Headaches: Types, Causes, Diagnosis, and Treatment
Having a headache can be a real…headache. You may be able to power through the occasional mild head throb, more severe ones can interfere with the ability to fulfill the responsibilities and commitments of daily life. Often it is necessary to take time off completely in order to fully recover. Recurring headaches or worse, migraines, can really reduce your quality of life. This drives most people to seek some form of treatment.
In this article, we will take a close look at headaches and migraines: What are the different types/symptoms? What causes them? How are they diagnosed? How are they treated? I especially want to highlight for you the latest research on natural approaches for headache and migraine management. The second half of this article addresses the treatments for headaches.
Types of Headaches
You might be surprised to learn there are more than 150 different types of headaches! Now, for the sake of time, space, and general reading ease, I am not going to discuss all of them here. Instead, I want to highlight some of the most common types and their symptoms. As you read about these, some of them may sound familiar and you may be able to pinpoint the types you have experienced.
The most common type of headache among teens and adults is the tension headache. This type of headache usually just has the primary symptom of mild to moderate pain. Typically, this type of headache will dissipate on its own over time, perhaps as the tension causing stressor remits, after a bit of rest, or with the help of some over-the-counter pain medication.
Sinus headaches are so named because the pain occurs along the sinus region of the face. This means deep and constant pain in the forehead, cheekbones, and bridge of the nose. Aside from pain, there may also be symptoms of runny nose, discomfort in the ears, and perhaps a fever. The pain and symptoms are due to inflammation in the sinuses, usually as a result of sinus infection.
Posttraumatic stress headaches occur after a head injury. Aside from a pain that might feel like a dull ache, other symptoms include: lightheadedness, vertigo, difficulty concentrating, memory problems, irritability, and fatigue. Such headaches will usually last for a few months after the head injury. Given the cause, it is advisable to consult a doctor and have these headaches properly examined.
Exercise headaches are less common, and they are so named because they are the result of activity a person might be engaged in during exercise. During that activity, the head, scalp, and neck need more blood. To facilitate this, the blood vessels swell. This can cause a pulsing pain throughout the skill. This type of headache can last up to 48 hours but will usually remit on its own.
Some women may suffer from hormone headaches due to changes in hormonal levels as a result of menstruation, pregnancy, or menopause. Hormone replacement therapy and birth control pills can also cause these headaches. Depending on the timing of these headaches, if they occur just before the start of menstruation or just after the start of menstruation, they may be menstrual migraines.
Migraines are often thought of as the worst type of headache a person may experience. They typically involve throbbing and even pounding pain. Other symptoms may include sensitivity to stimuli such as light and sound, blurry vision, nausea/vomiting, stomach pain, and low appetite. These can last for hours to days. For some people, migraines can be recurring, occurring perhaps several times each month.
Although migraines might be typically thought of as the worst type of headache, medical professionals consider cluster headaches to be the most severe. A cluster headache involves an intense piercing or burning pain around or behind one eye. This pain may be constant or throbbing. The location of the pain may also cause eye reddening, pupil contraction, and eyelid drooping.
Part of the challenge with cluster headaches is that they occur in groups. This is how they got their name, as they occur during what is called a cluster period. During these cluster periods, headaches may occur several times per day, lasting up to 3 hours at a time. This can go on for weeks or months. The cluster headaches may remit for a period of time, only to return months or years later.
A more unusual type of headache is hemicrania continua. This type usually affects one side of the face and head. The pain can be chronic and almost ongoing, although the severity may vary. The pain may worsen during physical activity or when drinking alcohol. Other symptoms can include stuffy nose, teary eyes, droopy eyelid, and contracted iris. There may also be stimuli sensitivity and nausea/vomiting.
Another particularly troublesome type of headache is the new daily persistent headache. This type of headache will have a sudden onset and can last three months or more. The pain is most often moderate but can be more severe. Doctors are not entirely sure what causes these headaches. It could be infection or illness that triggers them. As a result, these headaches are difficult to treat.
