Headache Types and Treatment Options

What is headache?Headache is a term used tooften as once or twice a week, but not daily.
describe aching or pain that occurs in one or moreWomen who have migraines often find that their
areas of the head, face, mouth, or neck.headaches occur or worsen around the time of
Headache involves the network of nerve fibers intheir menstrual periods.One unique feature of
the tissues, muscles, and blood vessels located inmigraines is an unusual sensation that a migraine is
the head and at the base of the skull.Almostabout to occur. This sensation is called a
everyone has occasional headaches, especiallyprodrome. Prodrome symptoms can include
when they are sick, tired or otherwise underfatigue, hunger and nervousness. Not all people
stress. Headache is the result of pain signalswho get migraines have prodromes.An aura is a
caused by interactions between the brain, bloodcomplex of neurological symptoms that occur just
vessels, and surrounding nerves. During abefore or at the onset of migraine headache. An
headache, the pain comes not from the brain. Itaura involves a disturbance in vision that may
comes from specific nerves surrounding the skull,consist of brightly colored or blinking lights in a
head muscles, and blood vessels that arepattern that moves across the field of vision.
activated and send pain signals, interpreted by theMost patients with migraine have attacks without
brain as a headache. The reasons why theseaura. About one in five migraine sufferers
nerves are activated are not clearly understood.experiences an aura.TreatmentHow your
Most headaches go away on their own or aremigraines are treated will depend on the
easily treated with over the counter (OTC)frequency and severity of attacks. People who
drugs.Headache typesThere are two mainhave a headache several times per year often
categories of headache: primary andrespond well to nonprescription pain
secondary.The major types of primary headachesrelievers.There are two types of medications to
include:treat migraines:
Tension headacheabortive medications - drugs that are taken
Cluster headachewhen a headache starts
Migrainepreventive medications - drugs that are taken
Primary headaches are not caused by otherevery day to prevent migraines
underlying medical conditions. More than 90% ofAbortive MedicationsMigraine-specific abortive
headaches are primary.SecondarySecondarymedications usually are necessary for moderate
headaches result from other medical conditions,to severe migraine headaches. When possible, an
such as cerebrovascular disease, head trauma,abortive medication should be taken immediately
infection, tumor, and metabolic disorder. Theseafter an aura or migraine headache starts.
account for fewer than 10% of all headaches.However overusing abortive medications can lead
Head pain also can result from syndromesto chronic headaches, that occur day after day
involving the eyes, ears, neck, teeth, or sinuses. Inwithout a specific cause or diagnosis. Several
these cases, the underlying condition must beprescription and nonprescription drugs are used as
diagnosed and treated. Also, certain types ofabortive medications: aspirin, ibuprofen (Advil,
medication produce headache as a sideApsifen, Motrin, Nuprin and other brand names) or
effect.Many people have occasional headachesnaproxen (Aleve, Anaprox, Naprosyn)Effective
that get better on their own or go away withagents available by prescription include:
OTC drug treatment. Most of these people never
see a healthcare provider for their headaches,Triptans - sumatriptan (Imitrex), naratriptan
however, there are several circumstances in(Amerge), zolmitriptan (Zomig) and rizatriptan
which an evaluation by a physician may be useful(Maxalt). Triptan drugs are effective in 60% to
or important:65% of patients, completely or significantly
relieving migraine pain and associated symptoms
Headaches that are getting worse over timewithin 2 hours of administration. Triptans reduce
Severe headaches that start suddenlyinflammation and constrict the blood vessels. The
Headaches that start after a head injurytriptan with the longest history of use is
Headaches that always occur on the same sidesumatriptan (Imitrex).
of the headErgots - sublingual ergotamine (Ergomar) and
Headaches that are not responding to treatmentdihydroergotamine (Migranal). Ergots cause
Severe headaches that interrupt work or theconstriction of blood vessels, but ergots tend to
enjoyment of daily activitiescause more constriction of vessels in the heart
Daily headachesand other parts of the body than the triptans,
Aggravated by exertion, coughing, bending, orand their effects on the heart are more
sexual activityprolonged than the triptans. Ergots are not as
Tension HeadacheTension headaches are thesafe as the triptans.
