By Dr. Loretta Lanphier, ND, CN, HHP, CH

A headache once in a while is just part of life for most of us, and the majority of the time they don’t cause significant problems. However, there are headaches, and there are headaches. Let’s take a quick look at some of the major types of headaches, what may cause them, and what steps can be taken to manage them.

What Are Headaches?

A headache is characterized by pain in the head which may be classified as either primary (a disorder of its own) or secondary (the result of another disorder). The vast majority headaches are of the primary type. Headaches are a very common condition. Almost everyone will have a headache from time to time, but it is estimated that up to 45 million people in the United States suffer from chronic, recurring headaches. Some types of headaches affect women more than men, and vice-versa. There are many different varieties of headaches. Most of them are not indicators of serious illness, but certain types or patterns regarding headaches may indicate a critical condition that needs immediate attention. These types are the less common secondary headaches associated with another medical condition.

The tissues of the brain have no sensitivity to pain, so headaches are experienced due to muscle contractions of the face, neck, or scalp; swelling of the brain that causes the coverings of the brain to expand; or dilation (enlargement) of blood vessels in the cranial area.

There are three types of primary headaches that account for most cases: Tension headaches, migraine headaches, and cluster headaches.

Tension Headaches

Also called tension-type headaches, these buggers are the most common of all headaches, but surprisingly they are not well understood. Symptoms of tension headaches include:

ü       Dull, achy pain, usually mild to moderate.

ü       Sensation of “tightness” around the circumference of the head.

ü       Some describe it as a “tight band of pressure” surrounding the head.

ü       Some people get pain even into their neck and shoulder muscles, with one person calling it a “hooded cape that drapes down over my shoulders.”

ü       Soreness of the scalp

ü       Difficulty concentrating

ü       Irritability

ü       Insomnia

ü       Loss of appetite

ü       Fatigue

Many folks who have tension headaches find that they often come on first thing in the morning, or later in the evening, the latter thought to be from cumulative stress throughout the day.

What Causes Tension Headaches?

Despite the fact that tension headaches are as common as an old shoe, the actual cause behind them has been a subject of debate and has spawned many different theories as to how and why they occur. “Experts” have speculated for years as to whys and wherefores of these headaches, and they have gone by many names based on these theories: muscle contraction headache, essential headache (so common that they are “necessary??”), depressive headache, psychogenic headache (all in your head, no pun intended), and ordinary headache.

The general consensus has been that tension headaches (hence the name) are typically the result of the pain produced by muscle tension in the head, face, neck, etc., and that they are triggered by emotional and/or physical stress. But recent research has put that theory into question. Clinical studies have been done using an instrument called an electromyogram that can measure the amount of tension in the muscles of a person with a “tension” headache, based on the behavior of electrical impulses in the muscles. These studies do not show any increase in muscle tension of headache victims versus folks without a headache. So, it appears that muscle tension may not be the cause of these common headaches after all. This discovery caused “The “International Headache Society” (yes, there really is an organization named such) to change the term officially to tension-type headache. Whew! All this uncertainty is enough to give me a headache.

The latest science points towards chemical changes in the brain that have a two-fold effect. First they stimulate pain “pathways” in the brain, and secondly they impede with the brain’s normal ability to block pain. These chemicals such as endorphins and serotonin normally help the brain to communicate with the rest of the nervous system. But the role of muscle tension cannot be totally ruled out. Some think tightened muscles are the result of these chemical changes, while others think that tense muscles may help trigger chemical imbalances.

There are many risk factors that may contribute to tension headaches. These vary from person to person, and may be one of the reasons these headaches are so common. Typical ones include:

  • Stress (physical and emotional)
  • Sleep disturbances
  • Poor diet or skipping meals
  • Bad posture
  • Sitting in one place or one position for long periods of time
  • Changes in hormone levels (pregnancy, menstrual, etc.)
  • Depression
  • Anxiety
  • Side-effects of medications
  • Noise
  • Bright lights
  • Vision problems (such as improper eyewear)

Migraine Headaches

Some studies done in recent years on tension-type headaches have found similarities between them and migraine headaches in the fact that they may both be related to chemical changes in the brain. One major difference is that many more women than men experience migraines, and this is due to hormonal factors.

Migraines are typically intense, throbbing headaches that usually occur on only one side of the head at a time. The symptoms can be severe, to the point of being debilitating to migraine victims. Signs may include nausea, vomiting, blurred vision, super sensitivity to light and sound, and worsened symptoms during movement. Some migraine suffers will experience an “aura” whereby they are able to sense and predict an oncoming attack. Others have migraines without aura.

