Headaches aren’t just annoying, they’re disruptive. They mess with focus, zap energy, and make even simple tasks feel like struggles.
In our busy world, they’re unwelcome guests that steal joy and impact work, relationships, and everything else. While medicine helps, a true cure eludes us, leaving many hoping for a future without the constant ache.
This article will discuss the different types of headaches, their causes, and treatment options for each based on the most recent published scientific literature.
What is Headache?
Headaches are one of the most common complaints and reasons for visits to the doctor in Canada and the United States, affecting 90% of the population at some point in their lifetime.
A large majority of headaches are called primary headaches, which are benign and include Migraines, Tension Headaches, Trigeminal autonomic Cephalgia, and others.
However, there are rare occasions when a headache can result from an underlying medical condition. These are called secondary headaches, are less common, and can have vascular, neoplastic (tumor), infectious, or pressure causes.
Patients should always be evaluated for headaches to determine whether it is a primary or secondary headache.
Types of Headaches
Headaches are widespread amongst the general population. They are classically described as pressure, squeezing, or throbbing/pulsating feelings that can occur anywhere along the head.
The headache distribution, onset, quality, and intensity of the pain can give us many clues as to the type of headache being experienced by the patient.
Different headache types carry different management and treatment techniques.
Some respond favorably to manual therapy such as chiropractic and massage and can resolve with only a few treatments. Other headaches may require more investigation and attention to lifestyle, diet, genetic predispositions, and vascular mechanisms.
Some of the most common types of headaches include:
- TTH (Tension-Type Headache)
- Migraine Disorder
- Trigeminal Autonomic Cephalalgia (Medical Term for Cluster Headache)
- Headache Related to Hormonal Fluctuations
- Headache from Physical Activity
- Allergic Rhinitis Headache
- Caffeine Withdrawal Headache
- Medication Overuse Headache
A tension-type headache is described as a headache that evokes a sensation of the head being compressed or squeezed but without any underlying medical causes.
Tension headaches are the most common category and affect 38% of the population. They are benign and can have many triggers, such as stress, dehydration, joint stiffness, or dysfunction in the neck or shoulders.
Tension headaches tend to be in different parts of the head (front, sides, back) but are seldom unilateral. These headaches respond favorably to manual therapy and chiropractic adjustments, mainly where the underlying cause is a joint dysfunction or a muscle trigger point.
Fun Fact: In some recent studies, researchers have found a connection between trigger points and tension in the hamstring muscle and tension headaches. In another study, the release of tension and trigger point of the hamstring muscle group resulted in a clinically significant reduction of tension headaches for the participant.
Based on these findings, a straightforward home remedy to relieve tension headaches can be to stretch your hamstrings for at least 5 minutes/day for seven days!
- Poor Sleep
- Poor Posture
- Clenching of the Jaw and Neck
- Prolonged Computer Use
- Trigger Point Release
- Active Release Technique on the Suboccipital Muscles at the Base of the skull
- Chiropractic Adjustments
- Hydration and Improved Sleep Hygiene
Migraine headaches affect about 12% of the general population. They can have varying causes among individuals. The literature on migraine is vast but inconclusive, and the treatments that may work for some may not work for others.
Migraines also tend to be one-sided, and the quality of pain is throbbing and pulsating in nature. They are associated with photophobia (light sensitivity) and phonophobia (sound sensitivity).
It is believed that migraines have a genetic predisposition and can run in the family. It affects females more than males and is often associated with a prodrome phase called the aura accompanied by light flashes.
Reported triggers can be sudden changes in blood sugar, stress, hormones, seasonal allergies, and even certain meds. Food triggers such as wine and chocolate also have been reported to contribute to migraines.
Effective treatments include identification and control of triggers, massage therapy, spinal adjustments focused on the upper thoracic and cervical spine, acupuncture, diet, and certain medications.
In terms of medication use for acute cases of migraine, the use of acetaminophen, Non-Steroidal Anti Inflammatory Drugs (NSAIDs), and a combination of medications with caffeine has proven helpful for some.
20-30% of patients respond favorably to the use of Triptans. However, it is not recommended for those suffering from cardiovascular diseases.
This type of headache is often classified as severe in quality. The headache affects only one side of the head (ipsilateral). It is a classically described feeling of a “rod poking through the eye.”
Associated symptoms are red eyes, sweating, nasal congestion or runny nose, pale skin, and restlessness. Men are more prone to this headache than females, and the duration can last between 15 minutes and 3 hours.
