Headache - Symptoms, Types, Causes, Prevention, and Treatment

Headache definition

A headache is defined as pain in any part of the head, including the face, scalp, and inside the head. Headaches can affect people of all ages, races, and economic status. Headaches vary considerably in intensity and the severity of the underlying medical conditions that cause them. Some headaches occur frequently (episodic) and may last for days or weeks at a time (chronic). Pain may be slight or severe, and it may be accompanied by symptoms like nausea or increased sensitivity to noise or light. The activation of pain-sensitive structures in the brain, skull, face, sinuses, and teeth causes headaches.

Without proper treatment, headaches may be severe and disturb daily activities. These complex conditions, which affect the individual in many aspects of everyday life, require a treatment plan that includes both preventive and acute therapies. Headaches can be treated effectively by general physicians or neurologists. Treatment for a headache varies by its frequency, severity, and symptoms.

Headache meaning

The term headache comes from the Old English word heafodece, which means "head" and "ache," and refers to head pain. In medical terminology, headaches are also known as cephalalgia, where "cephalo-" means head and "-algia" means pain.

Headache prevalence

Prevalence of headaches in the world

The worldwide prevalence of headache disorders is high, with estimates indicating that roughly 52% of the population suffers from active headache disorders. Specifically, 14% suffer from migraine, 26% from tension-type headaches, and approximately 15.8% have headaches every day.

Prevalence of headaches in India

Headaches are India's most frequent neurological condition, affecting around 4.88 crore people. Among these, 2.13 crore suffer from migraines and 3.74 crore from tension-type headaches, with a significant increase in prevalence over the years, especially among women aged 35 to 59 years. 

Types of headaches

There are different types of headaches, which differ significantly according to cause, frequency, and severity. Below are the three types of headaches: 

• Primary headache
• Tension-type headaches
• Migraine
• Trigeminal autonomic cephalalgias
• Other primary headache conditions
• Secondary headache
• Neuropathies, facial pain, and other headaches
  

Primary headache

This type of headaches occurs on their own. Primary headache types include: 



• Tension-type headaches: Tension type headaches are the most prevalent type of headache. People can experience this form of headache infrequently, frequently, or chronically. Although the exact causes of tension-type headaches are uncertain, current research suggests that a person's genes, brain impulses, and muscle discomfort all play an essential role. Tension-type headaches typically cause mild to moderate pain and feel like persistent pressure on the face, head, and neck. They may also feel like a belt is tightening around the head. Most people have pain on both sides of their heads.

• Migraine: Migraine is a condition in which a person experiences repeated episodes of moderate to severe throbbing and pulsating pain on one side of the head. Migraine occurs in both children and adults, and it affects women more frequently than men. Migraine symptoms vary from person to person, although they typically include recurring headaches. They may also include nausea, vomiting, mood changes, excessive fatigue, and sensitivity to light, noise, and odors. These symptoms might occur simultaneously during a migraine episode or separately in between migraine attacks. Migraine attacks can range from hours to days, making it difficult to do daily tasks.

• Trigeminal autonomic cephalalgias (TACs): TACs are rare conditions in which pain occurs on one side of the head. Other symptoms include eyelid swelling, nose congestion, and sweating. Cluster-type headaches are the most prevalent type of TAC and the most severe primary headache. They includes sudden, severely painful episodes that frequently occur at the same time of day or night for several weeks.

• Other primary headache conditions: Other types of primary headache conditions do not exhibit the symptoms of tension-type headaches, migraines, or TACs. It might be difficult to diagnose certain types of headaches, but a doctor can diagnose them by performing tests and considering all of a person's symptoms.

Secondary headache

Secondary headaches are caused by another health condition that stimulates pain-sensitive nerve endings. Brain-related diseases cause these headaches. Various causes of secondary headaches include brain injury, brain tumors, brain stroke high blood pressure, seizures, infections, and substance misuse.

