Types of Headaches

What is a migraine?

A true migraine headache is one-sided, pounding, aching and can cause nausea and vomiting. Patients with migraine usually avoid bright lights, which we call photophobia, and avoid sound, which we call phonophobia. Some people can’t tolerate smells, which we call osmophobia. The headache can last anywhere from a couple of hours to several days for some people. If the patient is not on any type of specific medication, the headache usually goes away after they go into a quiet, dark room and get some sleep.

What causes a migraine?

There’s a disturbance of a substance known as serotonin in the blood that people with migraine do not handle.

How do headaches and migraines differ?

A headache is an ache in the head. For example, if I hit you in the head with a baseball bat, that would be a headache, not a migraine. Migraine is a specific headache disorder that we believe is familiar and possibly even genetic. It’s due to a biological predisposition of the brain — an increased sensitivity of the nervous system to light, sound or odors. So migraine is a biological disorder that is manifested in very characteristic ways. The pain is typically moderate or severe, often unilateral, throbbing and aggravated by movement. It’s invariably accompanied by nausea or sensitivity to light, sound or odors.

What is a Cluster headache?

Cluster headache is a very specific type of headache. It has a male predominance, whereas migraine has a three to one female predominance. It is most common in men who smoke and we are not sure exactly why that is. For a long time cluster was considered to be a variant form of migraine. And there’s some emerging information now to suggest that it should be classified as an entirely separate headache type. There have been some studies conducted at Harvard looking at blood oxygen levels in the brain. They have found that migraines begin in the part of the brain called the brain stem, and the cluster headache begins in a different part of the brain and is therefore a different type of headache altogether.

Cluster headaches are usually shorter in duration than migraines. It is extremely severe pain. To give you some perspective on how bad the pain is, men who suffer from them liken it to passing a kidney stone, and women with cluster headaches have said they’d rather give birth. While a migraine patient is usually in the dark with their head under a pillow trying not to move, the cluster patient is more likely pacing and pounding their head with their fists.

The reason they are called cluster is because they often occur in a cluster of attacks. The headaches will start the same time of the day each day. Someone might have 15-minute to two-hour headaches two to three times a day at the same time getting worse over a three- to four-week period and then sort of fading away over another three- to four-week period. This may happen once a year, twice a year, six times a year or every two years.

As far as treatment is concerned, there is some overlap with the same treatments used for migraine. But unlike migraine, cluster patients sometime respond to inhaled oxygen.

What’s a normal amount of tension headaches in a month?

90 percent of the population has had a tension headache at some time in their life. Most people probably have a tension headache once a month.

At what point do frequent tension headaches become serious enough to have checked out?

If you need medication to treat your headaches more often than once a week, then you should have them checked out.

If you are having frequent headaches should you be concerned you might have a brain tumor?

Brain tumors are exceedingly uncommon. There was a study done recently in which they did scans on 1,000 consecutive headache patients, and they found tumors in only two. That’s just .2 percent. So it’s not something one should be terribly concerned about. Usually someone with a brain tumor will have other symptoms besides a headache. They will have balance problems, a change in personality, difficulty walking properly. And only about 50 percent of patients with brain tumors have headaches at the time of diagnosis. By the time the headaches happen, it is a tumor in the late stages where it has gotten so large it’s pressing on areas of the brain.

When should someone seek professional treatment for headaches?

You should seek help if you get three or more headaches a month that are in any way disabling or are keeping your from your social or work activities.

What’s the difference between the signs and/or symptoms of primary and secondary headaches?

There are five major red flags when it comes to serious headaches. You should see your doctor if you:

1. Have a new headache and are above the age of 55.
2. Have a headache of sudden onset that hits you, “Bang,” like that.
3. Have a new headache and any immune deficiency such as HIV or cancer.
4. Have a headache that changes in character or frequency and gets progressively worse over a couple of months.
5. Have weakness with your headache or any neurologic symptoms such as double vision, fever, stiff neck, vertigo, weakness or numbness on one side or the other, or inability to talk, think, concentrate or walk.

The majority of overwhelming headaches are benign primary headache disorders. The two major categories are migraine and tension headaches.

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