Headache Basics
Headaches do not originate in the brain, as many people think; they are the products of malfunctioning muscles, blood vessels, and nerves in the head. One or more of these malfunctions — for example, the dilation of arteries or overcontraction of muscles — can activate sensory nerves in the head, resulting in a headache.
Hormones such as estrogen can make headaches worse. This is why women, who undergo hormonal fluctuations as part of their monthly menstrual cycle, are twice as likely as men to experience moderate and severe headaches and more likely to experience certain types of headaches, such as migraine.
What Type of Headache Do You Have?
About 95% of headaches aren’t caused by an underlying disease or structural abnormality. Instead, their origins lie in such common conditions as stress, fatigue, lack of sleep, hunger, changes in estrogen level, weather changes, or caffeine withdrawal.
The three most common types of headache are tension, sinus, and migraine. Table 1 offers brief descriptions of these, and each is discussed in greater detail later in this report (see the sections “Tension headache,” “Sinus headache,” and “Migraine headache”). Headache that occurs daily or almost daily is also addressed (see “Chronic daily headache”), as well as a rare but very painful type of headache known as a cluster headache (see “Cluster headache”).
Table 1: Common types of headaches
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Type
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What it feels like
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Who gets it
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How often and for how long
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Tension
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Mild to moderate steady pain throughout the head, but commonly felt across the forehead or in the back of the head. Generally not accompanied by other symptoms.
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Can affect children, but is most common in adults.
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Frequency varies. Generally hours in length.
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Sinus
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Mild to moderate steady pain that typically occurs in the face, at the bridge of the nose, or in the cheeks. May be accompanied by nasal congestion and postnasal drip.
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Affects people of all ages. People with allergies seem most vulnerable.
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Frequency varies. Generally hours in length. Often seasonal.
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Migraine
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Moderate to severe throbbing pain, often accompanied by nausea and sensitivity to light and sound. The pain may be localized to the temple, eye, or back of the head, often on one side only. In migraine with aura, visual disturbances precede the pain.
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Typically occurs from childhood to middle age. In children, migraine is slightly more common among males, but after puberty, it’s much more common in females.
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Attacks last a day or longer. They tend to occur less often during pregnancy and with advancing age.
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Mixed Headaches
As understanding of the different types of headaches has evolved, researchers have altered some of their beliefs about tension and migraine headaches and the relationship between the two. This is largely because of the realization that some headaches don’t neatly fit either category. “Mixed” headaches have characteristics of both types, and because they’re hard to classify, treatment can be challenging.
For instance, the more intense a tension headache gets, the more it resembles the sharp, throbbing pain of a migraine headache. Likewise, when a migraine headache becomes more frequent, its pain begins to feel like that of a tension headache. Thus, experts now believe that headaches fall along a continuum ordered by their characteristics: The occasional tension headache is at one end and the migraine headache is at the other. In between are chronic tension headache and a hybrid sometimes referred to as chronic tension headache with migraine.
This doesn’t mean that all headaches share the same mechanisms. Experts still generally believe that tension headaches are stimulated by muscle tightness, while migraine headaches are caused by the dilation and inflammation of blood vessels. However, if you have migraine headaches frequently, you may develop muscle tightness, which can trigger more headaches.
Headache Caused by a Medication or Illness
Some headaches are actually symptoms of another health problem. Many non-life-threatening medical conditions, such as a head cold, the flu, or a sinus infection, can cause headache. Some less common but serious causes include bleeding, infection, or a tumor. A headache can also be the only warning signal of high blood pressure (hypertension). In addition, certain medications — such as nitroglycerin, prescribed for a heart condition, and estrogen, prescribed for menopausal symptoms — are notorious causes of headaches.
Because the following symptoms could indicate a significant medical problem, seek medical care promptly if you experience
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a sudden, severe headache (with or without a stiff neck)
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a headache with fever
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convulsions
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a headache following a blow to the head
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confusion or loss of consciousness
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a headache along with pain in the eye or ear
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a persistent headache when you were previously headache-free
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a headache that interferes with routine activities.
Always take children who have recurring headaches to the doctor, especially when the pain occurs at night or is present when the child wakes in the morning.
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Do you scream after ice cream?
Ice cream scoops
One minute you’re enjoying a delicious ice cream cone; the next, you have “brain freeze.” Generally, the headache is immediate and lasts for under a minute. It’s usually a very sharp, steady pain felt in the center of the forehead, but it may also occur on one side.
The cause of cold-stimulus headache, or “ice cream headache,” remains largely a mystery. One theory is that the pain originates in the back of the throat, which is chilled by the ice cream, but is felt in the head. This is known as referred pain. Any cold food or drink can induce this type of headache, but ice cream is the main culprit because it’s very cold and is often swallowed quickly. This doesn’t allow for the treat to be warmed slightly in the mouth before it contacts the back of the throat.
To the relief of ice cream lovers, doctors don’t prescribe abstinence for headache prevention. Instead, they suggest taking smaller bites and eating slowly, to give your mouth enough time to warm up the ice cream.
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