Migraine and Headache Awareness Month

June is National Migraine and Headache Awareness Month. Now is the perfect time to learn about the types of headaches people can have, the causes of migraines and overall headache treatment options.  

Types of Headaches

The word “headache” is a broad term used to describe pain in the scalp, head and neck. There are many different types of headaches. They may be primary conditions such as tension headaches, migraines and cluster headaches, or they may occur due to underlying health conditions. 

Headaches are very common, most people experience them to some degree during their life.  

“Headache disorders are amongst the world's most debilitating conditions globally,” says Susan Broner, M.D., medical director of the Weill Cornell Medicine Headache Program. “In fact, migraine itself is the second most disabling condition in the world in terms of years lost to disability. And if you look at populations of people under 50, it's the first most disabling condition yet many people go undiagnosed and untreated.” 

Severe or recurring headaches of any type can significantly impact daily life. Learning about them can help you communicate your concerns more clearly to your primary care provider. 

Tension Headaches

Tension headaches are the most common type of headache. People often experience occasional tension headaches and don’t seek medical care. However, if you have tension headaches 15 days per month or more, you should consult with your primary care provider. 

Causes of Tension Headaches

These headaches are caused by tense muscles around the head and neck, often due to stress, anxiety or depression. Tension headaches may also be triggered by: 

  • Alcohol 
  • Caffeine or caffeine withdrawal 
  • Dental problems such as frequently grinding your teeth or clenching your jaw 
  • Eyestrain 
  • Keeping your head in one position for a long time 
  • Not getting enough sleep 

Symptoms of Tension Headaches

Tension headaches typically feel like dull pressure around the head. You may also feel muscle tightness in your head or neck.  

The pain is usually mild to moderate and is not accompanied by other symptoms. Tension headaches can last from half an hour to a week. 

Treating and Preventing Tension Headaches

Occasional tension headaches can often be prevented by:  

  • Exercising regularly 
  • Getting enough sleep 
  • Maintaining good posture while seated and taking breaks from sitting 
  • Managing daily stress 

Chronic tension-type headaches are typically treated with stress reduction techniques such as meditation or cognitive behavioral therapy and biofeedback 

Over-the-counter pain medications (e.g., ibuprofen or acetaminophen) may be used to decrease pain. Muscle relaxers or prescription antidepressants may also be recommended in some cases. 

Migraines

While tension headaches are the most common, they’re not what drive people to see a healthcare provider. 

“Although tension-type headaches are the most common headache disorder and about 70% to 80% of people will experience them, they’re generally less debilitating,” Dr. Broner says. “Migraine is really the most common headache disorder that I see in my practice.” 

Migraines are a severe, recurring type of headache that is often debilitating. About 12% of people in the United States have migraines and they are more common in women. 

Causes of Migraines

The exact cause of migraines is unknown. But researchers believe that genetics plays a part. Having certain medical conditions may increase your risk of developing migraines, including: 

  • Anxiety 
  • Bipolar disorder 
  • Depression 
  • Epilepsy 
  • Sleep disorders 

Migraines can be triggered by several factors. Caffeine is one of the more common triggers people encounter. [Text Wrapping Break] Caffeine is always a mystery to people because many people find that it helps a headache,” Dr. Broner says, “but some data suggests that drinking more than eight ounces a day of caffeine, whether it's coffee or tea or sodas can increase your risk of having more frequent migraines.” 

Other common migraine triggers include: 

  • Caffeine or withdrawal from caffeine 
  • Certain medications or taking particular medications too often 
  • Changes in the weather 
  • Dehydration 
  • Flashing or bright lights 
  • Getting too much or not enough sleep 
  • Hormonal changes in women 
  • Loud noises 
  • Skipping meals 
  • Stress 
  • Strong scents 
  • Too much physical activity (overexertion) 

Certain foods, drinks and ingredients may also trigger migraines in some people, especially if other triggers are present at the same time. Some of these triggers are: 

  • Aged cheeses 
  • Alcohol 
  • Certain fruits, such as avocados, bananas, citrus fruit or figs 
  • Chocolate 
  • Monosodium glutamate (MSG) 
  • Pickled or fermented foods 
  • Processed meats 

Symptoms of Migraines

Migraines have four phases: prodrome, aura, headache and postdrome. Each phase features different symptoms. However, not everyone goes through every phase during each migraine. 

