What is a headache?

Headache disorders are the most prevalent neurological disorders, affecting more than 90% of all Americans.  Headaches can be classified as 1) primary, 2) secondary, and 3) cranial neuralgias, facial pain, and other headaches.  The most common types of primary headaches are 1) tension type headaches, 2) migraine, and 3) cluster headaches.  Secondary headaches are a symptom of an injury or illness. While some secondary headaches are not dangerous, patients should seek medical care for new onset headaches, fever, stiff neck, change in behavior, vomiting, weakness, or a change in sensation. 


Tension type headache, the most common primary headache disorder, tends to be mild to moderate, non-throbbing, and involve both sides of the head. They usually do not get worse during routine activities (bending over, walking stairs, etc.) and many find relief with over-the-counter (OTC) medications.  Migraine is another type of primary headache disorder and is often the reason patients may seek medical attention.  Typical features of migraine include throbbing pain, one sided in location, moderate to severe intensity, worse with exertion, and may be associated with nausea, vomiting, light, sound, and/or smell sensitivity.  Migraines can last 4 hours to 3 days, but may become daily in some individuals.  Many patients feel their headache must be severe to be a migraine.  This is not necessarily accurate and a consultation with a neurologist may help clarify the diagnosis.  Cluster headache is a less common primary headache disorder, though they are severe and occur only on one side of the head.  They often happen in groups, or “clusters,” usually over weeks or months and often have additional features such as one sided eye tearing, eye redness, nasal congestion and/or rhinorrhea (runny nose).  New Daily Persistent Headache is another primary headache disorder that affects individuals daily and starts abruptly as headache that is new to the patient. Patients can often recall the date the headaches began.  These headaches may not be related to other diseases, they tend to be constant or persistent, bilateral (located on both sides of the head), and may be more challenging to respond to medications. 


Some patients may develop headaches due to specific causes.  These may include sinusitis, temporomandibular joint dysfunction (“TMJ”), medication overuse headaches (also known as rebound headaches) as well as other conditions including tumors, clots inside the brain, and life threatening infections like meningitis and encephalitis.  Mild head traumas may also cause post-concussion headaches.  Some secondary headaches


Neuralgia means nerve pain (neur= nerve + algia=pain). Cranial neuralgia describes inflammation of one of the nerves that provides sensation to the head and/or neck. One of the most commonly recognized examples of this problem is trigeminal neuralgia, which affects cranial nerve V (the trigeminal nerve) and can cause intense facial pain.  This pain often occurs on one side of the face, is very brief in duration per attack, and may re-occur through the day.

Is there any treatment?

There are many options available for patients depending on the type of headache disorder they are managing.  Treatment for primary headache disorders often require consideration of:

1.     Non-medication options including biofeedback training, stress reduction and relaxation training, elimination of certain foods from the diet (as well as monitoring the frequency of meals), hydration, stretching, regular exercise such as swimming or vigorous walking, sleep hygiene, cessation of tobacco use, and eliminating medication overuse if applicable.

2.     Preventative medications:  When headaches occur several times a month or cause debilitation from work or school or significantly affect one’s quality of life, a daily medication may be considered to help reduce the frequency and/or severity of the headaches.  Examples of preventative medications include topiramate, amitriptyline, propranolol, timolol, valproic acid, and botulinum toxin.

3.     Abortive or rescue medications: Abortive medications (also known as rescue medications) are used to help eliminate a headache. These medications are used to eliminate headaches when they occur. If one has daily headache at baseline, these medications may be best used to eliminate or reduce more severe headaches, also called “exacerbations.”  Examples of abortive medications may include sumatriptan, rizatriptan, diclofenac potassium, and Dihydroergotamine.  Abortive medications and other treatments may be available by mouth, nasal inhalation, injection, suppository, or topically (on the skin).

What is the prognosis?

Not all headaches require medical attention. However, some types of headache are signals of more serious disorders and call for prompt medical care. These can include: sudden, severe headache or sudden headache associated with a stiff neck; headaches associated with fever, convulsions, or accompanied by confusion or loss of consciousness; headaches following a blow to the head, or associated with new pain in the eye; persistent headache in a person who was previously headache free; new onset of sensory loss or weakness, and recurring headache in children.  Primary headache disorders such as migraine may be genetic and effective management of migraines often leads to significant reduction in frequency and severity of headaches, as well as significant improvement in one’s quality of life.