Headaches

Almost everyone has had a headache at some time in their lives. Headache is the most common form of pain. It’s a major reason people miss days at work or school or visit the doctor. At Atrium Health Floyd and Harbin Clinic, our doctors can develop a treatment plan to help relieve your pain and get you back to the things you enjoy doing.

What is a headache?

Headaches result from a combination of activity shared between your brain, blood vessels and nerves. When something triggers the specific nerves that affect your blood vessels and muscles, pain signals are sent to your brain, causing a headache.

Tension headaches

The most common type of headache is a tension headache. Tension headaches are due to tight muscles in your shoulders, neck, scalp and jaw. They’re often related to stress, depression, anxiety, or holding your head and neck in an abnormal position. You’re more likely to get tension headaches if you work too much, don’t get enough sleep, miss meals or use alcohol.

Tension headache pain may feel dull or squeezing, like a tight band or vice. Your shoulders, neck or jaw may feel tight or sore. The pain tends to be on both sides of your head and often starts at the back of your head and spreads forward.

Rebound headaches

Rebound headaches are headaches that keep coming back. They often occur from overuse of pain medicines. For this reason, these headaches are also called medicine overuse headaches. People who take pain medicine more than three days a week on a regular basis can develop this type of headache.

Migraine headaches

Migraines are recurring attacks of moderate to severe pain. Migraine pain is throbbing or pulsing and is often on one side of the head. For some people, the pain from a migraine can be debilitating.

During migraines, people are very sensitive to light and sound. They may also become nauseated and vomit.

Causes of migraine headaches

A migraine headache is caused by abnormal brain activity. This activity can be triggered by many things. But the exact chain of events remains unclear. Most medical experts believe the attack begins in the brain and involves nerve pathways, chemicals and certain genes. The changes affect blood flow in the brain and surrounding tissues.

Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes, they begin later in life. Migraines may run in families. Migraines occur three times more often in women than men. Some women, but not all, have fewer migraines when they’re pregnant.

Triggers for migraine headaches

Migraine attacks may be triggered by any of the following:

• Caffeine withdrawal
• Changes in hormone levels
• Changes in sleep patterns
• Drinking alcohol
• Exercise or other physical stress
• Loud noises or bright lights
• Missed meals
• Odors or perfumes
• Smoking or exposure to smoke
• Stress and anxiety

Migraines can also be triggered by consuming certain foods and drinks. Some common food and drink triggers for migraines are:

• Baked goods
• Chocolate
• Dairy foods
• Foods with monosodium glutamate (MSG)
• Foods with tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans
• Fruits (avocado, banana, citrus fruit)
• Meats containing nitrates (bacon, hot dogs, salami, cured meats)
• Onions
• Peanuts and other nuts and seeds
• Processed, fermented, pickled or marinated foods

Types of migraine headaches

There are two common types of migraines:

• Migraine with aura
• Migraine without aura

Migraines with aura

An aura is a group of nervous system symptoms. These symptoms are considered a warning sign that a migraine is coming. Most often the vision is affected in some of the following ways:

• Temporary blind spots or colored spots
• Blurred vision
• Eye pain
• Seeing stars, zigzag lines or flashing lights
• Tunnel vision (only able to see objects close to the center of the field of view)

Other nervous system symptoms of an aura include yawning, difficulty concentrating, nausea, trouble finding the right words, dizziness, weakness, numbness and tingling.

An aura often occurs 10 -15 minutes before the headache but can occur just a few minutes to 24 hours beforehand. A migraine headache does not always follow an aura.

Symptoms of migraines

Migraine headaches usually:

• Start as a dull ache and get worse within minutes to hours
• Are throbbing, pounding, or pulsating
• Are worse on one side of the head with pain behind the eye or in the back of the head and neck
• Last six to 48 hours

Other symptoms that may occur with a migraine headache include:

• Chills
• Fatigue
• Increased urination
• Loss of appetite
• Nausea and vomiting
• Sensitivity to light or sound
• Sweating

Symptoms may linger, even after the migraine goes away. This is called a migraine hangover. Symptoms of a migraine hangover may include:

• Feeling mentally dull, like your thinking is not clear or sharp
• Needing more sleep
• Neck pain

Diagnosis of headaches

Doctors usually use your description of your headache, in combination with an examination, to determine the type of headache. Some people have more than one type of headache.

