Headache – Causes, Symptoms, Diagnosis & Treatment

Headache is one of the most common medical conditions that affect everyone at some point in their lives. The main symptom of a headache is a pain in the head or face that can be throbbing, constant, sharp, or dull. Doctors treat headache pain with medicines, stress management, and biofeedback.

How common are headaches in adults?

Headache is one of the most common conditions in the world that causes throbbing pain. About 75% of adults worldwide have a headache in a year. Headaches are a major reason for absenteeism from work and school. It also affects the social and family life of the patient. For some people, continuously battling headaches may result in anxiety and depression.

Headache Types

• More than 150 different types of headaches fall into three main categories – primary headaches, secondary headaches, and cranial neuralgias.

1. Primary Headaches – A primary headache is not a symptom of an underlying illness but a result of problems involving the head and neck structures. Stress and disruptions in sleep patterns are often the cause of these headaches.                                                     
2. Secondary Headaches – Secondary headaches typically have an underlying illness associated with them, such as sinus headaches that occur when the pressure or infection in the sinuses increases. A migraine is one of the forms of headache with throbbing pain and typically occurs on one side of the head. It is often triggered by stress, hormones, sound, environment, and many other factors. Women are more commonly affected than men.

If a headache persists for a prolonged time and is associated with symptoms such as neck stiffness, fever, vomiting, vision changes, changes in sensations on one side of the body. In that case, it may be due to the development of serious infections.
3. Cranial Neuralgia’s: The pain that occurs in the face and other headaches include rebound headaches. When a person overuses medication then the patient experiences rebound headaches. It occurs when frequent use of pain medications leads to persistent headaches. 

Types of primary and secondary headaches:

The common types of primary headaches include:

• Cluster headaches – these headaches generally last between 15 minutes and 3 hours and may occur one to eight times a day. They may frequently arise for 4–12 weeks and then disappear. Cluster headaches tend to occur at around the same time each day.
• Migraine – migraine is a headache that might cause severe throbbing pain or a pulsing sensation, generally on one side of the head.
• New daily persistent headaches (NDPH) begin suddenly and last for more than three months. It generally occurs in people with infrequent headaches before the onset of NDPH.
• Tension headaches –cause mild to moderate pain and frequently occur over time.

Certain types of secondary headaches include:

• Medication overuse headaches – also known as rebound headaches, it occurs in people who take medications to treat their headaches frequently. 
• Sinus headaches – are caused due to a sinus infection that leads to congestion and inflammation in the sinuses. 
• Spinal headaches – are caused due to low pressure or volume of cerebrospinal fluid. It is due to the spontaneous cerebrospinal fluid leak, spinal tap, or spinal anaesthesia.
• Thunderclap headaches – are excruciating and begin suddenly. Thunderclap headaches cause intense pain within 1 minute and last at least 5 minutes.

Are headaches hereditary?

Headaches tend to run in families, particularly migraines. Children suffering from migraines have at least one parent who also has them. Children whose parents suffer from migraines are up to four times more likely to develop them too.
Headaches can also be triggered due to factors that are shared in a household, like:

• • The consumption of certain foods or ingredients, like caffeine, alcohol, fermented foods, chocolate and cheese
  • Passive smoking
  • Exposure to allergens
• Strong odours from perfumes or household chemicals

A headache can be caused by many factors, such as the following:

• Irritation or inflammation in the skull structure, including the system surrounding the brain, may affect brain function.
• Changes in the blood flow or circulation of blood due to nasal trauma 
• Dehydration and systemic illness, including infections
• Reaction to medication and changes in the chemistry of the brain activity
• Drug withdrawal and drug abuse
• Environmental factors such as exposure to strong odours from household chemicals or perfumes
• Exposure to allergens.
• Strenuous physical activity.
• Hormonal changes.
• Lack of sleep or disturbed sleep.
• Other factors include stress, women having menopause or menstrual period, and food habits.

