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Headaches are common but usually do not represent a serious illness. Even when headaches do not have a serious cause, they may be quite painful and disrupt your daily activities.

There are many different causes of headache. The pain in different types of headache varies in intensity, location, and duration. Another important feature that helps distinguish among different types of headache is the quality of the pain: whether it is sharp, dull, constant, intermittent, or pounding. Additional symptoms may accompany a headache such as dizziness, numbness or weakness, changes in vision, difficulty with balance, eye, ear, or facial pain, cold symptoms, and even fever

All these factors help determine whether or not a headache needs emergency treatment. Ultimately, the cause of the headache determines the best treatment. Headache can affect anyone, of any race, socioeconomic status, age, and gender. Stress and anxiety are reported to trigger some peoples headaches. Others find no apparent reason for theirs.

The most common types of headache are known as tension-type, while the next most common are called migraine. What most people consider to be a mild headache is most often tension-type headache or a mix of tension-type and migraine.

Headache is caused by irritation or injury to pain-sensing structures of the head. The structures that can sense pain include the scalp, the muscles of the neck and head, major arteries and veins in the head, the sinuses, and the tissues that surround the brain.

Headache may occur when these structures suffer compression, spasm, tension, inflammation, or irritation. The brain has no nerve endings so the brain itself cannot “hurt.”

Research into the mechanisms of various headache types continues, and new theories arise frequently. Specifically, the causes of mild tension-type headache are not completely understood, and debate continues regarding the cause.

A common theory involves nerve endings in the head that are irritated by tight muscles in the neck, face, and scalp, along with irritation to the arteries and veins nearby. The events that trigger mild headache vary widely among people who get headaches. Each person seems to have his or her own pattern.

Common headache triggers stress, before, during, or after menstruation, muscle tension in the back and neck, exhaustion, hunger, and medications (Many drugs designed to relieve pain can actually cause headache when the drug is stopped after a period of prolonged use.)

Other causes of headache include household hazards such as carbon monoxide poisoning: If the headaches are recurrent or worse each morning or if more than 1 person in the household experiences the same type of headache, there may be an excessive level of carbon monoxide in the air.

Carbon monoxide poisoning comes from faulty heaters or stoves that do not have proper exhaust to the outside of the house. If you suspect carbon monoxide poisoning, leave the building immediately and do not return until the levels of carbon monoxide are checked.

Headache associated with eye pain and vomiting: These headaches often indicate an eye disease called glaucoma and warrant immediate medical attention, or vision can be permanently harmed. Headache that occurs with neck stiffness or pain, light sensitivity, fever, and confusion: These types of headaches could mean meningitis. This is a true medical emergency and needs immediate attention.

Mild headache symptoms are unlikely to need immediate medical attention. These mild symptoms include mild head pain that is aching, squeezing, or band like, on both sides of the head, generally above the level of the eyebrows.

These headaches can occur often and may appear at predictable times. People who have these types of mild headache often know the triggers and symptoms of their headaches in great detail, because the pattern repeats itself for each episode.

Common headache types include tension-type headache is thought to be the most common headache type. It occurs more often in women than in men. Attacks can be occasional or more frequent. Symptoms include tight, or pressing, mild to moderate head pain, which may be on both sides.

Migraine is the second most common headache type. These are classified according to whether or not they include an aura (a visual disturbance, weakness, or numbness that occurs 1-2 hours before the onset of the headache). Migraines with this aura are called classic, while those without are called common. Migraine is more common in women than men. It is often one-sided, throbbing, of moderate to severe intensity. The headache may be accompanied by nausea, vomiting, and sensitivity to light.

Cluster headache is a less common headache that occurs in men more often than women. With a cluster headache, there is intense pain that is generally on one side and located around the eye or temple.

A bloodshot eye, tearing, runny nose, and eyelid drooping or swelling on the same side of the face may also occur. The headaches tend to occur in “clusters,” sometimes daily or every few days over a period of weeks to months. After such a “cluster” of headaches, there may be symptom-free periods of years before another cluster of headaches occurs.

