What Kind of Headache do I Have?

When people tell me that they have or get headaches, the first question I ask is what kind.  Many people might wonder why I care what type of headache it is.  After all, a headache is a headache right?  Not exactly.  In fact one can argue that a headache isn't a condition at all, but merely a symptom of an underlying cause.  Headaches can be caused by a variety of different things, and each cause can present with different pain patterns and symptoms.  The reason why it is so important for me as a practitioner and even for you as the person with the headache to know what kind it is, is because it doesn't do nearly as much good to treat the symptom (the headache) without treating the cause.  Because of the variety of causes, each headache may require different types of treatment.  Today, I will share with you some common symptoms and patterns for a variety of types of headaches so that you are better able to determine what kind you have, and therefore better able to treat it effectively.

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Tension Headaches
​Also referred to as "stress headaches", tension headaches are one of the most common types that people get with an estimated 3 million every year in the US.  Tension headaches can range anywhere from mild discomfort to severe pain, and are usually fairly easy to treat.  Tension headaches can be caused by mental or emotional stress, being overworked, poor quality or not enough sleep, or tightness in certain muscles.  Often the muscle tightness is due to postural changes caused by the others.  Tension headaches are considered episodic if you get fewer than 15 a month, and chronic if you get more than 15 per month.

Who's at risk?  Tension headaches generally start in the late teens and affect slightly more women than men at a 3:2 ratio.  So, pretty much any adult is at risk for tension headaches because the causes can be so varied and are usually associated with stress or muscle tension which is widespread and nondiscriminatory.

Symptoms for tension headaches can include a dull ache usually on both sides of the head and/or neck, stiff or tight feeling of muscles in head or neck, tenderness in muscles of the head and neck, or the feeling of pressure along your forehead or the sides of your head.

Treatments for tension headaches can include a reduction in stress, yoga or meditation, heat or ice for sore muscles, massage therapy, acupuncture, chiropractic, talk therapy, or treatments for sleep disorders.

Sinus Headaches
​Sinus headaches are pain generally associated with an infection in the sinuses (sinusitis).  They are one of the most commonly misdiagnosed headaches and are often confused with migraines or tension headaches or vice versa.  Headache inducing sinus infections generally occur after a viral infection of your upper respiratory tract (a cold).

Who is at risk?  Pretty much anyone is at risk for sinus headaches.  Because they are usually associated with an infection which often occurs with a cold or flu virus, they can affect people of any age, gender, or ethnicity.  There are people who are prone to regular sinus infections, so if you have had them in the past, you are more likely to have them again.

Symptoms for sinus headaches can include pressure or pain in the face which usually feels worse with bending forward or facing downward, a feeling of fullness in the cheeks, throbbing pain in the face particularly above the eyes or in the cheeks, stuffy nose, pain in upper teeth, and fatigue.  Symptoms do not include nausea, vomiting, or sensitivity to your surroundings (lights, sound, movements, etc.)

Treatments for sinus headaches can include steam (with essential oils to boost effectiveness if you choose), saline washes, humid air, drinking extra water, massage to drain the sinuses, eating spicy foods, warm compresses (a washcloth soaked in warm water will do the trick), and acupuncture.  Try to avoid things like decongestants or nasal sprays, as these can be very addicting because they treat your symptoms rather than the cause.  This means that when they wear off, you will often feel just as bad as you did before, and symptoms may stick around for longer.

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Rebound Headaches
Also known as medication overuse headaches, rebound headaches generally occur due to repeated use of medication to treat other headaches. 

Who's at risk?  Anyone who takes pain medication to soothe a headache more than twice a week is at risk.  Although there are many reasons why someone might take pain medication more than twice a week, evidence suggests that rebound headaches only tend to occur in people who already have a headache condition.  Migraine sufferers are some of people most at risk for rebound headaches.

Symptoms of rebound headaches are pain in the head nearly every day, often upon waking.  The pain generally gets better with medication, but returns when the medication wears off.  They may be accompanied by restlessness, nausea, irritability, or memory loss.

Treatment for a rebound headache is fairly straight forward.  Stop taking the pain medication.  This will be hard initially because it usually means suffering through headaches that you would normally be able to dull, but in the long run, it will lead to fewer headaches overall.

