not overuse them to avoid toxicity, ulcers, and other gastrointestinal problems. In addition, overuse may make migraines worse.

Treatment: Triptans

Triptans (Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Treximet, and Zomig) are the most commonly prescribed medication for the treatment of migraines. However, people with hypertension, heart disease, stroke, and those who take certain medications may not be able to take triptans; your doctor can help with medication choices. Unfortunately, side effects of nausea, dizziness, chest pain, and paresthesia may occur with triptans.

Treatment: Ergotamines

Ergotamines (Cafergot, Migergot, or Migranal) are used to treat migraines although they are usually not as effective as triptans. However, they have side effects such as nausea, dizziness, muscle pain, or an unusual or bad taste in the mouth and may interact with other drugs. These side effects and drug interactions may limit the patient’s use of the drug.

Is Your Treatment Working?

Sometimes the initial treatments for migraines either do not reduce the symptoms or only marginally reduce them. If, after trying the prescribed treatment(s) about two or three times and getting little or no relief, you should ask your doctor to change the treatment. However, patients are urged to treat the migraines early (within about 2 hours) to get full benefit of treatments.

Limits of Medication Use

Some chronic headaches are due to overuse of medicine; avoid using migraine prescribed medicines more than twice per week. Using and tapering medicine for migraines should proceed under your doctor’s supervision. Narcotics are used as a last resort for migraines because they can be addictive.

Treatment: Preventive Medicines

If your migraines are frequent and severe, your doctor may prescribe medication(s) to lessen the frequency or to prevent the headaches. Medicines that are used in this manner include Timolol (Blocadren), divalproex sodium (Depakote), propranolol (Inderal), and topiramate (Topamax), although the drugs were designed to reduce hypertension or prevent seizures.

Alternative Therapy: Biofeedback

Other methods that may reduce or prevent migraines include biofeedback techniques to reduce migraine triggers like stress and early symptoms such as muscle tension.

Alternative Therapy: Acupuncture

Although studies on acupuncture are not definitive, some patients may respond well to this Chinese method of inserting needles into specific body locations to reduce or stop pain. Because the results are so variable, some doctors do not recommend this treatment; but because some patients benefit, it is another treatment method to consider.

An Advantage of Aging

The peak intensity and frequency of migraines occur between ages of about 20 to 60 years of age. As you age past 60, migraine intensity and frequency decrease and in some patients, migraines cease.

When You Need Quick Care

Most people know the pattern of their migraines (triggers, auras, and pain intensity). However, new headaches, in people with or without a migraine history, that last about 2 or more days should be checked by a doctor. However, if a headache develops with other symptoms such as fever, stiff neck, confusion, or paralysis, the person or their relative, friend, or caretaker should be examined emergently.