Chronic daily headaches may be diagnosed when a person experiences headache during 15 days or more per month, for at least three months. With this diagnosis, the headaches may be short, or they may last for hours. This diagnosis can be assigned with various types of recurrent headaches: chronic tension headache, chronic migraine, new daily persistent headaches, and hemicrania continua.
These are some of the most common types of headaches and their symptoms. As noted, there are many other types, another one worth mentioning is a headache caused by stopping a medication for pain or an antidepressant. Each type may have various causes, but there are some commonalities. Knowing which type you suffer from can help you to figure out the cause or causes, which can help with selecting treatment options.
Causes of Headaches
Headache pain is the result of signals between your brain, nerves, and blood vessels. The nerves may tell your blood vessels and the surrounding muscles to send pain signals. In some ways, it is still unclear exactly why these signals get triggered and how all this communication happens. Nonetheless, research has found some common causes of headaches, that seem to lead to these unpleasant outcomes.
Some headaches seem to be caused by illness. Most people can recall some instance where they were sick and one of their symptoms was a headache. Infections, fevers, and colds can cause headaches. Emotional stress can cause headaches, especially when that stress alters sleep patterns and diet. Finally, environmental factors and genetics may make some people more prone to experiencing headaches.
Doctors are more uncertain about the causes of migraines as it is more complex. One theory is that some factors cause unusual brain activity, which then causes changes in the blood vessels. Lifestyle factors, diet and physical activity patterns also play a role in triggering migraines. There is a genetic contribution to migraines as well. This means that if your parents and close relatives suffer from migraines, you are at an increased risk for experiencing them too.
Diagnosis of Headaches
Most people will not go immediately to the doctor when they experience a headache. However, there are some instances when you should. A severe headache with a sudden onset could be a warning sign before a stroke or other serious medical event. Going to the doctor right away will be crucial to get treatment. Otherwise, most people will seek medical help with their headaches are recurring.
When you visit a doctor for diagnosis of headaches, they will likely start by gathering information about your symptoms and history. Then, they will give you a physical exam, which may include some scans. They may also ask you to track information about your headaches, such as when they occur. They may also ask you to complete other diagnostic tests, such as an electroencephalogram (EEG).
Treatments for Headaches
Depending on your symptoms and diagnosis, your doctor may recommend various types of treatment. One of the most common approaches is the use of medication. Some medications may be used daily to prevent headaches/migraines. Other types of medication may be used when a headache or migraine starts, to reduce the severity and shorten the duration. However, medication use can be challenging.
One reason to limit using medication to treat headaches is to avoid something called a rebound headache. This type of headache occurs as a result of medication overuse. Research indicates that using a prescription or over-the-the counter pain medication more than twice per week can lead to this problem. Essentially, when the medication wears off, the pain returns and may be difficult to treat.
Aside from the risk of rebound headaches, most medications will produce at least some side effects. Also, if the medication is prescribed and not over-the-counter, it may be costly. For these reasons, many people choose instead to use other approaches. In some cases, attending psychotherapy may be helpful, such as to develop stress management skills. Other lifestyle changes may also be necessary.
While lifestyle changes could seem as simple as getting enough sleep, being active with exercise, and eating a healthy diet; recent research shows the latter of these—diet, may be particularly important. I am excited to highlight more of the dietary methods, alternate approaches, and other lifestyle changes that can help to manage headaches/migraines.
Final Thoughts for Now…
Headaches really are no laughing matter. The symptoms can range from annoying to debilitating. If you are looking for a way to reduce your headaches and get back your quality of life, consider working with an integrative provider. These specialists offer a combination of medical and psychological approaches to make a holistic and unified treatment plan to help you manage your headaches. To locate an integrative provider near you, search online (for example, “Integrative Psychiatry in Brooklyn”).
