TENSION-TYPE HEADACHES

Tension-Type headaches are the most common type of headaches. They can be called tension headaches or muscle contraction headaches. The typical description is a dull squeezing band of pain typical on both sides of the head and can be more in the temple regions or back of the head and into the neck area. These are often more obviously present during times of physical and emotional stress. They can last from an hour to a day, then multiple days. The pain is usually described more in the mild or moderate range and not typically described as being severe.

MIGRAINE HEADACHES

Migraine headaches are typically described as being one sided although they can be on both sides, and are usually described as either throbbing or pounding although they can be described as sharp or stabbing as well. The pain can be behind the eye or above the eye or behind or above both eyes as well. They will often describe that it is worse with physical activity and better if they lie down and particularly if they fall asleep. Migraine headaches usually last from several hours up to a day although they can be several days in length. There is typically an accompaniment of other symptoms, such as seeing funny lights or other visual changes, increased sensitivity to light or sound, and nausea and vomiting. There are genetic factors in migraines with a majority of migraine suffers having a first degree relative also having migraine headaches. Migraine headaches may have triggers such as certain foods (e.g. chocolates, cheeses, tomatoes, monosodium glutamate, aspartame, red wine, other alcoholic drinks), hormonal changes, odors such as paints and certain medications. Migraine patients can have neurologic impairments from their migraines such as some vision impairment or numbness or even sometimes weakness and rarely a significant neurologic impairment may occur. Patients may develop some of the associated symptoms with migraine headaches without actually experiencing a headache.

CLUSTER HEADACHES

Cluster headaches are often sometimes called histamine cephalgia or Horton’s neuralgia. These headaches are typically severe and are usually around one eye and accompanied by tearing or nasal congestion on the side of the headache. They are usually lasting from 15 minutes up to sometimes several hours. It can awaken patients in the middle of the night and may occur on a regular basis through a number of days and then apparently resolve and then recur again months or years later. Unlike migraine headaches cluster headaches are predominantly seen in males.

CHRONIC DAILY HEADACHES

Chronic daily headaches are defined as headaches that are occurring a majority of days. Many patients who have chronic daily headaches started off having a more typical intermittent headache pattern of Tension-Type headaches or migraine type headaches. Patients that evolve into chronic daily headaches often have underlying comorbid problem conditions such as depression, anxiety, bipolar disease, panic attacks, stress and drug overuse. This headache pattern can be extremely difficult to treat and it is important to identify and treat many of these other associated comorbid conditions. Many if not the majority of patients with chronic daily headache have a component of “analgesic rebound headache” which is described in the next section. For patients who have been using frequent analgesic medications who evolve into chronic daily headache the approach will be through a medication tapering schedule.

ANALGESIC REBOUND HEADACHES Analgesic rebound headaches as the name implies are headaches that occur as a consequence of taking excessive analgesic medications. This headache has recently become recognized as a very serious and extremely common problem. Headache disorders seem to be unique compared to other pain problems such as knee pain or back pain in the phenomenon of having the use of analgesic medications to treat a headache actually contribute to increasingly severe headache disorder in the future. Medications that can be a factor in this problem include aspirin, acetaminophen, nonsteroidal anti-inflammatory medicines such as ibuprofen, muscle relaxants, decongestants, caffeine, narcotics (e.g. Vicodin), barbiturates (e.g. Fiorinal), triptan medications (Imitrex, Maxalt etc). The most classic form of the rebound headache is one in which the pain medicine level in the body starts to drop down and wear off and then the headache comes back again, wanting to take more medication. Over time the medication becomes less effective. This is most often noted with the narcotic and barbiturate medications. Caffeine exposure is a well known cause of rebound headaches and even individuals who are not headache sufferers who become fairly significant coffee users will describe it if they stop drinking their coffee they will have a headache. Caffeine relates to the effect on constriction of the blood vessels that as the medicine wears off the blood vessels will expand (dilate) which will trigger pain.