Headaches & migraines

Migraine and other headache disorders can arise at the most inconvenient times, causing severe pain and interrupting your daily life. In some cases, a frequent or severe headache may indicate a serious problem.

Our neurology specialists are here for you and can provide you with the latest headache and migraine treatments. They will make sure your headaches are not being caused by an underlying health issue and use state-of-the-art treatment technology to address both primary and secondary causes.

Types of headaches

Most headache disorders are separated into two main categories: primary and secondary. With occipital neuralgia, this disorder can be a primary or secondary headache. At Advocate Health Care, our neurologists have the experience and expertise to identify and treat both primary and secondary headaches.

What are primary headaches?

Primary headaches are a standalone condition, meaning it’s not a symptom of another medical issue.

A primary headache is generally triggered by nerves, blood vessels or muscles in your head and neck. Primary headaches can also be caused by your diet or lifestyle. Some lifestyle factors include alcohol consumption, sleep deprivation, not eating enough or stress.

Types of primary headaches include:

• Hemicrania continua
• Migraine
• Cluster headache
• Tension headache

What are secondary headaches?

A secondary headache is a headache that is a symptom of another medical issue. For example, a sinus headache is a symptom of a sinus infection. Other serious conditions that can be related to secondary headaches include:

• AVM (arteriovenous malformation)
• Brain aneurysm
• Brain tumor
• Carbon monoxide poisoning
• Encephalitis
• Glaucoma
• Head injury
• Hydrocephalus (too much fluid around the brain)
• Hypertension (high blood pressure)
• Infections, colds, fevers
• Meningitis
• Narrowing tear, rupture or blockage of blood vessels near the brain
• Sinusitis (inflammation of sinuses)
• Sleep disorders
• Stroke
• Trigeminal neuralgia

When is a headache an emergency?

While most headaches are not serious, there are times a headache can be the only sign you’ll get of a serious condition. If you experience any of the following, it’s imperative to call 911 or have someone take you to the emergency department:

• The feeling of severe pain in one eye along with redness in that eye.
• Your headache feels like the “worst ever” even if you get headaches regularly.
• Your headache gets worse over 24 hours.
• It happens after a head injury.
• You get a headache after activities like weightlifting, jogging, aerobics or sex.
• You have a history of cancer and notice a new headache.

Other symptoms that might be a sign of an emergency include:

• Changes in vision
• Slurred speech
• Confusion
• Balance problems
• Memory loss
• Stiff neck
• Fever
• Nausea
• Vomiting
• Pain with chewing
• A headache that starts suddenly

Types of primary headaches & symptoms

There are several types of headaches that are classified as primary headaches, including migraines. Each type of headache has different symptoms and needs to be treated differently. One differentiating symptom between the types of headaches is where the pain is felt.

Migraine headaches

Migraine headaches are a type of headache characterized by intense and throbbing pain, often on one side of the head. A migraine can last for hours or days and can be accompanied by migraine symptoms such as nausea, vomiting, sensitivity to light and sound and visual disturbances known as auras.

Migraines can be debilitating and may significantly impact your quality of life. They are believed to be caused by changes in the brain and the release of certain chemicals, although the exact cause is not fully understood. Migraines tend to run in families.

What is the main cause of a migraine?

The exact cause of a migraine is still unknown. While it can be a symptom of another condition, it’s often its own disorder. In many cases, certain foods tend to cause migraines in some people.

Foods that could trigger a migraine headache include:

• Aged cheeses
• Aspartame (artificial sweetener)
• Caffeine consumption or withdrawal
• Gluten
• Chocolate
• Cured or processed meats
• Fermented foods, such as yogurt, kombucha or kefir
• Monosodium glutamate (MSG)
• Certain fruits and nuts
• Wine and other types of alcohol
• Yeast

Migraines & aura

Migraines often include a symptom called an aura. Migraines with an aura are more common than migraines without one.

A migraine aura happens before your headache starts and includes some sensory changes. Your hearing, speaking or vision may be affected, and you may notice weakness or tingling in your muscles at the same time.

Migraine treatments

Treatment for migraines typically involves a combination of lifestyle changes, prevention strategies and medications to alleviate symptoms during an attack.