Prodrome is the first phase of a migraine. It starts up to 24 hours before other migraine symptoms. This phase may cause: 

  • Cravings for specific foods 
  • Frequent urination 
  • Uncontrollable yawning 

The second phase of a migraine is an aura. It happens just before or during the headache phase of a migraine. You may see bright or flashing lights or zig-zag lines during this phase. You also may feel like you are being grabbed or touched or have muscle weakness. 

The headache phase often begins slowly and worsens over time. A migraine headache feels like pulsing or throbbing pain and may be very severe. Typically, your pain will be on one side of your head. With a migraine, you might also experience: 

  • Increased pain with movement, sneezing or coughing 
  • Nausea and vomiting 
  • Sensitivity to light, smells and sounds 

Postdrome follows the migraine phase. It may last for a day, and you may feel weak, confused or exhausted.  

Migraines are more likely to occur in the morning—it is common to wake up with a migraine. Some people have a predictable pattern of migraines, such as just before a menstrual period. Other people may have trouble recognizing a pattern to figure out what triggers their migraines. 

Migraine Treatments and Prevention

There is no cure for migraines, but there are steps you can take to help relieve symptoms. 

Over-the-counter triptans and pain relievers may help relieve symptoms. Medication is most effective when taken as early as possible during a migraine.  

It may also help to: 

  • Drink plenty of water 
  • Put an ice pack or cool cloth on your forehead 
  • Rest with your eyes closed 
  • Stay in a dark, quiet room 

Lifestyle changes like exercising regularly, eating a balanced diet, having a regular sleep schedule and taking steps to manage daily stress are often helpful in preventing or decreasing the frequency of migraines.  

“Migraines are something that we don’t cure, but we can manage,” Dr. Broner says. “For some people, lifestyle factors make a big difference. Those lifestyle factors include things like hydration, limiting caffeine, [and managing blood sugar by] eating balanced meals with protein, veggies and whole grains, not skipping meals, and keeping healthy snacks on hand. Also, stress is a big factor.” 

If you have frequent migraines, you may benefit from prescription blood pressure, anti-seizure or antidepressant medications. Botox injections have also been shown to help prevent migraines.  

Some alternative therapies may also help prevent migraines, including: 

  • Acupuncture 
  • Biofeedback 
  • Cognitive-behavioral therapy 
  • Massage therapy 

Cluster Headaches 

People with cluster headaches will have daily or almost-daily headaches for weeks or months, separated by a month or more with no headaches. Cluster headaches affect more men than women.  

Causes of Cluster Headaches

The cause of cluster headaches is unknown, but they often run in families. Cluster headaches may be related to a sudden release of certain chemicals in the body, particularly near a facial nerve called the trigeminal nerve.  

Triggers may include: 

  • Alcohol 
  • Being exposed to heat 
  • Bright lights 
  • Overexertion 
  • Processed foods 
  • Smoking 

Cluster Headache Symptoms

Cluster headaches start as sudden, severe headaches on one side of the head. You may also have a stuffy nose, drooping eyelid, a watery eye, swelling or redness on the same side as the pain.  

The pain typically feels like a burning or sharp pain on the side of the face. Pain often peaks within the first 10 minutes and lasts for up to two hours.  

Cluster headaches typically start within two to three hours of falling asleep but may also happen while awake. 

Treating and Preventing Cluster Headaches

Acute cluster headaches are often treated with anti-inflammatories, triptan medication or dihydroergotamine (DHE) injections. 

Antidepressants, corticosteroids or medications for allergies, blood pressure and seizures may be used for long-term treatment or prevention. 

Identifying and avoiding triggers and dealing with stress are essential parts of managing cluster headaches. 

Surgical options may be recommended when medications and avoidance of triggers are ineffective. One option is implanting a neurostimulator to send electrical signals to specific nerves. 

Diagnosing Headaches

A physical exam is the first step in diagnosing headaches. Your provider will take a medical history and ask you about your symptoms 

Your provider may also order blood tests, neurological testing or imaging tests to get more information and rule out other possible medical conditions that could be causing the headaches.  

Tracking your headache symptoms as they happen can help you identify your triggers. The information you collect may also help your provider decide what treatment options are best for you. 

“There are so many treatments for headaches,” Dr. Broner says. “If you find yourself struggling with headaches and you take your medicine and it works, but headaches just come back or you're getting more frequent headaches, speak to either your doctor or a headache specialist or neurologist about what other treatments and approaches you can take to really get your headaches under control.” 

If headaches impact your life, it’s time to seek help. 

The experts at Weill Cornell Medicine Headache Program are here to help. Call (212) 746-2596 to make an appointment with a specialist. 

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