Headaches are perhaps one of the most common physical ailments that people experience. Chances are everyone has had one at some point in his or her life. However, because headaches are common doesn’t mean they are all the same.
In fact, there are several different types of headaches and even more differentiating causes, ranging from simple factors such as fasting or hangovers to the life-threatening stroke or brain tumor.
The key to successfully eliminating headaches is to address the cause behind the headache rather than simply addressing the symptoms.
Headaches are the seventh most common reason people see their doctor in the United States, and 90 percent of the U.S. population has experienced some type of headache.1 On a global scale, it is thought that anywhere from 50 to 75 percent of adults have had a headache in the last year, with 10 percent of them reporting a migraine.2 Headaches are the most commonly reported pain condition resulting in loss of work, with 5.4 percent of the workforce reporting headaches. 3
Types of Headaches
Headaches are typically grouped into three main categories: primary, secondary and other. Primary is the most common type of headache and includes tension, migraine and cluster headaches.
Secondary headaches can be caused by health conditions such as hormones, nutritional status or more serious conditions like meningitis. Determining the cause is important to rule out more serious conditions.
Other headaches are typically caused by nerve pain localized to the head and upper neck.
Tension headaches are the most common type of headache overall and have several different causes, many of which are typically centered on physical and emotional stressors. Emotional stress causes headaches when the muscles outside of the skull and neck contract in response to emotional trauma.
The point of origin for most tension headaches are at muscle attachments on or nearby the skull, such as over the temporal bone (temple), at the temporomandibular joint, over the frontal bone (forehead) and at the occipital areas (the back and lower part of the skull).
Tension headaches can occur daily or infrequently, and more often than not, you are aware of the cause(s) of the headache, such as prolonged deskwork or emotional strain.
Symptoms of tension headaches include:
- A sensation of tightness changing to pain at the upper neck/base of the skull.
- One of the most frequent descriptors people use is “a band of pressure circling the head”. This band typically circumscribes the skull at the level right over the eyebrows.
Treating Tension Headaches
Many times, tension headaches respond favorably to over-the-counter analgesics. However, simple lifestyle changes can prevent the occurrence of tension headaches, including:
- Frequent stretching at the desk (at least once an hour).
- A brisk walk outside and taking deep breaths can relieve tension and “oxygenate” the brain, especially in dull/sedentary work situations.
- Massaging trigger points (the areas where the headache begins) at the outset of pain may help prevent or lessen the severity of the headache.
Migraines are the second most common type of headache, with 18 to 24 percent of women and six to nine percent of men experiencing them in North America. 4 They are caused when (typically) the temporal artery dilates, which in turn releases further inflammatory and pain-signalling molecules.
Migraines are notorious for the attendant symptoms that many sufferers describe as worse than the headache.
These include extreme nausea, vomiting, diarrhea and sensitivity to sounds and light.
Determining the cause of migraines can be elusive, but a detailed history can help find it. Hormonal imbalances (in women), food sensitivities and hypoglycemia are common causes.
Using detailed hormonal testing, measuring IgG-related food sensitivities (and removing sensitive foods from the diet) and ensuring balanced and supported blood sugar throughout the day and night can lead to substantial improvement in terms of decreased incidence.
Migraine symptoms can begin quite rapidly with intense, throbbing pain located nearer the temporal or frontal areas. This doesn’t mean that a person can’t have migraine pain in other areas of their head.
Nausea, vomiting, diarrhea and sound/light sensitivity are common—and intense. Finally, migraines are often preceded by an aura such as flashes of light or other visually related irregular light patterns.
An extract of the herb butterbur (Petasites hybridus) has been studied as a preventive medicine for migraines. A study published in September 2000 showed a decrease in migraine attacks by 60 percent, while another study published in December 2004 showed increasing reductions in migraine frequency up to 48 percent less with larger doses used. 5-6 Butterbur is typically well tolerated with rare side effects.
Feverfew (Tanacetum parthenium) is another herbal medicine with anti-migraine properties. In a study published in July 2011, people suffering from migraines were given feverfew combined with ginger. At two hours, 63 percent of subjects in the test group were pain free or had a mild headache. 7
A systematic review published in December 2000 that included six trials using feverfew for migraine prevention concluded, “Feverfew is likely to be effective in the prevention of migraines.” 8 Best of all, feverfew has no serious side effects.
Finally, riboflavin (also known as vitamin B2) has been well studied for migraine prophylaxis and treatment, with several studies showing substantial benefit. 9-11
Cluster headaches are the third main type of primary headaches. They are the rarest of the three types of headaches. They are more intensely painful than migraines, but typically shorter lived.
