Headaches can be a real pain in the neck, which most if not all people will experience multiple times throughout their lives. A headache is a pain in your head, face or neck which can include pressure that’s throbbing, constant, sharp or dull. It can vary significantly in pain type, severity, location and frequency. Chronic headaches may greatly hinder quality of life if someone is constantly in pain.
The first step toward reducing the frequency and severity of headaches is to pinpoint what type of headache you are experiencing, which will help determine the underlying cause. Use our guide to differentiate between the most common types of headaches and to learn how they can be effectively treated.
Cluster Headaches
One of the most painful types is the cluster headache, which occurs in cyclical patterns or cluster periods. These may wake you in the night with intense pain in or around one eye, on one side of the head. Bouts of frequent attacks could last weeks or even months. Those most affected are often ages 20 to 40. The cause is unknown, but cluster headache patterns suggest that abnormalities in the hypothalamus, which helps regulate the autonomic nervous system in the brain, play a role.
Cluster headaches strike quickly, usually without warning, and tend to have recognizable symptoms:
- Excruciating pain generally situated in, behind or around one eye, but which may radiate to other areas of your face, head and neck
- One-sided pain
- Restlessness
- Excessive tears or tearing
- Redness of your eye on the affected side
- Stuffy or runny nose on the affected side
- Forehead or facial sweating on the affected side
- Pale skin or flushing on your face
- Swelling around your eye on the affected side
- Drooping eyelid on the affected side
Treatment of a cluster headache involves stopping a current attack and preventing future attacks. To end or moderate an attack in progress, your healthcare provider may give you a high-dose oxygen therapy through a face mask for 15 to 20 minutes or prescribe a nasal spray to help with pain relief.
To prevent future cluster headaches, it’s critical to pinpoint what triggers your headaches. Avoiding smoking and alcohol is especially encouraged. Talk to your doctor, who may prescribe a medication regimen to help prevent cluster headaches.
Hypnic Headaches
Because it exclusively occurs during sleep and wakes the person experiencing it, a hypnic headache is nicknamed an “alarm clock” headache. The pain may last between 15 minutes to four hours after waking. Often, this rare sleep disorder begins after age 50, but it may occur in younger people as well.
The pain can range from mild to severe, is most commonly reported as “dull” and typically occurs on both sides of the head. Some report a throbbing or pulsating headache. Hypnic headaches also tend to occur more than once per night. Lithium carbonate, caffeine, melatonin, flunarizine, indomethacin and topiramate can be used to treat hypnic headaches.
Migraine Headaches
A migraine is a common neurological disease that often presents as a pulsating headache on one side of the head. It often grows worse with physical activity or exposure to certain lights, sounds or smells and can last at least four hours or multiple days. Migraines are frequently one-sided, but they may occur anywhere on the head, neck and face or all over.
Migraines can be classified into subtypes:
- Migraine without aura
- Migraine with aura
- Chronic migraine
- Probable migraine
Common symptoms for any migraine include:
- A throbbing or pounding feeling
- Sensitivity to light, noise and/or smells
- Nausea
- “Sinus-like” symptoms such as watering eyes, nasal congestion and a sense of facial pressure
There is not a cure for migraine headaches, but you can treat your symptoms right away for pain relief. Over-the-counter pain medicines can be helpful when a migraine is mild, while other medications can address nausea and/or vomiting.
To prevent future symptoms, try to avoid your known triggers. If you have frequent migraines, talk to your healthcare provider about prescribing medicine to lessen the number of attacks.
Tension Headaches
A tension headache is the most common type of headache. It’s usually a mild to moderate pain, often described as feeling like a tight band around the head. These typically cause a steady ache, as opposed to a throbbing one, and tend to affect both sides of the head. Tension-type headaches are divided into two main categories: episodic and chronic.
Symptoms include:
- Dull, aching head pain
- Sensations of tightness or pressure across the forehead or on the sides and back of the head
- Tenderness in the scalp, neck and shoulder muscles
- Slow onset
OTC medication can usually help with pain relief. Lifestyle changes such as regular sleep, exercise, hydration and meal schedules can reduce or prevent these headaches.
Secondary Headaches
A secondary headache is caused by another condition that triggers pain-sensitive areas in the neck and head. They are rare, but they can also be much more serious than primary headaches, where the headache itself is the problem. Secondary headaches may be a warning sign of a more serious underlying condition, including brain tumors, aneurysm, meningitis or a neck or brain injury.
We can distinguish secondary headaches from primary headaches by the features of the headache, other co-occuring symptoms and a physical examination.
Your healthcare provider will check for warning signs, which might include:
- “First or worst” headache of your life
- Abrupt onset, without any warning
- Fundamental changes in a pattern of recurring headaches
- Headaches beginning at unusual ages, namely under 5 or over 50
- The presence of cancer, HIV or pregnancy
- Abnormal physical exam
- Getting a headache after a seizure, passing out, exertion, sex or certain types of internal squeezing
When to Seek Care
You should seek immediate medical attention if you’re experiencing the worst headache of your life. Many patients describe such as event as a sudden, severe headache or a headache accompanied by:
- Confusion or trouble understanding speech
- Fainting
- High fever, greater than about 102 degrees Fahrenheit
- Numbness, weakness or paralysis on one side of your body
- Stiff neck
- Trouble seeing, speaking or walking
- Nausea or vomiting
These symptoms could indicate a serious condition like a stroke, meningitis or encephalitis. Without timely treatment, serious damage could ensue. If ever in doubt, it’s always a good idea to get checked out at an ER or urgent care.