Identify the Pain in Your Head: The 14 Kinds of Headaches
Getting the right diagnosis will help you get the right treatment.
It's critical to identify which type of headache you suffer from—tension, cluster, sinus, rebound, or migraine—so that the correct treatment can be prescribed. For example, patients with a history of self-described or doctor-diagnosed sinus headaches but none of the signs of sinus infection might actually meet the criteria for migraine. In one study, two-thirds of those patients expressed dissatisfaction with the medications they were using to treat their headaches.
“We know a lot more than we did 20 years ago about what causes headaches,” says Charles Flippen, MD, associate professor of neurology at the David Geffen School of Medicine at UCLA. “We know what areas of the brain are generating pain, but we don’t have the whole picture.”
That said, here are 14 headache types, their causes, and more importantly—how to make them go away.
Tension headaches, the most common type, feel like a constant ache or pressure around the head, especially at the temples or back of the head and neck. Not as severe as migraines, they are not usually accompanied by nausea and vomiting, and they rarely stop someone from continuing their regular activities. Over-the-counter treatments, such as aspirin, ibuprofen, or acetaminophen (Tylenol), are usually sufficient to treat tension headaches, which experts believe may be caused by contraction of neck and scalp muscles (including in response to stress), and possibly changes in brain chemicals.
Cluster headaches, which affect men more often than women, are headaches that occur in groups or cycles. Cluster headaches recur regularly, even multiple times daily, over a certain period of time and then may be followed by a headache-free period of months or even years. The headaches appear suddenly and are characterized by severe, debilitating pain on one side of the head often accompanied by a watery eye and nasal congestion or a runny nose on the same side of the face. During an attack, sufferers are often restless and unable to get comfortable and not likely to lay down the way someone with a migraine usually does.
The cause of cluster headaches is unknown, but they may have some genetic component. Triggers can include alcohol, cigarettes, high altitudes, and certain foods. There is no cure, but medications can reduce the frequency and duration of attacks.
When a sinus becomes inflamed, usually through an infection, it can cause pain. It usually comes with a fever, and can–if necessary–be diagnosed by MRI or CT scan (which can both detect changes in fluid levels), or by the presence of pus viewed through a fiber-optic scope.
These types of headaches win the gold medal for overdiagnosis, according to Peter Goadsby, MD, director of the Headache Center at the University of California, San Francisco. People with migraines often mistake them for sinus headaches. Symptoms like sinus pressure, nasal congestion, and watery eyes can happen in both types.
A true sinus headache is related to an infection and comes with nasal discharge that is green or tinged with red, says Dr. Goadsby. Sinus infections often resolve with time or antibiotics, if necessary, and shouldn't cause nausea or light sensitivity, which are migraine symptoms. Headaches due to sinus infections can also be treated with antihistamines or decongestants.
Overuse of painkillers for headaches can, ironically, lead to rebound headaches. Culprits include over-the-counter medications like aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin, Advil), as well as prescription drugs.
"Most of the patients we see in a headache center with daily headache have medication-overuse, or rebound, headaches," says Stewart Tepper, MD, director of research at the Center for Headache and Pain at the Cleveland Clinic Neurological Institute.
"They are on a merry-go-round and they can't get off," says Dr. Tepper. "They keep taking more medicine, they keep having more headaches, and so the patient becomes more and more desperate. That's when they end up coming to headache specialists to kind of reset the whole system."
One theory is that too much medication can cause the brain to shift into an excited state, triggering more headaches. Another is that the headaches are a symptom of withdrawal as the level of medicine drops in the bloodstream.
How often is too often? Regularly taking any pain reliever more than twice a week or taking triptans (migraine drugs) for more than 10 days a month, can put you at risk for rebound headaches in just a few months.
Migraine headaches are severe headaches that are three times as common in women as men. The cause isn't clear, but genes do play a role, and brain cell activity may affect blood vessel and nerve cell function. Migraine headaches are defined by certain criteria:
- At least five previous episodes of headaches
- Lasting between four hours and 72 hours
- Having at least two out of four of these features: one-sided pain, throbbing pain, moderate-to-severe pain, and pain that interferes with, is worsened by, or prohibits routine activity
- Having at least one associated feature: nausea and/or vomiting, or, if those are not present, then sensitivity to light and sound
An oncoming migraine attack may, for some, be foreshadowed by an aura, which can include visual distortions (such as wavy lines or blind spots) or numbness of a hand. It's estimated, though, that only 15% to 20% of migraineurs experience this.