Many migraines are brought on or intensified by certain foods that a person may be reactive to. Common offenders include aged cheeses, wine, and chocolate. Migraines are have a fairly predictable cycle for some sufferers, and seem to come and go at will for others. For more detailed information, see the article in this series entitled “Migraine Headache.”

Cluster Headaches

Cluster headaches are not nearly as common as some other common varieties of headaches, but they can be one of the most painful. They derive their name from the cyclical patterns that are characteristic of them. They come in “clusters,” much to the dismay of their sufferers. Fortunately, this condition is very rare, affecting only about 0.5% of the general population, with 80% of them being men. They can afflict folks of any age, but most cluster headaches are found in men between the ages of 20-40. The cluster periods when headaches are frequent alternate with periods of remission that may last for months or even years in some cases when patients experience no headaches at all. Most victims have cluster headaches that come on fast and very intensely without warning. They usually affect only one side of the head, and often a patient will always have them on that same side for their entire lives, but not always.

Cluster headaches can be extremely painful. Some patients have described them as if a hot piece of metal was being stuck in the eye or have felt as if the eye was being forced out of its socket. Victims will often pace or do some sort of physical activity such as pushups or jogging in place, as it seems to bring some relief. Some will also insist on being alone, even outside in frigid weather. Patients have sometimes felt as if they were going insane from the pain, often exhibiting behaviors such as screaming or banging their heads against a wall. Others suffer from sleep deprivation because the headaches consistently come on when they lie down or shortly after falling asleep. The lack of sleep and the pain often leads to depression and even suicidal thoughts in some sufferers.

Typical symptoms of a cluster headache include:

  • Stuffy nose and teary eye on the same side as the pain
  • Clammy, pale skin
  • Flushed appearance on the affected side.
  • Swelling near the eye on the affected side.
  • Droopy eyelid on the same side as the pain.
  • Reduced pupil size

The headaches themselves last from a few minutes up to several hours. The cluster periods can last anywhere from two weeks up to 3 months. Some people have uncannily predictable cycles, such as those beginning on the solstices, the shortest and longest days of the year. Sometimes during a cycle the headaches will occur at almost identical times during the day. Most attacks occur between 9pm and 9am, and seem to be closely related to “rapid-eye-movement” (REM) sleep cycles. Often the pain exits as quickly as it appeared, and most victims are exhausted after going another round with these awful headaches.

The causes of these headaches are thought to be related to abnormal functioning of the hypothalamus gland, the organ that controls our “biological clocks.” The levels of certain hormones are also a factor, another function that is sometimes regulated by the hypothalamus. Some research also implicates abnormal activity in the trigeminal nerve, a major pathway for pain that is located behind your eyes. It is speculated that some cluster headaches may be triggered by inflammation or blood vessel dilation in the region of the trigeminal nerve.

As you can imagine, cluster headaches can be very life controlling problem for many people. It is almost impossible to carry on with everyday activities such as work or family life, and there have been cases where patients have been declared totally disabled and unable to work due to a diagnosis of cluster headaches.

How Can Headaches Be Treated or Prevented?

Now that we have covered the major types of headaches, what can be done if we suffer from them? There are a glut of medications that have been designed to help folks with headaches. Of course, these can be used appropriately, and can bring significant relief in many cases. However, one thing to be aware of is overuse of medication. In addition to dangerous side effects such as over burdening your liver, a phenomenon called rebound headache can occur whereby continuous use of certain medications will not only cause them to lose their effectiveness, but may bring on unique headache pain as a result of the medication overuse. The cure then becomes the cause, and you certainly don’t want that to happen.

Some other favorite therapies for headache pain include:

  • Oxygen: Inhaling pure oxygen helps many patients find relief, especially from cluster headaches.
  • Massage: Gentle massage of the head and scalp, especially in the area of the temples, is very effective for many patients.
  • Regular exercise can help regulate the pain managing functions of the brain, and eliminate or minimize some headache pain.
  • Headache journal: Folks with chronic headaches may find it helpful to document their experiences. It helps to find patterns and/or triggers that may be avoided in order to manage headache pain.

Most headaches are not a serious or life threatening condition, although some types can cause excruciating pain. Learning to manage chronic headaches can be a big help. But one thing to be aware of is any significant changes in headache patterns or new pain that never existed before. This could be a sign of an underlying condition that should be checked out.

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