- Genetic Component
- High Flow Oxygen Administration
- Administering a Noninvasive Intranasal Sphenopalatine Ganglion Nerve Block
- Use of Prednisone for Short-term Episodic Cluster Headaches
There is clear evidence that suggests a correlation between migraines and female sex hormones, particularly Estrogen.
Migraine headaches affect women on a 2:1 ratio, and hormonal events such as menarche, menstruation, pregnancy, and menopause all have been linked to an increase in migraine attacks for some women.
In general, high levels of Estrogen are associated with lower migraine headaches as pregnant patients who have a history of migraines often report a reduction of their headache episodes during their term.
On the contrary, during menopause, where estrogen levels are lower, female migraine sufferers report an increase in the number of attacks as well as the duration of their headaches.
Studies suggest that it’s the reduction in estrogen levels, rather than consistently high or low levels, that primarily initiates menstrual migraines. Fluctuations in estrogen levels during pregnancy and menopause also influence headache patterns.
One study investigated the effect of Hormone Replacement Therapy on migraine sufferers and found a significant increase in migraine attack episodes and severity in the HRT group.
- Hormonal Fluctuations
- Low Estrogen
- Hormone Replacement Therapy
- Estrogen Supplements
One common mechanism that is used to explain a headache phenomenon is our body’s ability to constrict and dilate certain blood vessels, especially those that supply blood to the head and neck.
If our vessels that carry more blood to the head and neck are more constricted (vasoconstriction), naturally our head and neck does not receive as much blood flow. This can happen in cases of exertion where our body is demanding significant blood and oxygen to the muscles in our legs or arms.
If the exertion reaches a certain threshold where our blood vessels to our head and neck are constricted for a longer period of time, this can result in an exertional headache.
Sustained Over Exertion
- Hydration + Electrolyte Consumption
These are our classic seasonal headaches. Some individuals that have certain allergies can experience Sinus and Allergy headaches during certain months in the year.
Sinus congestion and infections are another cause of sinus headaches. The classic symptoms are feeling heavy in the face and if there is a sinus infection, looking down will feel very uncomfortable.
- Sinus Infection
- Sinus Rinse
- Antibiotics in Case of an Infection
Caffeine’s effect on headache is one of the most fascinating. There are times that caffeine causes a headache and also times where caffeine can help a headache.
How is that possible? We will explain the physiology of the effect of caffeine and it will all make sense.
How caffeine helps:
Caffeine has an anti-inflammatory effect on the body and can bring pain relief. It is used in many of the common headache remedies and a study showed, addition of caffeine to Aspirin and Ibuprofen improved NSAID effectiveness by allowing them to work faster and more efficiently at reducing a headache.
Caffeine’s impact on the body’s physiological mechanism is strong that a headache can occur from caffeine withdrawal because the body becomes accustomed to receiving the dose of caffeine on a regular basis.
On the other hand, caffeine is also a vasoconstrictor of the body, this means it causes the blood vessels to the head to narrow through a constriction mechanism.
At times, especially for someone who is not a regular caffeine consumer, the vasoconstrictive effect can be the cause of a headache. It is important to identify your body’s response to caffeine.
Timing of consumption, frequency as well as the amount of consumption are all variables that should be taken into account. If you are a migraine sufferer, it may be worthwhile to try cutting out caffeine for 21 days to see the impact it may have on your migraines.
In summary, occasional consumption of caffeine may have a pain relieving function for headaches. However, regular and frequent use of caffeine is linked to developing headaches, physical dependence and dehydration.
- Caffeine Withdrawal
- Excessive Consumption
- Disrupted Sleep
- Reducing Caffeine Consumption
- Elimination Caffeine Consumption for at Least 21 Days
- Drinking Water and Electrolytes After a Caffeine Consumption
A rebound headache occurs from medication overuse. This happens when you are taking too much and too often of any kind of pain killer. The rebound headache refers to when the pain (such as headache) comes back once the medication dose wears off in the body, but this time the pain is stronger and lasts longer.
These types of headaches usually develop in those patients who have an existing primary headache such as migraine or tension headaches who overuse over the counter medications in an attempt to alleviate their primary headache.
This is a negative cycle that results in increased headache frequency and duration and likely contributes to chronic headaches.
This condition is more likely to happen when caffeine consumption is combined with taking an extra amount of the said painkillers such as Advil and Tylenol.
Why Headaches Should Not Be Ignored?
Headaches might seem like no big deal, but they can be more than just annoying. They could be a sign of something serious, like a tumor or infection. Even if they’re not, ignoring them can make them worse and mess with your sleep, work, and life.
So next time you have a headache, don’t just wait it out. Listen to your body and discuss your headache with a doctor, just in case.
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