Trigger Point Referral Pain
Many of you may have heard the term trigger point, but my guess is that few of you know what one actually is.  A trigger point is a spot in the connective tissue (fascia) surrounding a muscle that becomes hyper-irritable or hypersensitive.  This generally happens due to overuse, under-use, or misuse of the muscle.  Because fascia is connected to everything, the sensitivity in these points can cause pain that travels or refers.  Sometimes trigger points feel like pain is radiating from one spot, other times you may feel a sensation in another part of your body when the point is pressed or you move a certain way.  There are several common trigger point referral patterns that refer pain into the head, neck, and face.  This can cause a mild to severe headache, or mimic a migraine.

Who's at risk?  Everyone.

Symptoms of trigger point referral pain are a feeling of radiating pain or feeling pain that seems to move or occurs away from the area being stimulated.

Treatment for a trigger point is generally fairly simple.  Massage, particularly with someone who does trigger point therapy or something called neuromuscular therapy (NMT) or proprioceptive neuromuscular fascilitation (PNF).  You can often treat it yourself at home with sustained pressure on the point if you can find it.  A tennis ball can be particularly helpful to reach areas you can't with your hands.

Hormonal or Menstrual Headaches/Migraines
Hormonal or menstrual headaches are cause by the drop in estrogen just before your menses (period).  They are often called menstrual migraines because they share many of the same characteristics and treatments, and are often considered by doctors to be a kind of migraine. 

Who is at risk?  People who menstruate.  Particularly people who are prone to migraines, but a history of other types of migraines is not necessary to get menstrual headaches. 

Symptoms of menstrual headaches are head pain just before or at the start of your period.  The pain is usually described as throbbing, and will generally occur on one side of the head and/or face and may be accompanied by nausea or vomiting, sensitivity to light and sound, sensitivity to movement, and may be preceded by an aura.

Treatment for menstrual migraines is pretty similar to treatment for any other migraine.  Apply ice the area where you are feeling pain (I often put an ice pack under my neck and a cold eye pillow over my eyes), lowered or no light, soft music or silence, aromatherapy, acupuncture, massage (try to come in before the worst of it), or over the counter pain killers preferably specific to migraines.  For more suggestions, check out my migraine survival kit!

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Migraines
There is a huge misconception that the term "migraine" is simply what you call a bad headache.  This is not true.  It is possible to have severe pain with many of the headache types listed above, however, a migraine is a completely different diagnosis.  In fact, a migraine itself is not a headache.  A headache is merely one of many symptoms, albeit one of the most common symptoms, of certain types of migraines.  This means that you can have a migraine without having any pain in your head.  There are numerous different types of migraines, far more than there is room for in this post, so we will not focus on individual types today.

Who is at risk?  About 70% of migraine sufferers are people assigned female at birth.  If we look at the genders as a whole, about 18% of all people assigned female get them as opposed to 6% of all those assigned male at birth.  This is likely due to the number of migraines caused by large drops in estrogen.  The vast majority of migraine sufferers have someone in their family who also has migraines.  They are more common in Caucasians than any other racial group, and most commonly begin between the ages of 35 and 55, however can affect people at any age including children.

Symptoms of migraines vary based on the type of migraine and the individual who has it.  Most migraines follow a similar pattern which starts with what is called the prodromal phase.  During prodrome, some common symptoms include mood swings, fatigue, stiffness, constipation, food or drink cravings, and aura (visual disturbances, blurred vision, loss of vision, sensitivity to light, hearing sounds, tingling or pins and needles feeling in limbs, uncontrolled movements, trouble speaking).  Many long term migraine suffers may not notice specific symptoms, but will have a feeling that one is coming.  This is the best time to start treating the migraine.  After prodrome, the next phase is the attack phase.  During a migraine attack, common symptoms include aura, sensitivity to surroundings (light, sound, smell, movement, or touch) pain (often throbbing) on one or both sides of the head, nausea or vomiting, and feeling lightheaded.  After the attack phase is the post-dromal phase which I often refer to as my "migraine hangover" which may include symptoms such as fatigue, hunger, continued sensory sensitivity (light, sound, smell), weakness, dizziness, and confusion.

Treatment for migraines can vary because there are so many different types of migraines, and a lot of it depends on the individual.  What works for some people will not work for others, so it is a good idea to try different things and narrow down your own migraine treatment plan.  Some things you can try are cold therapy, massage therapy (before, after, or between attacks), acupuncture, acupressure, aromatherapy (try lavender, peppermint, or basil), silence, soft music, darkness, sleep, caffeine (unless you already consume a lot of caffeine, in which case, you will want to lay off of it), electrolytes, and a variety of medications both prescription and over the counter (OTC).  Before taking any medication, it is a good idea to talk to a doctor.  A neurologist, preferably one who specializes in migraines is best.  If you missed the link above, you can check out my own personal migraine survival kit for more.