Consult a doctor about your headache and find out what can be done for pain relief in these situations: you have a chronic medical illness such as high blood pressure, heart disease, heart attack or stroke, diabetes, or liver problems, you are not obtaining relief with over-the-counter pain medications.

Consult a doctor about your headache if you are taking any other prescription or nonprescription medications, there is any change in the normal pattern of your headache, you have a new type of headache that you never had before, you have pain in your face or eyes, and if you have a very severe headache.

Although headaches are very common, they may be a sign of serious disease that warrants immediate medical attention. Go to an emergency department if any of the following symptoms occur.

Severe pain, pain that develops very rapidly, a change in concentration or ability to think, a change in level of alertness, altered speech, weakness, numbness, or difficulty walking, changes in vision, headache with a stiff neck or neck pain, or if light hurts your eyes, worst headache of your life, headache with dizziness, room spinning, or falling to one side, headache from an injury or blow to the head, and headache with fever (over 100.4F or 38C when taken by mouth).

Treating a mild headache will usually involve over-the-counter pain medications. There are many different medications marketed for control of headache pain. The pharmaceutical companies spend millions of dollars each year to advertise their products. However, many “special” headache remedies are no better than simple acetaminophen, ibuprofen, or aspirin. In addition, stress reduction and rest may be helpful.

Doctors usually recommend over-the-counter pain medications for mild headache. If these medications do not adequately treat your headache, consult a doctor for further recommendations.

Although relatively safe, over-the-counter pain medicines all have potential side effects. Inappropriate use may have serious consequences. Always read the label and follow the recommended dosage.

Even nonprescription pain medicines can be dangerous if taken improperly or if taken for headache that is caused by certain diseases (such as bleeding or stroke). Potential problems include overdose, overuse, cross-reactions with other medications (especially with blood thinners), and toxic effects on various organs (especially the liver).

Acetaminophen (brand names include Tylenol, Aspirin Free Anacin, and Feverall, for example) is a safe and very effective pain reliever and should be considered the first-line treatment of headache.

Although acetaminophen has few cross-reactions with other medications, avoid taking with alcohol and sleeping medicines (barbiturates and benzodiazepines such as Valium). If acetaminophen alone is inadequate, some people report that the addition of caffeine to the acetaminophen provides more relief from pain (examples include Excedrin and Aspirin-Free) and is a reasonable choice for those people who can tolerate caffeine well.

Unless advised by a doctor, people with liver diseases such as cirrhosis or hepatitis, and heavy drinkers, should avoid acetaminophen. Drinking a cup of caffeinated coffee with a pain reliever can provide the same caffeine effect. By increasing the production of stomach acid, caffeine helps the body absorb headache medicines more quickly.

Aspirin is another common pain reliever. Its most common side effects are stomach upset and increased risk of bleeding. Aspirin is a type of “nonsteroidal anti-inflammatory drug.” People with stomach ulcers or on blood thinners such as warfarin (Coumadin) should not take aspirin.

Alcohol use increases the risk of bleeding. Heavy drinkers should not take aspirin because of the risk of bleeding from stomach irritation or ulcer formation. People older than 60 years and those with kidney problems should not take aspirin unless advised by their doctor.

Aspirin is commonly prescribed by doctors after a stroke without bleeding and can prevent another stroke. Taking aspirin for undiagnosed severe headache may be dangerous. The severe headache could come from a bleeding stroke and taking aspirin may make the bleeding worse.

Nonsteroidal anti-inflammatory drugs known as NSAIDs include such medications as ibuprofen (Advil and Motrin, for example) and naproxen sodium (Aleve and Naprosyn are commonly known brand names). These medications are often used for headache. The side effects are similar to those of aspirin.

It is important not to take aspirin and other NSAIDs together because the side effects are additive meaning they build on each other and become worse than one taken alone. The same warnings about age, kidney disease, stroke, and alcohol problems apply to other NSAIDs as well as to aspirin.

Homeopathic, herbal, and other remedies that are not tested for safety or regulated by the Food and Drug Administration (FDA) can be potentially dangerous and are not recommended. Without FDA regulation there is no control over the quality, dose, or ingredients. Scientific studies that document safety and effectiveness are not required prior to the sale of these unregulated products.



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