The causes of the three main types of headaches

1. Primary headaches – they may be due to overactivity or problems in the pain-sensitive structures in the head, including:

• Specific areas of the brain
• Blood vessels
• Muscles
• Nerves
• Brain chemicals

The causes of the types of primary headaches are as follows:

• Tension headaches – are the most common type of primary headaches, and the cause remains unknown. It is presumed to be due to various factors that cause inflammation or irritation of the structures present in the head and upper part of the neck. The most common sites of tension headaches are the forehead, the temples (muscles that move the jaw located in this area), and the region where the trapezius muscle of the neck joins at the base of the skull. Physical stress (manual labour and sitting at a computer or desk for a prolonged time) and emotional stress can also cause this type of headache. 
• Cluster headaches – are usually caused by a sudden release of chemicals (serotonin and histamine). They frequently occur for a long period of time or may occur daily (periods of the week).

• Migraines – are caused when unstable nerve cells overreact to different triggers. The nerve cells send out impulses to blood vessels and lead to chemical changes in the brain resulting in a lot of pain.
• The cause of new daily persistent headaches (NDPH) is unknown. It normally develops in people with no previous or significant headache history.

2. Secondary headaches are often caused by underlying structural disease or infections. They may be life-threatening and must be diagnosed and treated effectively. Diagnostic testing can be done to identify the causes of underlying diseases. The other causes include:

• Trauma to the head and neck. This trauma may cause edema and swelling in the brain (without bleeding), pain, bleeding inside the space in the brain (between the meninges), concussions without bleeding due to head injury, post-concussion headache and, pain due to a neck injury and whiplash injury.
• Systemic infections include pneumonia, influenza, encephalitis, meningitis. In certain cases, HIV/AIDS can cause secondary headaches
• Problems in blood circulation (arteriovenous malformations) and head and neck injuries causing TIA (Transient ischemic attack) or stroke may lead to secondary headaches. Inflammation of the carotid and temporal arteries, and aneurysm (a weakened area in the blood vessel causing bleeding) can also cause headaches.
• Seizures, brain tumours (cancers), and hypertension (high BP) can also cause significant headaches.
• Medications and drugs that are used in treating cardiac problems, hypertension, cardiac problems, erectile dysfunction, and oral contraceptives can lead to a headache. Pain medications, narcotics, and some analgesics such as ibuprofen and aspirin can also cause headaches too. 
• Infections of the teeth, nose, and eyes such as sinusitis, iritis, glaucoma, and dental pain can be the reason for headaches.
• Underlying diseases like hypothyroidism and high blood pressure (hypertension) may cause headaches. Patients suffering from dehydration or kidney failure may also experience secondary headaches.

3. Rebound headache: The headache medications that usually cause rebound headaches are painkillers, combination of pain relievers, migraine medications, and opiates. If the recommended daily doses are exceeded, aspirin and acetaminophen may contribute to rebound headaches. The common culprits are pain relievers that combine aspirin, caffeine, and acetaminophen. High risk is seen in Butalbital-containing compound. Triptans (sumatriptan) and certain ergots such as ergotamine used in the treatment of migraine often cause this type of headache. Painkillers derived from synthetic opium compounds include combinations of codeine and acetaminophen, and they can also cause this type of headache.

What do headaches feel like?

Headache symptoms vary, depending on the type of the headache the patient experiences:

1. Tension headaches: As this is the most common form of headaches, the pain tends to be:

• Mild to moderate
• Consistent without throbbing
• On both sides of the head (bilateral)
• Worse during routine activities such as bending over or walking upstairs
• Responsive to over-the-counter treatment

2. Migraines: This is the second most common headache. The suffering from migraines experience:

• Nausea or vomiting
• Moderate to severe pain and in some cases, pounding or throbbing pain
• Headaches that last for four hours to three days
• Sensitivity to light, noise, or odours
• Abdominal pain

3. Cluster headaches: These are the most severe form of primary headache and as the name suggests come in groups or clusters. They occur one to eight times a day and may lead to two weeks to three months. Sometimes, these headaches may disappear completely for months or years, only to return later. The patient experiencing the pain of a cluster headache may get:

• Intense with a burning or stabbing sensation.
• Situated behind one of the eyes or in the eye region and does not change sides.
• Throbbing or constant.

