For some people, a headache is a minor or occasional nuisance prompting the use of headache medicine to stop the pain and get back to life as usual. For others, however, headaches can be painful and disabling. In fact, every 10 seconds, someone goes to an emergency room in the US with a migraine headache. But, did you know, not all headaches are created equal. There are several different headaches, some of which include migraine, tension, sinus, cluster, and medication overuse headaches. Do you know the difference?
More than just a simple headache, migraine is a collection of neurological symptoms that can be debilitating. The hallmark of a migraine is moderate-to-severe throbbing or pulsing pain on one side of the head, with one-third of attacks affecting the entire head. One or more of the following symptoms may also accompany migraine episodes: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. Migraines can last from 4 to 72 hours. Some people experience them with aura—a strange light, unpleasant smell, or confusing thought—which can act as a warning sign that a migraine headache is coming.
Migraines are three times more common in women than men, and usually occur in people with a family history of it. There are medications to help people with migraines, and certain lifestyle changes may help.
Tension headaches, also called “stress” headaches, are the most common type of headache. The pain in a tension headache may range from mild to severe, and occurs on both sides of the head as a band of pain around the head, or as a tight feeling in the jaw or neck. Some people describe the pain as a feeling similar to having their head in a vice or an intense pressure. The pain may start slowly and gradually become more severe. Tension headaches are thought to be caused by tight muscles in your shoulders, neck, scalp and jaw, and are often triggered by stress, depression, or anxiety.
Though some may have tension headaches on occasion, some people suffer from chronic tension headaches, meaning they occur 15 or more days per month for at least 3 months. It may be hard to tell the difference between tension and migraine headaches. But it can help to know that people with tension headaches do not usually experience nausea, vomiting, or sensitivity to light, sound or smell, the way some people do with migraines.
Sinus headaches are actually rare. They cause a dull, throbbing pain across the face and front of the head where the sinuses are located. Associated symptoms typically include nasal congestion, runny nose, and facial and forehead pressure. The pain worsens with head movements and when bending or lying down—and they are usually worse in the morning.
Some people who experience these symptoms and think they have a “sinus headache” might actually have migraines or tension headaches. In fact, many people who were diagnosed with migraine initially may have thought that they had a “sinus” headache. True sinus headaches (called rhinosinusitis) almost always occur when a person has a bacterial or viral sinus infection and may experience symptoms such as thick nasal discharge, the inability to smell, and facial pain or pressure with a fever. The headache subsides when the sinus infection resolves or is properly treated in the case of bacterial infections.
As the name suggests, cluster headaches recur over a period of time—meaning headaches occur in a group or “cluster” of attacks. They cause short, severe burning pain on one side of the head and may include eye-redness and a stuffy nose on the same side of the head as the pain. Cluster headaches can cause recurrent and throbbing pain on one side of the head. However, unlike migraines, cluster headaches characteristically arrive in a cyclical pattern, such as at the same time every day or every season. They can come on suddenly, without warning as a severe pain, can last for a week, a month, or a year, (hence the name “cluster”) and then go away for a certain period of time. People with cluster headaches may become restless due to the excruciating pain, and usually are seen pacing or sitting up through the attack, because lying down tends to increase the pain.
Cluster headaches are more common in men more than in women, in smokers, and in those with a family history of these headaches. Alcohol is a known trigger of intense headaches during a “cluster period.”
Medication Overuse Headaches
A medication overuse headache (also known as rebound headache) is a major cause of chronic daily headaches due to the overuse of certain headache medicines, including over-the-counter pain medications, or certain prescription medicines. Depending on the type of medicine taken, overuse is defined as taking headache medication frequently for at least 10 days per month for 3 months or longer. The headache may either develop or worsen despite the use of medication. People who suffer from medication overuse headaches often develop chronic daily headaches which can cause them to take more medication to help treat their headache, and consequently get stuck in a vicious ‘medication-headache’ cycle. Unfortunately for headache sufferers, the overuse of headache pain medication actually causes more frequent headaches.
Medication overuse headaches generally cease or go back to their original pattern within 2 months after the medication is stopped. Some people require inpatient detoxification, or an outpatient gradual withdrawal from pain-relieving medicines supervised by a doctor. Withdrawal symptoms during detoxification, may include severe headache, nausea, vomiting, sleep problems, agitation.
What You Can Do
If you experience headaches that are not well controlled by your current treatment regimen, or have any recurrent head pain, be sure to speak to your healthcare provider to find a treatment that is right for you.
Margaret L. Frazer, MD is Senior Director within the Cardiovascular and Metabolic team at Pfizer.