What to do for headaches?


What do I have to do to get rid of my headache?

— Throbbing

Dear Throbbing,

There's nothing that can ruin a day like a headache! That being said, not all headaches are the same, nor will they respond to treatment in exactly the same way. While the brain can't feel pain, headaches happen when brain signals collide, causing the brain to perceive pain; or when inflammation occurs in muscles, blood vessels, or nerves in the head and neck. Headaches can have many causes, ranging from tension (which is most common) or eyestrain, to illnesses, or even, in rare cases, tumors. Additionally, headaches can create different types of pain, such as shooting, throbbing, sharp, dull, constant, inconsistent, and so on, that may vary depending on the type of headache.

Since there are so many different types (enough to cause another headache), it’s helpful to understand the differences in the two main categories of headaches, primary and secondary:

Primary headaches are due to oversensitive pain receptors in the brain without other underlying causes. They may have a genetic component as well. Common causes include emotional stress or physical stress, such as poor posture. The muscles in the neck, scalp, and jaws tighten, producing a dull, aching sensation, or band of tension, around the head. Primary headaches can typically be treated with over-the-counter (OTC) pain medications. Some specific primary headaches types include:

  • Cluster headaches, which usually include throbbing or constant pain around the eyes. These are typically short lived, but may occur several times daily for up to a few weeks to months. A stuffy nose is also not uncommon to experience with cluster headaches. Typical treatments include preventative pain medications or prescribed injectable medications, nasal spray, or oxygen therapy.  
  • Tension headaches, which usually include constant pain that lasts for a few hours to days at the temples, forehead, or back of the head. Tension headaches are usually treated with OTC pain medications, but other possible treatments may include physical therapy or muscle relaxants.
  • Hypnic headaches, which specifically afflict people in post-menopause are usually prominent during the night. Typical treatment of hypnic headaches can include caffeine, lithium, or calcium channel blockers, as prescribed by a physician. 
  • Vascular headaches, including migraines, which are more severe, throbbing headaches caused by blood vessel constriction and expansion in the head. Migraines, in particular, may be accompanied by other symptoms such as seeing flashing lights, stars or "auras" around objects, or nausea or vomiting. They unfortunately don't have a straight forward treatment available, as there isn't scientific consensus on their exact causes (although some attribute migraines to overreactions in nerve cells to different stimuli). For most, typical treatment for migraines includes rest in a room without noise or light, application of a compress (hot/cold), and massage. Some people who experience migraines are also prescribed magnetic stimulation or medications to prevent and manage symptoms. 

Secondary headaches, on the other hand, are symptoms of other issues, such as infections. For example, sinus headaches are caused by blockage of the sinus cavities with resulting nasal congestion, pressure and pain in the cheeks, forehead, and upper teeth. Other causes of secondary headaches may include high blood pressure, blood clots, neck or brain injury, other illnesses or brain tumors. Secondary headaches can be very painful, and their treatment must target the underlying cause. They may require medical treatment, especially if the cause is more severe. 

Not all headaches are created equal, and sometimes a combination of different types of headaches may occur simultaneously. If you have an unusually severe headache, if it's accompanied by a fever and a very stiff neck, if you've recently had a head injury, if it persists for more than three days, or you experience an increase in the severity or frequency of your headaches — it may be best to see a health care provider as soon as possible. 

If you believe you have a primary headache, there are some tips you may consider to help manage the pain:

  • Apply ice packs or heat on your neck and head.
  • Gently massage the muscles of your neck and scalp.
  • Use relaxation exercises, such as deep breathing.
  • Take an OTC painkiller such as aspirin, ibuprofen, or acetaminophen. 
  • Use a decongestant medication, if you have nasal congestion.
  • Reduce emotional and physical stressors, such as anger, eye strain, or continuous loud noise.
  • Avoid foods that may trigger headaches, such as aged cheeses, chocolate, nuts, red wine, alcohol, avocados, figs, raisins, or pickled foods.

If tips like these don't work for you, you may want to visit your primary care provider. They may be able to prescribe preventative medications or refer you to a headache clinic. 

Best of luck finding relief!

Last updated Jan 28, 2022
Originally published Apr 19, 1994

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