Neuropathies, facial pain, and other headaches

A third category comprises neuropathies, facial pains, and other headaches that occur as a result of nerve damage or result in head pain that are not included within the symptoms of primary or secondary headaches. Trigeminal neuralgia, a condition that affects the trigeminal nerves and is characterized by intense facial pain that occurs suddenly, is one example. 

Headache causes

Various physiological and environmental factors can cause headaches. The main causes of headaches are classified into the following categories:

• Tension-type headaches: These are frequently caused by muscle strain in the head, neck, and shoulders due to of stress, anxiety, poor posture, or excessive computer use.

• Migraine: Changes in brain activity, which are frequently linked to genetic factors, trigger migraine. Specific diets, hormonal fluctuations, stress, and environmental conditions like bright lights are all common triggers.



• Cluster headaches: These headaches are caused by severe pain around one eye and can be worsened by alcohol intake or changes in sleeping patterns. The specific cause is unclear; however, it may include the hypothalamus.

Secondary headaches

• Sinus headaches: Sinus infections or inflammation can cause pressure and pain in the forehead and cheekbones.
• Trauma or injury: Head traumas can cause headaches due to inflammation or pressure changes in the brain.
• Dehydration: Insufficient water consumption can cause generalized headaches.
• Hormonal changes: Hormonal fluctuations during menstrual cycles or pregnancy may cause headaches in some women.
• Systemic illnesses: Infections (for example, the flu), high blood pressure, and other systemic conditions can cause headache symptoms.

Headache symptoms

The symptoms of a headache vary according to its type. The frequency of headaches and intensity of symptoms may also vary. Common headache symptoms include the following:

Pain characteristics

• Location: Headaches can be unilateral (one-sided) or bilateral (affecting both sides). Migraines, for example, are characterized by unilateral throbbing pain, whereas tension headaches can cause a dull, pressing sensation on both sides of the head.
• Intensity: Pain can be slight or severe and disrupt daily activities. Migraines are often considered moderate to severe and can be challenging, but tension-type headaches normally cause mild to moderate pain.

Associated symptoms

• Nausea and vomiting: These are frequently related to migraines; people may experience nausea and vomiting during a migraine.
• Sensitivity to light and sound: Phonophobia (sensitivity to sound) and photophobia (sensitivity to light) are common in people with migraines but less common in tension headaches.
• Aura: Some people have an aura before a migraine episode, which can include visual disturbances (such as flashing lights), sensory alterations, or motor symptoms.
• Fatigue and mood changes: Individuals may experience tiredness or irritability after a migraine attack. Mood changes may also occur before a headache starts.

Specific symptoms by type

• Migraine: Symptoms include throbbing or pulsating pain lasting 4–72 hours, along with nausea, vomiting, and sensitivity to light and sound.
• Tension-type headache: Symptoms include dull, aching pain and tightness or pressure on the forehead or back of the head, without nausea or sensitivity to light.
• Cluster headache: Severe and sharp pain that occurs in clusters over weeks or months, usually centered around one eye, and is associated with autonomic symptoms such as tearing, nasal congestion, or drooping eyelids.

Severe headache symptoms 

• The sudden onset of a severe headache ("thunderclap headache")
• Headache along with neurological symptoms such as disorientation or weakness.
  

Headache risk factors

Several risk factors can increase the likelihood of getting headaches. Understanding them can help people identify potential triggers and manage them more effectively. Below are some of the risk factors for headaches: 

• Genetics: A family history of headaches, particularly migraines, considerably increases the risk; children with parents who experience migraines have a higher probability of getting them.
• Dietary triggers: Particular foods (e.g., aged cheeses, processed meats, alcohol) and additives (such as monosodium glutamate) can cause headaches in susceptible people.
• Stress: Emotional stress and anxiety are a major triggering factors for tension type and migraine headaches.
• Sleep issues: Irregular or inadequate sleep patterns can cause headaches, and illnesses such as sleep apnea are also associated with morning headaches.
• Environmental factors: Headaches can be triggered by bright lights, strong odors, smoke, or weather changes.
• Physical activity: Heavy physical activity or bad posture during activities can result in tension type headaches.
  