Most people don’t need X-rays or imaging tests to diagnose their headaches. However, a CT scan or MRI may be recommended in certain circumstances, such as if symptoms are unusual, if there are any dangerous signs or if abnormalities are seen during examination. 

Other possible reasons for brain imaging include:

• Headaches that steadily worsen despite treatment
• A sudden change in the pattern of headaches
• Signs or symptoms that suggest that another medical condition may be causing symptoms

Treatment for headaches and migraines

Treatment for headaches and migraines often involves a combination of medications, lifestyle changes and alternative therapies. Over-the-counter pain relievers like ibuprofen or acetaminophen can be effective for many headaches. Your Atrium Health Floyd and Harbin Clinic care team can recommend the best approach to combat headache pain.

For more severe headaches or migraines, prescription medications may be necessary. Preventive medications, including beta-blockers, antidepressants and anticonvulsants, can help reduce the frequency and severity of headaches.

Lifestyle changes that may help with the pain include:

• Maintaining a regular sleep schedule
• Staying hydrated
• Managing stress
• Avoiding known headache triggers
• Stretching your neck gently
• Applying heat to the area that hurts (warm compress or shower)

Some other therapies that may provide relief from a headache or migraine include:

• Biofeedback
• Cognitive behavioral therapy
• Massage
• Meditation
• Relaxation training

Treatment for migraine headache

There is no specific cure for migraine headaches. The goal is to treat your migraine symptoms right away and to prevent symptoms by avoiding your triggers.

A key step in treatment is learning how to manage your migraines at home. Keeping a record of your headaches can help you identify potential headache triggers. Then you and your doctor can plan how to avoid these triggers.

If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. You need to take the medicine every day for it to be effective. Medicines may include:

• Antidepressants
• Blood pressure medicines
• Seizure medicines

Other medications for a migraine headache

Other medicines are taken at the first sign of a migraine attack. Over-the-counter (OTC) pain medicines, such as acetaminophen, ibuprofen or aspirin are often helpful when your migraine is mild. Be aware that:

• Taking medicines more than three days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain medicine.
• Taking too much acetaminophen can damage your liver.
• Too much ibuprofen or aspirin can irritate your stomach or kidneys.
• If these treatments don’t help, ask your doctor about prescription medicines. These include nasal sprays, suppositories or injections.

Some migraine medicines narrow the blood vessels. If you’re at risk for having a heart attack or have heart disease, talk with your doctor before using such medicines.

Some migraine medicines should not be used by pregnant women. Talk with your doctor about which medicine is right for you if you are pregnant or planning to become pregnant.

Other medicines treat symptoms of migraine, such as nausea and vomiting. They may be used alone or along with other drugs that treat the migraine itself.

Feverfew is an herb that may be used for migraines. It can be effective for some people. Before using feverfew, make sure your doctor approves. Herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.

Risk factors for dangerous headaches

Not all headaches require a doctor’s attention. But sometimes headaches warn of a more serious disorder. Let your Atrium Health Floyd and Harbin Clinic provider know if you have sudden, severe headaches. Get medical help right away if you have a headache after a blow to your head, or if you have a headache along with a stiff neck, fever, confusion, loss of consciousness, or pain in your eyes or ears.

Migraine headaches are a risk factor for strokes. Risk is higher in people who have migraines that occur with aura. People with migraines should avoid other risk factors for stroke. These include:

• Smoking
• Taking birth control pills
• Eating unhealthy foods

True migraine headaches are not a result of a brain tumor or other serious medical problems. Only a health care provider who specializes in headaches can determine if your symptoms are due to a migraine or other condition.