One common migraine trigger is change, including hormones, stress, and sleeping or eating patterns. "If you know skipping meals is a trigger, don’t skip meals while menstruating and having a late night," says Dr. Goadsby. Treatment can include acetaminophen, ibuprofen, or triptans (such as Imitrex or Zomig), which are drugs that help treat or prevent migraines.
RELATED: 18 Signs You're Having a Migraine
There are dental-related conditions that can trigger headaches or face pain, such as bruxism and temporomandibular joint disorder (TMJ).
Bruxism is grinding your teeth at night, while TMJ affects the joints, located just in front of your ear, which connect the jaw to the skull.
TMJ can be caused by bad jaw alignment, stress, poor posture (like sitting at a computer all day), or arthritis, which affect the cartilage, muscles, or ligaments in the jaw.
Your dentist can help diagnose these types of headaches. Treatment includes stretching the jaw, hot or cold packs, stress reduction, and bite guards.
You love your coffee, but it can be a cruel companion. For example, if you have two cups of coffee every day at 9 a.m., and then miss those cups when you oversleep on Saturday—boom!—you can end up with a caffeine withdrawal headache.
You will be more likely have them, though, if you drink a lot (say, five cups of coffee a day), then go cold turkey.
You have two options, Dr. Goadsby says: “You can take caffeine when you normally do and feed the addiction, or quit altogether."
Orgasm-induced headaches are caused by, well, having an orgasm.
These are relatively rare and are more common in younger people, particularly men, Dr. Flippen says. They usually start shortly after intercourse begins and end in a “thunderclap” headache at climax.
A dull headache can often linger for hours or a day. Dr. Flippen says that there is often no known cause for these headaches, and they usually go away on their own. He does recommend seeing a doctor, however; in rare cases they can be a sign of something more serious. A dose of pain reliever before sex may help ease the pain.
If you’re waking up in pain, there are several possible culprits. Migraines are more likely to happen in the morning, or medication may be waning in your body as you sleep, which causes a rebound headache, Dr. Goadsby says.
Sleep apnea sufferers may also be more prone to headaches early in the day, as are those with dental headaches.
Finally—and this one is the least likely, so relax all of you hypochondriacs out there—it could be a symptom of a brain tumor, Dr. Goadsby says.
Ice cream headache
Brain freeze! Most people have experienced the shooting head pain that can occur while enjoying a icy cold drink or treat on a hot day. People with migraines may be especially prone to them.
They have an impressive medical name—sphenopalatine ganglioneuralgia—but they’re not all that serious. Experts think a cold sensation on the roof of the mouth can cause an increase in blood flow to one of the brain’s arteries.
The cure? Take a momentary break from the frosty goodness until the pain subsides, or sip warm water to help constrict the brain artery.
Chronic daily headaches
If you have a headache at least 15 days per month for more than three months you’re considered to have chronic daily headaches, says Dr. Goadsby.
These could be caused by overuse of pain medications (i.e., rebound headaches), head injury, or in rare cases, meningitis or tumors.
If there is no obvious cause, it could be because your body’s pain signals are heightened or not working properly.
These headaches may respond to antidepressants; beta blockers like atenolol, metoprolol, or propanolol (used to treat high blood pressure and migraines); anti-seizure medications like gabapentin or topiramate; pain relievers like naproxen (Aleve); and even Botox injections.
As if PMS wasn’t bad enough, the sudden drop in estrogen right before your period can sometimes trigger migraines, Dr. Flippen says.
These usually occur between three days before and two days after your period has started. Other women may have PMS-related headaches that aren’t migraines.
These arrive about six days or so before your period, at the same time as any moodiness, cramping, or other PMS symptoms. Dr. Flippen recommends over-the-counter headache remedies; magnesium supplements may also help PMS-related head pain.
Some people may experience headaches that mainly show up on the weekend. These are thought to be caused by oversleeping on weekend mornings, going to bed later at night, or caffeine withdrawal.
Also, if your stress level is high all week, the weekend release may trigger a headache.
Over-the-counter pain medications can be helpful, as can sticking to your regular sleep-wake schedule.
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Most headaches aren’t an emergency, but there are a few symptoms that warrant rapid attention, says Dr. Flippen. One is a sudden onset headache that is quickly “explosive.” Another is when a headache comes with a fever or extreme rise in blood pressure, or if it occurs after a blow to the head or exertion.
Other problematic symptoms include vision or speech change, neck pain, dizziness, loss of sensation, or muscle weakness on one side of the body. Call 911 if you have these worrisome symptoms in addition to headache.