*A note on migraines and pregnancy.  It is very unlikely to get migraines during pregnancy due to hormone levels.  A lot of people who start having bad headaches in pregnancy may assume they are getting migraines when they are actually experiencing severe tension or sinus headaches, or have trigger points that refer like migraines, but the likelihood of an actual migraine is possible but relatively low.  Because our hormones change so much during pregnancy and never really go back to exactly the way they were before, it is not uncommon for women to either start having migraines after pregnancy or for long time migraine sufferers to cease having them after pregnancy.  If you are having symptoms specific to migraines during pregnancy, especially after the first trimester, talk to your doctor.

Cluster Headaches
Cluster headaches are known as the most painful type of headache.  They occur much like many autoimmune attacks with periods of flare up and remission.  During flare ups, people will experience what are called cluster periods meaning that you will experience several at once and then have a period of remission that is free of headaches.  Cluster periods can last anywhere from a week to several months, and remission periods can last anywhere from months to years.  During a cluster period, headaches can occur every day, or sometimes multiple times a day with each headache lasting between 15 minute to a few hours. 

Who is at risk?  The cause of cluster headaches is unknown, but there are certain risk factors.  Those assigned male at birth are more likely to get cluster headaches than those assigned female, and they usually occur between the ages of 20 and 50.  Smokers and people who drink alcohol are more at risk for developing cluster headaches, and there may be a genetic component meaning that if someone in your family has them, you are at an increased risk.  Cluster headaches are pretty rare and only affect about 1% of the population.

Symptoms for cluster headaches include pain on one side (especially around the eyes), restlessness or an inability to remain still (rocking, pacing, etc.), drooping eyelids, excessive tearing, sweating or swelling in the head and face (generally around the affected area), redness or congestion on the affected side, and extreme pain that may radiate to other areas of your head, neck, and face.  More than half of cluster headache sufferers experience suicidal thoughts.  If you are experiencing any suicidal thoughts, please seek emergency medical care or call the National Suicide Prevention Hotline at 800.273.8255, The Trevor Project for LGBTQIA+ at 866.488.7386, or Trans Lifeline for those in the trans community at 877.565.8860.

Treatments for cluster headaches require a diagnosis.  There aren't really any at home methods that have been proven to be effective.  If you believe you are getting cluster headaches, you will need to see your doctor who will perform an examination and may order an MRI or CT scan.  Once diagnosed, there are several treatments that your doctor may prescribe.

Headaches That Require Emergency Medical Care
Most headaches, while not fun, are not emergencies.  However, there are certain conditions that may present with head pain that require emergency medical care.  If you experience any of the following symptoms, please call 911 or have someone take you to an emergency room right away as these can be signs of some serious and sometimes potentially fatal conditions that require emergency medical treatment:

• Change in speech- loss of speech or slurring, or inability to say the words you mean
• Major visual disturbances- inability to focus your gaze or loss of vision.
• Dizziness or trouble moving/walking
• Loss of feeling in parts of your body (especially just on one side), or loss of ability to control movements or facial expressions 
• Extreme stiffness in the neck (especially accompanied by a fever)
• Confusion or memory loss 
• Nausea or vomiting (unless they commonly accompany migraines and you have already been evaluated)
• A sudden onset of severe or explosive pain, or if you can describe your symptoms as the worst headache you have ever had and have been prone to headaches in the past
• Severe headache after strenuous activities such as playing sports, running, or having sex
• Headache after a trauma or injury (especially to the head) 
• A sudden spike in temperature or blood pressure
• If you are pregnant and experiencing severe headaches, especially with any of the symptoms listed above or excessive swelling (particularly in your hands or face), and the headache doesn't change at all with an over the counter drug as recommended by your doctor.  You should also contact your doctor if you have a sudden severe headache with a history of high blood pressure or protein in your urine or have been diagnosed with hypertension or preeclampsia.

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Disclaimer:  I am not a doctor and this post is not intended to work as a diagnosis or to prescribe treatments for any condition.  In general, if your symptoms remain longer than 2 weeks, it is best to seek out medical care if you have not already.