4. Sinus headaches: it is a result of a sinus infection caused due to congestion and inflammation in the sinuses – it is the open passageways behind the checks and forehead. Most often, healthcare providers and individuals mistake migraines for sinus headaches. The symptoms may include:

• Deep and constant pain the cheekbones and forehead
• Bad taste in the mouth
• Facial swelling
• Feeling of fullness in the ear
• Pain that worsens with sudden head movement or straining
• Fever
• Mucus discharge

5. Medication overuse headaches: These are also called rebound headaches. It affects close to 5% of people who frequently take pain relievers for headaches. Constant intake of pain relievers may eventually lead to the increase of the number of headaches. The signs of medication overuse headaches include:

• Headaches may become more frequent
• Experience more headaches than without
• Pain that is worse in the morning

6. Headaches in children:  Most children experience headaches when they reach high school. In close to 20% of children experience tension headaches and migraines are a reoccurring problem. The triggers include:

• Certain foods
• Change in sleep cycle
• Environmental factors
• Stress

7. New Daily Persistent Headaches: These come on suddenly and last for more than three months. These typically occur in individuals who haven’t experienced frequent headaches before. The pain is:

• Constant and persistent without easing up
• Located on both sides of the head
• Non-responsive to medications

headache symptoms

The symptoms of headaches differ depending on the type of headache.

1. Primary headaches

a. Tension Headaches
The common signs and symptoms are

• Pain is associated with band-like tightness or pressure and may encircle the head. The pressure is felt at the temples and all over the forehead. Bilateral pain (pain on both sides) is seen. 
• Nausea and vomiting are not seen in this type. The headache is not aggravated by sound and light. 
• The quality of life is not affected much, and the patient can follow a daily routine.

b. Cluster Headaches

• The pain comes in groups (as clusters) separated by pain-free periods. The pain can last from months to years, and one may not experience headaches for a few months to years. These headaches often wake the patient in the middle of the night.
• Each episode of the pain may last from 30-90 seconds. It is excruciating pain and usually occurs behind or around the eyes. The nose on the affected side may become runny or congested, and the eyes may become watery, swollen, or inflamed.
• It may be hereditary. Sleep pattern changes, medications such as nitroglycerin, alcohol consumption, cigarette smoking and some foods such as smoked meats and chocolate may trigger these headaches.
• According to a study conducted, brain scans performed on patients during cluster headaches, researchers observed abnormal activity in the hypothalamus. 
• Regularly counselling is required for patients with such headaches as they might develop suicidal tendencies (due to excruciating and throbbing pain).   

c. Migraines
The symptoms of migraines include the following:

• Moderate to severe pain and in some cases pounding or throbbing pain
• Pain that lasts between four hours to three days
• Nausea or vomiting
• Sensitivity to light, noise, or odours
• Stomach upset or abdominal pain

2. Secondary headaches

a. Sinus headaches
The symptoms of sinus headaches include the following:

• Fever 
• Bad taste in the mouth
• Facial swelling
• Deep, constant pain in the cheekbones and forehead
• A feeling of fullness in ears
• Pain that gets worse with sudden head movement or straining

b. Medication overuse headaches
The symptoms of medication overuse headaches include the following:

• Nausea
• Restlessness
• Difficulty concentrating
• Memory problems 
• Increase in frequency of headaches
• Pain that’s worse in the morning

c. Thunderclap headaches
The symptoms of thunderclap headaches include:

• Numbness
• Weakness
• Speech problems
• Nausea or vomiting
• Seizures
• Change in vision
• Confusion
• Change in sensation

3. Rebound Headaches

They wake the patient during sleep in the early hours. As such, headaches occur almost every day. They can be relieved by painkillers, but the headache rebounds as the medication wears off. The common signs and symptoms seen are:

• Nausea
• Restlessness
• Irritability
• Difficulty in concentration
• Memory problems

People should seek the advice of their physician if they have the following symptoms:

• If a headache is aggravated by coughing, bending over, exertion, or sexual activity.
• If it is associated with fever and neck stiffness, vomiting or nausea, seizures, and changes in speech and behavior.
• If it is related to any recent trauma or injury
• If it is persistent and affects the quality of life
• If a headache worsens even with the use of medications

Diagnosis of headaches

A headache is diagnosed only after receiving a detailed patient history. A physician may ask questions regarding the

• Duration and quality of pain
• Whether accompanied by nausea or vomiting and
• Location of the pain and other associated symptoms

Diagnosis of primary headaches

1. Tension headaches: The diagnosis of a tension headache is done when the patient’s complaints of pain that are mild to moderate, worsens with activity, and is located on both the sides of the head. Typically, the pain is non-throbbing in pain and may not be associated with symptoms such sensitivity to light, sound, ad odour, vomiting or nausea. Neurological examination is usually done, and the results are often normal. When pressure is applied to the scalp or neck muscles, some tenderness may be observed.
2. Cluster headaches: The diagnosis is done after receiving the patient’s history and the description of episodes of pain. During the attack of this headache, redness and swelling of an eye on the affected side can be observed. The nose on the affected side may be runny or congested.

