Signs and symptoms: Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are extremely rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and occasionally by taking medications.
Tension headaches are due to tight, contracted muscles in your shoulders, neck, scalp, and jaw. They are often related to stress, depression, or anxiety. Overworking, not getting enough sleep, missing meals, and using alcohol or street drugs can make you more susceptible to them. Headaches can be triggered by chocolate, cheese, and monosodium glutamate (MSG). People who drink caffeine can have headaches when they don't get their usual daily amount.
Other common causes include:
Tension headaches tend to be on both sides of your head. They often start at the back of your head and spread forward. The pain may feel dull or squeezing, like a tight band or vice. Your shoulders, neck, or jaw may feel tight and sore.
Migraine headaches are severe, recurrent headaches generally accompanied by other symptoms like visual disturbances or nausea. They tend to begin on one side of your head, although the pain may spread to both sides. You may have an "aura" (warning symptoms that start before your headache) and feel throbbing, pounding, or pulsating pain.
For information on migraine, see migraine headache.
Other types of headaches:
Headaches may occur if you have a cold, the flu, fever, or premenstrual syndrome.
If you are over age 50 and are experiencing headaches for the first time, a condition called temporal arteritis may prove to be the cause. Symptoms of this condition include impaired vision and pain aggravated by chewing. There is a risk of becoming blind with this condition. Therefore, it must be treated by your doctor right away.
Rare causes of headache include:
Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches. When a headache occurs, write down the date and time the headache began, what you ate for the past 24 hours, how long you slept the night before, what you were doing and thinking about just before the headache started, any stress in your life, how long the headache lasts, and what you did to make it stop. After a period of time, you may begin to see a pattern.
A headache may be relieved by resting with your eyes closed and head supported. Relaxation techniques can help. A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches.
Try acetaminophen, aspirin, or ibuprofen for tension headaches. DO NOT give aspirin to children because of the risk of Reye's syndrome.
Migraine headaches may respond to aspirin, naproxen, or combination migraine medications.
If over-the-counter remedies do not control your pain, talk to your doctor about possible prescription medications.
Prescription medications used for migraine headaches include ergotamine, dihydroergotamine, ergotamine with caffeine (Cafergot), isometheptene (Midrin), and triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), eletriptan (Relpax), almotriptan (Axert), and zolmitriptan (Zomig). Sometimes medications to relieve nausea and vomiting are helpful for other migraine symptoms.
If you get headaches often, your doctor may prescribe medication to prevent headaches before they occur. Examples of these include:
If you are using pain medications more than 2 days a week, you may be suffering from rebound headaches. Rebound headaches are caused by a cycle of using pain medications for short-term relief, followed by the headache pain returning for increasingly longer periods of time despite taking more pain medications.
All types of pain pills (including over-the-counter drugs), muscle relaxants, some decongestants, and caffeine can cause this pattern. If you think this may be a problem for you, talk to your health care provider.
When to Contact a Medical Professional
Take the following symptoms seriously. If you cannot see your health care provider immediately, go to the emergency room or call 911:
See your provider soon if:
What to Expect at Your Office Visit
Your health care provider will obtain your medical history and will perform an examination of your head, eyes, ears, nose, throat, neck, and nervous system.
The diagnosis is usually based on your history of symptoms. A "headache diary" may be helpful for recording information about headaches over a period of time. Your doctor may ask questions such as the following:
Diagnostic tests that may be performed include the following:
If a migraine is diagnosed, medications that contain ergot may be prescribed. Temporal arteritis must be treated with steroids to help prevent blindness. Other disorders are treated as is appropriate.
The following healthy habits can lessen stress and reduce your chance of getting headaches:
Lipton RB, Bigal ME, Steiner TJ, Silberstein SD, Olesen J. Classification of primary headaches. Neurology. August 10, 2004;63(3):427-35.
Snow V. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med. 2002; 137(10): 840-849.
Kaniecki RG. Migraine and tension-type headache: an assessment of challenges in diagnosis. Neurology. 2002; 58(9 Suppl 6): S15-20.