Headaches: Alternative and Holistic Treatment Approaches
In this part of the article, I want to highlight some of the alternative and more holistic treatment options for headaches. There is a respectable body of research literature on this topic addressing various aspects of lifestyle and dietary changes, along with natural remedies, that may be beneficial:
As I noted earlier stress can be a factor in some types of headaches. For this reason, many people do choose to pursue approaches that will allow them to improve their stress management skills and thereby reduce their stress levels. Psychotherapy may be the most obvious approach to doing this; however, there are several other options that can also be beneficial.
Therapists can teach relaxation skills for stress management. One approach many people find beneficial is biofeedback. This uses technology to give real-time information about stress responses in the body, which includes factors such as heart rate, and breathing pace. By knowing this information, and using relaxation techniques, you can learn to reduce those stress responses and induce a state of calm.
Alternative headache treatments are also helpful because of their abilities to result in stress reduction. For example, massage is often recommended and seems to be helpful because it also promotes muscle relaxation and blood flow, which can assist with some types of headache including migraine. It may be beneficial to receive a chiropractic massage from someone trained to target the necessary muscles.
Aromatherapy has also been found to be helpful in the treatment of migraine. If you are not familiar with aromatherapy, it involves using plant extracts (usually called essential oils) for mind and body wellness. Essential oils can be put directly on the body, placed into bathwater, or diffused into the air. Many people use an aromatherapy diffuser, in which they can place whichever oil they prefer.
Lavender oil and peppermint oil seem particularly helpful for migraine management. A research study confirmed that inhaling lavender is a safe treatment for migraine management. Many people also like to spray lavender on their pillow to help them sleep at night. Peppermint oil is also recommended because it has calming properties. Other options include wintergreen, basil, and ylang-ylang.
Acupuncture is another approach that works by way of stress management. If you have not seen my series on acupuncture, be sure to check it out. One of the biggest take-aways from it, is that acupuncture was historically misunderstood. It works on much more than just ‘energy’ and in fact the fine needles used have been found to stimulate the nervous system, which can have various benefits.
Two benefits of acupuncture include its ability to help with relaxation and restoration of homeostasis in the body. Also helpful to headache management, is that acupuncture seems to trigger the body to release pain blocking chemicals (such as endorphins). This makes it ideal for pain management. Taking these benefits collectively, this approach certainly appears useful for the management of headaches.
As noted, psychotherapy can be helpful for headache sufferers. I want to elaborate on this because, in this case, therapy can do much more than just assist with stress management. One particularly helpful approach seems to be cognitive behavioral therapy (CBT). This is not surprising because CBT is one of the most popular and well-proven forms of therapy, it is known to be helpful for many conditions.
In this case, CBT helps with people’s secondary reactions to headaches/migraines. You might wonder what that means. Well, headaches are unpleasant and oftentimes, people who suffer recurrent headaches start to become fearful and anxious about the possibility that they will have another one. The problem is, that fearing setting off a headache can prevent individuals from engagement in activity, and the stress of it can actually trigger a headache.
CBT is the gold-standard approach for addressing fear-based anxiety. One of the ways this can be done is by learning to recognize automatic negative thoughts that might then lead to anxiety. For example, perhaps you have had a few headaches and you start thinking, “I will get a headache every day now.” Well, that is going to set you up for some anxiety and hold you back from life.
By learning to recognize these thoughts and then learning to challenge them (for example, perhaps thinking instead “There are many days where I do not have migraines”) you can shut off that anxiety and prevent some of the deleterious effects it might otherwise have on your health. CBT also often teaches people new techniques for stress management. Altogether, it all ends up being a very helpful approach.
Others might prefer and benefit from behavioral therapy, which focuses more on outward behavior rather than inner thoughts. In this approach, the psychotherapist helps their client to identify headache triggers, which may include stress. Then, the psychotherapist teaches techniques for how to manage those triggers in effective ways. Simply avoiding the triggers may not always be helpful in the long-term.