most common type of headaches. They affectMidrin. It is a combination of isometheptene (a
up to 75% of all headache sufferers. Tensionblood vessel constrictor), acetaminophen (a pain
headache is usually episodic but may be chronic,reliever), and dichloralphenazone (a mild sedative)
occurring daily or almost daily for more than 15Preventive MedicationsPreventive medication are
days a month. This type of headache is linkedprescribed when migraine attacks that don't
with tension in neck and scalp muscles, affectingrespond well to abortive medications or adverse
blood flow within the skull.Tension headachesreactions to abortive medications occur, migraine
often start in the afternoon or early evening. Theattacks occur too often, complicated migraines.
pain is typically on both sides of the head,Many drugs are listed as potentially useful to
pressing or tightening. Some people get tensionprevent recurrent migraine attacks. The drugs in
headaches in response to stressful events.the following classes are useful to prevent
Tension headaches usually do not get worse withrecurrent migraine attacks:
physical activity (such as walking or climbing
stairs).TreatmentThe occasional tension headacheBeta-blockers. Propranolol (Inderal) and nadolol
can be alleviated by a hot shower, massage,(Corgard) have a good track record of being safe
sleep, and through patient recognition andand effective. Metoprolol (Lopressor) and atenolol
avoidance of stress factors.For episodic tension(Tenormin) are reasonable alternatives.
headaches that occur less than three times perBeta-blockers have been used for many years to
week, OTC pain relievers such as aspirin,prevent migraine headaches. It is not known how
acetaminophen (Tylenol) or ibuprofen (Advil,beta-blockers prevent migraine headaches.
Motrin) are convenient and effective. CombinationTricyclic antidepressants. These medications are
products of pain medication with caffeine mayvery effective, but often have troublesome side
help some people, but also may be habit forming.effects such as sedation, blurred vision, dry
Use of any OTC pain reliever should be limited tomouth and constipation. The first choice is often
no more than two or three days per week. Ifamitriptyline (Elavil). Nortriptyline (Pamelor,
pain medications are overused, reboundAventyl), doxepin (Sinequan), imipramine (Tofranil)
headaches may occur on the days thatalso can be tried.
medications are not taken.Chronic tensionAnticonvulsants. Of the drugs in this class,
headaches are more difficult to treat, becausevalproate (Depakote, Epival) has the best
rebound headaches are common when painevidence to support using it for prevention.
relievers are stopped. The most effectiveGabapentin (Neurontin) and topiramate (Topamax)
medications for treatment of chronic tensionalso are effective. It is not known how
headaches are tricyclic antidepressantsanticonvulsants work to prevent migraine
(amitriptyline HCl, doxepin HCl, nortriptyline HCl).headaches.
However, it is often more effective to preventSerotonin antagonists. Methysergide (Sansert)
these headaches than to treat them.Some peoplehas been available for many years and is very
are able to treat their tension headaches withouteffective. Methysergide prevents migraine
medications. An ice compress, a heating pad or aheadaches by constricting blood vessels and
massage to any tight areas in the neck andreducing inflammation of the blood vessels.
shoulders can be extremely helpful. RelaxationHowever, this medication has side effects that
techniques, such as deep breathing exercises orare potentially very serious and therefore is not
acupuncture, may help to decrease the frequencywidely used.
