Overview of Headaches in Adults

How common are headaches in adults?

According to the National Headache Foundation, more than 45 million Americans suffer from chronic, recurring headaches and of these, 28 million suffer from migraines. About 20 percent of children and adolescents also have significant headaches. About 70% of headache sufferers are women.

Headaches are the most common cause of absenteeism from work and school. Migraine sufferers lose more than 157 million work and school days annually because of headache pain.

What are the types of headaches?

A comprehensive headache classification guide was established by the International Headache Society and includes more than 150 diagnostic headache categories.

Based on research, a practical headache classification includes primary and secondary headaches.

Primary headaches

Primary headaches are those that are not the result of another medical condition. The category includes tension, migraine, mixed headache syndrome and cluster headaches.

Secondary headaches

Secondary headaches, or those that result from another medical condition, include sinus headaches, hormone headaches, chronic progressive headaches or headaches that occur as a result of a head injury, trauma, or more serious condition such as a tumor.

Are headaches hereditary?

Yes, headaches, especially migraines, have a tendency to run in families. Children who have migraines usually have at least one parent who also suffers from the condition. Headaches also can be triggered by specific environmental factors that are shared in a family's household, such as exposure to second-hand tobacco smoke, strong odors from household chemicals or perfumes, exposure to certain allergens, or eating certain foods. Stress, pollution, noise, lighting, and weather changes are other environmental factors that can trigger headaches for some people.

People with migraines may inherit abnormalities in certain areas of the brain, as well as the tendency to be affected by certain migraine triggers, such as fatigue, bright lights, weather changes, and others.

What causes headaches?

Headache pain results from signals interacting among the brain, blood vessels and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain. It's not clear, however, why these signals are activated in the first place.

There is a migraine "pain center" or generator in the mid-brain area. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels, causing constriction, followed by the dilation of these vessels and the release of prostaglandins, serotonin and other inflammatory substances that cause the pulsation to be painful. Serotonin is a naturally occurring chemical essential for certain body processes.

Headaches that occur suddenly (acute onset) are usually caused by an illness, infection, cold or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat), or otitis (ear infection or inflammation).

In some cases, the headaches may be the result of a blow to the head (trauma) or, rarely, a sign of a more serious medical condition.

Common causes of tension headaches or chronic non-progressive headaches include emotional stress related to family and friends, work or school; alcohol use; skipping meals; changes in sleep patterns; excessive medication use; tension; and depression. Other causes of tension headaches include eye strain and neck or back strain caused by poor posture.

When chronic headaches become progressive and occur along with other neurological symptoms, they can be the sign of a disease process in the brain (organic cause), such as:

How are headaches evaluated and diagnosed?

The good news for headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started.

If you have headache symptoms, the first step is to go to your family physician. He or she will perform a complete physical examination and a headache evaluation. During the headache evaluation, your headache history and description of the headaches will be evaluated. You will be asked to describe your headache symptoms and characteristics as completely as possible.

A headache evaluation may include a CT scan or MRI if a structural disorder of the central nervous system is suspected. Both of these tests produce cross-sectional images of the brain that can reveal abnormal areas or problems. Skull X-rays are not helpful. An EEG (electroencephalogram) is also unnecessary unless you have experienced a loss of consciousness with a headache.

If your headache symptoms become worse or become more frequent despite treatment, ask your family physician for a referral to a specialist. Your family physician should be able to provide the names of headache specialists.

How are headaches treated?

Your family physician may recommend different types of treatment to try or he or she may recommend further testing, or refer you to a headache specialist. You should establish a reasonable time frame with your family physician to evaluate your headache symptoms.

The proper treatment will depend on several factors, including the type and frequency of the headache and its cause. Not all headaches require medical attention. Treatment may include education, counseling, stress management, biofeedback, and medications. The treatment prescribed for you will be tailored to meet your specific needs.

What happens after I start treatment?

When your doctor starts a treatment program, keep track of the results and how the treatment program is working. Keep your scheduled follow-up appointments so your doctor can monitor your progress and make changes in the treatment program as needed.

References

 

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 5/1/2013

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