Diagnosis of secondary headaches

 The diagnosis is done based on the patient’s history followed by a physical examination.  Laboratory and radiology tests can also be done. If a headache is caused due to the underlying infections or diseases, then the doctor may decide to start the treatment even before the diagnosis is confirmed.

Laboratory Investigations Include

• CBC (Blood Tests): Rise in the white blood cell count, the erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP) is seen when infection or inflammation in the body is observed.

• Toxicology Tests:  It may be helpful in the patients suspected of abusing alcohol, other drugs of abuse or prescription drugs.

• CT Scan (computerized tomography): Used to detect swelling, bleeding and, some tumours within the skull and brain and aneurysms.

• MRI (magnetic resonance imaging) of the head shows the anatomy of the brain and the layers that cover the brain and the spinal cord.

• Lumbar Puncture spinal tap is done in cases suspected of meningitis.
• EEG is helpful only if the patient passes out during a headache.

Risk factors for headaches

The common risk factors of a headache are:

• Depression
• Anxiety
• Female sex
• Sleep disturbances
• Snoring
• Obesity
• Caffeine overuse
• Overuse of painkillers for a headacheChronic pain conditions

• Tension headaches: These risk factors are caused by the tightening of muscles in the neck like teeth clenching and grinding, anxiety, depression, gum chewing in children, spondylosis, or arthritis in the neck and being overweight. Emotional stress, anger, fatigue, smoking, little physical activity, and disturbed sleep are other risk factors.

• Migraine: Loud or sudden noises, disturbed sleep, emotional events, skipping meals, excessive alcohol use, and hangovers. Food products such as aged cheeses, fermented or pickled foods, chocolate, and processed foods. Other risk factors include medications such as birth control pills, changes during menstruation, glaring lights, perfumes, and odours.

• Cluster Headaches: The major risk factor is smoking as this type is often seen in smokers. Another risk factor is a head injury.

• Sinus Headache: In these headaches, major risk factors include allergies, persistent ear and nose infections, nasal deformations, nasal polyps, deviated nasal septum, previous sinus surgeries, and a weakened immune system.

What is the difference between a migraine and a headache?

Both these conditions affect the head and neck parts of the body; each condition has its own set of symptoms:

Conclusion

Headaches affect almost everyone, and the causes of headaches are many. While most cases of headaches tend to go away on their own, with home remedies, or through over the counter medication. But persistent headaches need to be checked by a physician, as they can indicate the presence of another underlying disorder. 

Diagnosis of headaches

A headache is diagnosed only after receiving a detailed patient history. A physician may ask questions regarding the

• Duration and quality of pain
• Whether accompanied by nausea or vomiting and
• Location of the pain and other associated symptoms

Diagnosis of primary headaches

• Tension headaches: The diagnosis of a tension headache is done when the patient’s complaints of pain that are mild to moderate, worsens with activity, and is located on both the sides of the head. Typically, the pain is non-throbbing in pain and may not be associated with symptoms such sensitivity to light, sound, ad odour, vomiting or nausea. Neurological examination is usually done, and the results are often normal. When pressure is applied to the scalp or neck muscles, some tenderness may be observed.
• Cluster headaches: The diagnosis is done after receiving the patient’s history and the description of episodes of pain. During the attack of this headache, redness and swelling of an eye on the affected side can be observed. The nose on the affected side may be runny or congested.

Diagnosis of secondary headaches

 The diagnosis is done based on the patient’s history followed by a physical examination.  Laboratory and radiology tests can also be done. If a headache is caused due to the underlying infections or diseases, then the doctor may decide to start the treatment even before the diagnosis is confirmed.