Complications of headache

Complications of headaches can result from both primary and secondary headache conditions. The following is a brief list of potential complications resulting from particular conditions:

Complications of primary headaches

• Medication overuse headaches: These are also known as rebound headaches. Excessive use of pain relief medications can lead to increased headache frequency and intensity, requiring a change in treatment approach.
• Status migrainosus: A severe migraine attack lasting longer than 72 hours can cause dehydration and may need hospitalization.
• Gastrointestinal issues: Long-term usage of nonsteroidal anti-inflammatory medicines (NSAIDs) for headache treatment can cause abdominal pain, ulcers, and gastrointestinal bleeding.
• Persistent aura without infarction: Aura symptoms that last more than a week can resemble stroke symptoms but do not indicate actual damage in the brain.
• Migrainous infarction: This uncommon but life-threatening complication resembles a stroke and happens when a migraine with aura leads to diminished blood supply to the brain, potentially resulting in irreversible damage.
• Neurological complications: Seizures, particularly those with aura, can occur along with migraines.
• Mental health disorders: Frequent migraine sufferers are at a greater risk for depression and anxiety, which may worsen their headache symptoms.

Complications of secondary headaches

• Visual disturbances: Secondary headaches associated with conditions like glaucoma can cause vision loss if not managed or treated immediately.
• Sleep disorders: Headaches can affect sleep habits, causing insomnia (sleeplessness) and complicating headache treatment.
• Increased intracranial pressure: Conditions that cause high pressure in the skull can cause severe headaches and neurological impairments.
• Life-threatening conditions: Secondary headaches may suggest underlying severe conditions such as brain tumors, subarachnoid hemorrhage, or meningitis and require prompt treatment.
• Chronic pain syndromes: Persistent secondary headaches may change into chronic pain issues that considerably affect quality of life and require continuing management.
• Cervical artery dissection: This condition is characterized by significant neck pain and headaches after trauma and can cause stroke-like symptoms.

Headache diagnosis

Headaches are diagnosed using a systematic approach, which includes several important factors. Following are the steps commonly included in the diagnostic process for headaches:

• Medical and headache history
• Physical and neurological examination.
• Laboratory tests 
• Blood
• Urine
• Fluid tests
• Neuroimaging tests 
• CT (computed tomography) scan 
• MRI (magnetic resonance imaging)
• Cerebrospinal Fluid (CSF) analysis
• Lumbar puncture (also referred to as spinal tap)
• Electroencephalogram (EEG)
  

Headache treatment

Modalities of treatment differ depending on the type of headache, its frequency, and intensity. The following are the primary headache treatment options, which include:

• Non-pharmacological therapy

• Pharmacological therapy
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Triptans
• Anticonvulsants
• Beta-blockers
• Calcium channel blockers
• Antidepressants



• Alternative therapies
• Acupuncture 
• Chiropractic
• Biofeedback
• Meditation
• Relaxation training
• Cognitive-behavioural therapy
  

Headache prevention

Taking preventative measures for headaches can help to lessen their frequency and intensity. Below are some of the preventive measures for headaches:

• Considering preventive medications: People experiencing frequent headaches are advised to consult a physician to enquire about preventive drugs such as beta-blockers, anticonvulsants, and antidepressants. 

• Maintaining regular sleep patterns: People need to maintain consistent sleep patterns by going to bed and waking up early at the same time every day. Adequate sleep can help avoid headaches caused by tiredness or irregular sleep. 

• Maintaining a healthy diet: To maintain blood sugar levels normal, people need to eat regular, well-balanced meals. Avoid missing meals and restrict the consumption of headache-inducing items like processed meats and monosodium glutamate (MSG).

• Limiting caffeine and alcohol: Limiting the consumption of coffee and alcohol, as both can cause headaches in certain people. Consuming both of these in moderation can help prevent headaches.



• Managing stress: People need to practice stress-reduction strategies, including yoga, meditation, and deep breathing exercises. Regular physical activity can help reduce stress.