When you feel a headache coming on, your natural reaction might be to turn down all the lights, grab your water bottle, and crawl into bed — but could you be doing more?
In order to properly treat your head pain, it's important to understand what type of headache you have. Yes, there are types, and they have different triggers, symptoms, and even remedies.
We've collaborated with two headache specialists to create a guide to three types of primary headaches (or headaches that aren't the result of another medical condition) — a migraine, tension, or cluster headache.
Read on to find out more about how to identify and end that ache.
Migraines are caused by the "inappropriate activation of nerve fibers in the central pain modulatory system," Dr. Lauren R. Natbony, MD, assistant professor of neurology and headache specialist at the Icahn School of Medicine at Mount Sinai Center For Headache and Facial Pain explained. Simplified, it's when the brain gets over-excited and produces pain signals when it's not supposed to. One's vulnerability to migraines is believed to be hereditary.
According to Dr. Noah Rosen, MD, director of Northwell Health's Headache Center in Great Neck, NY, 70 percent of migraine sufferers have a first-degree relative who also has the condition. The condition affects about 18 percent of women and six percent of men — or close to 12 percent of the population — in one year.
While genes could be involved in the condition, Dr. Natbony said the actual headache is triggered by internal (stress, anxiety, illness) or environmental (food, alcohol, dehydration, etc.) factors.
Ranging from moderate-to-severe pain intensity, migraines usually occur as throbbing sensations on one side of the head, Dr. Natbony said. Sometimes debilitating, they can last from four to a whopping 72 hours, with symptoms like sensitivity to light and sound, nausea, vomiting, difficulty concentrating, and blurry vision, as well as neurological problems such as numbness, visual disturbances, speech and language impairment, and weakness.
The most common preventative prescription medications are topiramate, propranolol, and amitriptyline, said Dr. Natbony. For an over-the-counter remedy, she suggested acetaminophen. There is also a new class of migraine preventative medication called CGRP antibodies, which are once-monthly injections.
Botox is also commonly used for chronic migraines, or more than 15 migraine days per month for more than three months.
For the treatment of episodic migraines, Dr. Natbony uses triptan medications, though some patients respond to NSAIDs for pain relief, too.
Interestingly enough, the underlying root of tension-type headaches are unknown, as there are multiple plausible causes.
Dr. Natbony explained that tension-type headaches lasting less than 15 days (episodic) are likely due to the excessive tightening of head-and-neck muscles that trigger nerves to fire pain signals. Tension-type headaches lasting more than 15 days per month (chronic) are likely due to dysfunction in central pain processes, similar to migraines.
Dr. Rosen noted that tension-type headaches are the most frequent, affecting about 40 percent of men and women in the last year alone.
Tension-type headaches come to in the form of pressing or tightening sensations on both sides of the head, which range from mild to moderate severity, Dr. Natbony said. Stress is the most common trigger for tension-type headaches. They are rarely associated with light or sound sensitivity, nausea, or vomiting, and attacks can last anywhere from 30 minutes to seven days.
Dr. Natbony's treatment of choice for low-frequency, tension-type headaches is NSAIDs such as ibuprofen. "However, if headaches occur and require treatment more than two days per week on average, then a preventative daily medication (like tricyclic antidepressants, mirtazapine, and venlafaxine) should be considered."
Cluster headaches — which are rare and extremely painful — are a series of relatively short headaches that can be present for weeks at a time and then disappear. Dr. Natbony admitted that while the exact cause of cluster headache is unknown, there is some suggestion that it might be due to abnormalities in the hypothalamus (an area of the brain that controls the body's biological clock).
Unlike migraine and tension-type headaches, cluster headache isn't usually associated with triggers such as stress, skipping meals, or dehydration.
Dr. Natbony's patients usually describe cluster headache symptoms as excruciating one-sided pain around the eye that lasts from about 15 minutes to three hours. "The pain may be accompanied by a red or teary eye, swollen or drooping eyelid, nasal congestion, or runny nose on one side." She said attacks tend to be seasonal in nature — some of her patients have attacks multiple times per year while others can go years between attacks.
Dr. Rosen pointed out that these headaches are relatively uncommon, affecting about one in 2,000 people.
Since cluster headaches are very specific, so is the treatment — patients should seek specialized medical care for close monitoring and medication management. But Dr. Natbony confirmed that the most effective medication for an acute cluster attack is a prescribed sumatriptan injection and zolmitriptan nasal spray.