Laboratory Investigations Include

• CBC (Blood Tests): Rise in the white blood cell count, the erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP) is seen when infection or inflammation in the body is observed.

• Toxicology Tests:  It may be helpful in the patients suspected of abusing alcohol, other drugs of abuse or prescription drugs.

• CT Scan (computerized tomography): Used to detect swelling, bleeding and, some tumours within the skull and brain and aneurysms.

• MRI (magnetic resonance imaging) of the head shows the anatomy of the brain and the layers that cover the brain and the spinal cord.

• Lumbar Puncture spinal tap is done in cases suspected of meningitis.

• EEG is helpful only if the patient passes out during a headache.

Treatment for headaches

Physical Therapy

Tension Headaches

Stress management can also be used to treat tension headaches.
Over-the-counter medications are to be used with precaution and are advised to be taken only when your physician prescribes the medications. Some over the counter medications have side effects. Aspirin increases the risk of Reye’s syndrome and should not be used in teenagers and children. Kidney damage can be caused by overuse of aspirin, ibuprofen, and naproxen. If acetaminophen is taken in large doses, it can cause liver damage or failure.
When painkillers are used for a prolonged period, headache may recur when the medication wears off. This type of headache was referred to as a “rebound headache,” and is classified as a secondary headache.

Cluster headaches

The treatment of a cluster headache is aimed at controlling the pain of a headache and preventing the episodes of a headache that follows them. They do not have a definite protocol for the treatment and your physician may suggest many treatment options before a specific treatment is confirmed.

Other Treatment Options to Treat Headache

• High concentrations of oxygen are inhaled,
• Spraying of a local anesthetic (lidocaine) into the nostril,
• Using medications like dihydroergotamine (medication that causes constriction of blood vessels)
• Injection of sumatriptan and rizatriptan (triptan medications) that are used commonly in a migraine and,
• Drugs that contain caffeine,
• Drugs such as calcium channel blockers, prednisone, lithium and anti-seizure medications (valproic acid and topiramate) can prevent cluster headaches.

Home Remedies

They can also be used in thetreatment of a headache.
Staying well hydrated and getting good sleep is helpful in tension headaches.
Rubbing or massaging the muscles of the back and temples may relieve a headache.
Humidifying air may be helpful (in sinus problems).

Education

It includes identifying the triggering factors and duration of your headache. Additional causes like eating certain foods, having caffeine, not having proper meals at regular times and stress patterns have to be identified to treat a headache.

Stress Management

The cause of stress that triggers a headache has to be identified and treated accordingly. Deep breathing exercises, progressive muscle relaxation and relaxation to music can relieve stress and headache.

Counseling

Coping techniques such as group therapy, one on one sessions and counseling can be taken to identify the risk factors causing headache.

Biofeedback

It is the equipment that includes sensors connected to your body. The equipment examines the involuntary physical response (physical reaction of the body in stressful conditions that triggers headache) to headaches such as breathing, heart rate, pulse, brain activity and muscle tension.
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Prevention of headaches

A headache can be prevented by taking certain precautions like

• Avoid triggering factors like severe physical activity, stress, and certain foods (smoked meat).
• Take prescribed medications at the right time (Do not overuse the medications and do not take less than the prescribed dosage)
• Cluster headaches cannot be prevented but can be minimized by lifestyle changes such as avoiding alcohol and smoking.
• Exercise regularly (can reduce stress and pain)
• Maintain good sleeping habits (a regular sleep pattern is important for reducing the risk of a headache).
• Quit smoking and lose weight to reduce the risk of a headache.
• Consult the physician if there is a change in the pattern of the headache.

What Causes Headaches?
Frequently Asked Questions (FAQs)

• What does a COVID headache feel like? 

COVID headaches are slightly different from headaches caused by other conditions. They tend to be more pulsating in intensity, occur on both sides of the head and can be resistant to painkillers. 

• What can you eat to stop headaches? 

Consuming leafy vegetables and nuts are known to reduce and stop headaches.

• What type of headaches are serious? 

Headaches that are intense in pain and that cause fevers are serious, and they need to be checked by a physician at the earliest. 
 

• What is the most painful headache?

Cluster headaches are known to be the most painful headaches in the world.