of headaches.Cluster HeadacheCluster headachesRebound HeadacheIncreasing headache over time
are relatively rare, affecting about 1% of thewith repeated use of pain medicines can lead to a
population. They are distinct from migraine andrebound headache. The headache is typically
tension headaches. Cluster headaches primarilylocated on both sides of the head and is described
affect men between the ages of 20 and 40.as a pressing or tightening type of pain. When
Attacks usually occur in a series, or "clusters" of 1headache sufferers use too much pain medicine,
- 8 headaches per day over a period of severaltheir headaches often recur. This leads to a
weeks to months. The pain is extremely severerepeated cycle of taking more medicines and still
but the attack is brief, lasting 15 minutes to 3having headaches. Rebound headache may appear
hours. The pain of cluster headache almost alwaysif:
occurs on one side of the head. During cluster
headaches, the eye on the same side as the paintaking analgesics on 15 or more days per month
may become teary or droopy or develop a smallfor more than 3 months
pupil. There may also be nasal congestion on thetaking opioid or combination medication 10 or
affected side of the face.About 80% of clustermore days per month for more than 3 months
headaches occur at night, and in about 70% ofWhen analgesics are discontinued, the headache
patients, drinking alcohol can trigger a clustermay get worse for several days and it may take
headache. Unlike migraine sufferers, those withup to 30 days to recover from the rebound
cluster headache often feel better if they keepprocess. Non-drug approaches, such as
moving during the headache.TreatmentIt is difficultbiofeedback, relaxation therapy, and exercise, can
to stop the pain of a cluster headache that is inbe helpful in reducing both headache frequency
progress, because the headache usuallyand need for medication.Headache
disappears by the time the patient reaches theTriggersTriggers are not direct causes of the
emergency room or doctor's office. Because theheadache, but they facilitate or provoke the
onset of cluster headache attacks is rapid andbeginning of an attack. Anything that stimulates
may occur several times a day, the bestthe pain receptors in the head and neck can
approach to treatment is with daily preventivecause a headache. Some of the more common
drugs to decrease the severity and frequency oftriggers for headache:
headaches. Lithium (Carbolith, Duralith, Lithane,
Lithobid, Lithonate and others) and verapamilEmotional triggers: problems at work, success at
(Isoptin, Calan, Chronovera, Verelan,work or school, anticipation, anxiety, an emotional
Novo-Veramil) are the two drugs that are mostcrisis, a new job. Emotions can bring on
effective at accomplishing this. Other drugs usedheadaches, keep them going, and make them
for this purpose include prednisone (Deltasone,worse. Emotions don't cause your headaches,
Meticorten, Orasone 1, Winpred and others),they just make you more vulnerable to them.
cyproheptadine (Periactin) and methysergideEnvironmental triggers: bright light, different kinds
(Sansert). Prophylactic medications usually areof aromas like perfume, tobacco, odors (such as
begun early during a cycle of cluster headachesgasoline), loud noises, altitude, barometric pressure
and continued for two weeks longer than thechanges.
usual cycle.Abortive treatments include inhalationStress triggers: strenuous exercise, excessive
of 100% oxygen. Inhaling 100% oxygen for aboutphysical work at the work place or at school,
15 minutes through a facemask has proven to bephysical sickness, not enough sleep or too much
helpful when it is done at the first signs of ansleep
attack. This oxygen must be prescribed by aChemical triggers: changes in hormone levels (that
doctor and obtained through a medical supplier.occur during the premenstrual period, during the
Other types of drugs that may be effectivepost-menstrual period), low blood sugar.
when used at the outset of cluster pain includeFood and beverage triggers: caffeine, alcohol
the triptans (Imitrex, Maxalt, Zomig, Axert,(especially red wine), hard cheese, vinegar, hot
Amerge), ergotamine (Cafergot) and indomethacindogs, chocolate, nuts, MSG (monosodium
(Indocin).Migraine HeadacheMigraine headaches areglutamate), pizza, pork. Foods containing nitrites as
less common than tension headaches. About 6%preservatives can also trigger headaches. Fasting
of all men and 18% of all women experience aor missing meals is a major headache trigger.
migraine headache at some time. MigraineChanges in the weather can change body
headache occurs on one or both sides of thechemistry, and have been known to trigger
head. The pain is typically pulsating or throbbing inheadaches.
nature. Nausea, with or without vomiting, as wellHeavy cigarette smoking.
as sensitivity to light and sound often accompanyYury Bayarski is the author of - a prescription
migraines. Migraines are made worse by activity,drug price comparison website. Please follow this
bright lights and bright noises. In most cases,link if you would like to read more about
migraine attacks are occasional, or sometimes asheadache relief prescription drugs.