They occur in clusters because they recur over shorter time periods (weeks to months), and the sufferer may have several headaches coming and going throughout a day. They tend to occur at certain times of the year (spring, fall, etc.), and will often wake a person from sleep a few hours after going to bed. As soon as they start, they can disappear for months or years before returning.
Cluster Headache Causes
While there are no well-established causes for clusters, there are interesting trends, such as:
- Eight out of 10 sufferers are adult men (over age 20).
- Those with African ancestry have twice the incidence of clusters than Caucasians.
- Most are smokers.
- Alcohol can trigger the headaches during a cluster period.
- Having a relative with clusters increases one’s risk of having them.
- Clusters are cyclical in nature, occurring every season or at the same time each night.
Cluster Headache Symptoms
- Cluster headaches almost always occur on the same side of the head.
- Pain is severe and intense. Those having it cannot ignore it.
- Pain is often located behind one eye or another, with local radiation.
- Clusters come on suddenly, and last from minutes to several hours.
- The pain will disappear and then reappear at another time in the day.
- Other physical symptoms include tearing, swelling and redness of one eye, nasal discharge and other one-sided facial symptoms.
Cluster Headache Treatments
Capsaicin (cayenne pepper extract) has been used with success when applied intranasally with repeated applications, 12 and can lessen the severity of cluster headaches as they occur. 13
Melatonin supplementation has been studied with some success in the treatment of cluster headaches as well. 14-15
Kudzu (Pueraria lobata) has a rich traditional use in Asia. Anecdotal evidence gained through a survey of cluster headache sufferers indicates that it was effective in decreasing the intensity, frequency and duration of cluster headaches in this group. 16 Stronger studies are lacking at this time.
Secondary headaches result from other health problems. These can be serious and life threatening such as bleeding in the brain or meningitis. More often, however, they are caused by underlying disorders that, when treated directly, end up resolving the headaches themselves.
Secondary causes include:
- Dental: Temporomandibular disorder (TMJ) and bruxism (clenching/grinding) are related, and evaluation by a qualified specialist should be considered if you are experiencing dental or jaw pain.
- Visual: Eyestrain is extremely common with computer use/heavy reading. An ophthalmologic exam can help to rule out vision-related headaches.
- Sinus: Sinus headache pain most often accompanies an acute sinus infection. However, chronic, subclinical chronic sinusitis can also contribute to headaches, especially those occurring in the frontal or ethmoid (behind the eyes) areas.
- Nutritional: Dehydration is a common cause of headache. Additionally, magnesium deficiency plays a role in headache and migraine pathogenesis. 17
- Hormonal: Headaches and migraines are strongly associated with a woman’s monthly hormonal fluctuations as well as the pre-perimenopause period when hormone levels begin to fluctuate. 18
The Solution Lies in the Cause
The key to treating headaches is determining the underlying cause. Once the nature of a headache is understood, truly effective treatment options designed for prevention or minimizing dependency of medications can be pursued.
3. Stewart WF, et al. JAMA. 2003;290(18):2443-54.
4. Stokes M, et al. Headache, 2011;51:1058-77.
5. Grossmann M, et al. Int J Clin Pharmacol Ther. 2000 Sep;38(9):430-5.
6. Lipton RB, et al. Neurology. 2004 Dec 28;63(12):2240-4.
7. Cady RK, et al. Headache. 2011 Jul-Aug;51(7):1078-86.
8. Ernst E, et al. Public Health Nutr. 2000 Dec;3(4A):509-14.
9. Boehnke C, et al. Eur J Neurol. 2004 Jul;11(7):475-7.
10. Mauskop A. 2012 Aug;18(4):796-806.
11. Pringsheim T, et al. Can J Neurol Sci. 2012 Mar;39(2 Suppl 2):S1-59.
12. Fusco BM, et al. Pain. 1994 Dec;59(3):321-5.
13. Marks DR, et al. Cephalalgia. 1993 Apr;13(2):114-6.
14. Leone M, et al. Cephalalgia. 1996 Nov;16(7):494-6.
15. Peres MF, et al. Cephalalgia. 2001 Dec;21(10):993-5.
16. Sewell RA. Headache. 2009 Jan;49(1):98-105.
17. Talebi M, et al. Neurosciences (Riyadh). 2011 Oct;16(4):320-3.
18. Silberstein SD. Rev Neurol (Paris). 2000;156 Suppl 4:4S30-41.