Over-the-counter pain relievers such as ibuprofen, aspirin or acetaminophen may offer some migraine relief for mild to moderate pain. For more severe pain, triptans are common prescription medications used to relieve migraine pain. Your doctor may also prescribe other medications to help relieve nausea.

For frequent or severe migraines, your doctor may prescribe medications to reduce the frequency and severity of attacks. These include beta-blockers, calcium channel blockers, antidepressants, anti-seizure medications and Botox injections.

Learning what is triggering your migraines, stress management and creating healthy habits can help prevent a migraine attack. You may also find migraine relief through alternative therapies such as acupuncture or cognitive behavior therapy (CBT).

Cluster headaches

Cluster headaches are extremely painful – painful enough to wake you up if one starts while you’re sleeping. The pain is described as an intense piercing or burning that:

• Is constant or throbbing
• Is located behind one eye or around the eyes
• Occurs regularly, often at the same time of day or night
• Lasts minutes or hours, but may recur multiple times in one day

Men are more likely than women to have cluster headaches. Sometimes, cluster headaches go away for a long time, but may come back.

Tension headaches

Tension headaches come and go over time. They’re the most common type of headache among teenagers and adults. Tension headaches cause mild to moderate pain that usually begins gradually and affects one or both sides of your head. Often it may feel like a belt is being tightened around your head. These symptoms may last only minutes or go on for days:

• Constant or dull pain
• Feeling of tightness or pressure
• Aches in your jaw or neck
• Women are slightly more likely to have tension headaches than men.

Headache triggers

While we don’t know what causes headaches, several things seem to be related to the start of a headache beyond food triggers. Here are some common signs of an oncoming headache or migraine attack:

• Alcohol use
• Allergens
• Caffeine use
• Changes in weather
• Changing sleep patterns
• Depression
• Loud noises
• Neck or back strain
• Perfumes
• Pollution
• Skipping meals
• Certain types of lighting
• Stress
• Strong smells
• Tobacco and tobacco smoke
• Too much physical activity

Tracking your headaches

Keeping a record of your headaches may help you identify triggers that affect you. It may also help your doctor diagnose your headache and choose effective treatments.

Keep track of the time of day, severity of pain on a scale from 1 to 10, description of the pain (e.g., pounding, burning, pressure), any triggers you noticed and any medicine or other things that helped ease the pain.

Headache diagnosis

Your doctor will perform a physical exam and gather your health history – including your observations about your headaches. They may run some of the following tests to help diagnose your headache:

• Testing blood or urine to check for blood vessel damage, identify any infections or find toxins that may have affected your nervous system
• Testing your cerebrospinal fluid (fluid that surrounds your brain and spinal cord) to detect bleeding in your skull or infections, or to measure excess pressure in the skull
• CT scan or an MRI to check if you have physical abnormalities that may contribute to your headache

Headache treatment options

Your doctor will recommend treatment based on your diagnosis. Each type of headache is treated differently, although some of the same treatments used for migraine headaches may be used for other types.

Your provider may recommend over-the-counter pain relievers or prescribe medications. They may also suggest changing your diet and getting more exercise to relieve stress.

Your doctor may prescribe a medication called Reglan to treat nausea aggressively. Even if you do not have nausea, Reglan allows headache medications to be absorbed better, especially if taken 15 to 20 minutes before the other headache medications. Reglan should be taken at the first sign of a serious headache.

Make sure to tell your doctor about any other medical conditions you have. Conditions like depression, insomnia and anxiety can contribute to headaches, so it’s important for those conditions to be treated effectively.

Lifestyle changes for headaches

To help treat or reduce the frequency of your headaches, you can try resting with your eyes closed with a cool cloth over your eyes or an ice pack on your forehead. Make sure you drink enough water, particularly if you’ve been vomiting. Dehydration is a common cause of headaches.

To prevent migraines or other types of headaches, your provider may recommend the following lifestyle changes.

• Avoid anything that you know contributes to your headaches such as alcohol, certain foods or lack of sleep
• Stick to a regular schedule for sleeping and eating. Try to eat, go to sleep and wake up at the same times each day
• Reduce stress
• Practice relaxation techniques such as deep breathing or meditation
• Try aromatherapy, biofeedback or other holistic practices
• Get enough exercise