Finally, in some cases, psychotherapy may be most helpful for headache management as just a source of support. Recurring or chronic headaches can themselves be stressful. This condition can be not only anxiety inducing but depressing as well. Having support from a therapist, who can validate those experiences and help you to identify ways to still have a good quality of life, makes a lot of sense.
As previously mentioned, good headache management can require some lifestyle changes. A great deal of research has indicated that dietary changes may be particularly beneficial. This can entail making changes to what you eat, adding certain herbs into your diet, and even taking vitamins/supplements. I am excited to delve into the research findings with you, to help you design a headache management diet.
Before making any changes, first evaluate your current diet. You might begin by considering whether you regularly ingest certain foods that are known to trigger headaches and migraines. Research has shown that foods such as caffeine, aged cheese/meats, alcohol, citrus fruits, chocolate, MSG, and spicy foods may trigger headaches for some people. To find your triggers, consider keeping a food journal or going through an elimination diet where you temporarily remove the suspect foods from you diet and observe for changes in headache frequency or intensity.
Next, you may want to evaluate the quality of the fat you consume. Some research suggests that eating less fat and the right kinds of fat will help your headache management. It seems that omega-3 fatty acids, such as those found in nuts and fish, are helpful. Research shows that supplementation with fish or olive oil can have similarly beneficial effects for the reduction of headache severity and duration.
Aside from eliminating trigger foods and monitoring fat quality, research suggests you may want to consider a ketogenic diet. A comprehensive study from Martin and Vij (2016) showed that a ketogenic diet was more effective for reducing migraine frequency, compared to a standard diet. It is believed that a ketogenic diet helps to counteract the neuroinflammation associated with migraines.
A ketogenic diet takes a low-carb, moderate-protein, and high-fat approach. It is thought that by reducing carbohydrates, the body’s metabolic state will be altered by switching to running on ketones rather than running on glucose. This causes the body to get efficient at using fat for energy. It also prompts the liver to turn fat into ketones. These can then be used to supply more energy for the brain.
For headache sufferers, the low-carb diet is also beneficial through lowering inflammation. Several studies have indicated that carbohydrates may play a key role in causing inflammation throughout the body, including in the brain. Likewise, research shows that a low-carb diet reduces inflammation. This is what allows for the reduction in neurological inflammation that benefits headache sufferers. Such dietary benefits can also be enhanced by using specific vitamins and supplements.
Research shows several vitamins and supplements play a role in headache management. Sun-Edelstein and Mauskop (2009) identified the key factors: magnesium, riboflavin (vitamin B2), CoQ10, and melatonin. You may choose to take a multi-vitamin or a selection of over-the-counter supplements. Medical advice can be helpful to ensure the right combination for your unique needs.
Further, people have been using herbal remedies for thousands of years to treat all kinds of ailments and conditions. It is no surprise then, that at least a few herbs have been found helpful for headache prevention and treatment. From the recent research, two herbs stand out as particularly efficacious for headache management. These have lovely names—feverfew and butterbur.
Feverfew is often offered in capsule form after being derived from medicinal plants. Research shows it is helpful for treating multiple conditions, including headaches/migraines, with little risk for side effects. Butterbur can be taken in capsule form and it has been shown to make migraines less frequent. Because research on both herbs is ongoing, it is ideal to receive professional guidance on how to best use butterbur and feverfew.
Final Thoughts and Recommendations
Aside from stress management and dietary changes, you can help manage your headaches with regular sleep and exercise. All of this can seem simple enough “on paper” but it can be more difficult to put everything into practice. This is especially the case when there are so many small (and big) changes that may be necessary to add up to full headache management.
Many people would find it helpful to have a professional to guide them on the best approaches for their specific health situation, which in some cases could include other symptoms and ailments. An ideal option would be an integrative provider or an integrative care center and someone with whom you can work over time. As addressing chronic headaches may be a one to two year process of gradually adjusting the lifestyle, diet and treatments to make a significant and sustainable change.