Headache Causes and Risk Factors

Chronic Daily Headache: An Overview

Headache Causes and Risk Factors

  1. Acute medication use month after month at greater than two days per week.
  2. Stress and life events, particularly with unrecognized/untreated anxiety and/or depression
  3. Poor Sleep, often influenced by all the other risk factors
  4. Obesity
  5. Caffeine, in smaller amounts than you may think!

Chronic daily headache refers to headaches of almost any type that occur very frequently, generally at least 15 days per month for a period of six months or more. Chronic migraine is diagnosed when headache occurs greater than 15 days per month and migraine or pain killer use occurs at least eight of those days. Patients with tension-type headaches and no migraine occurring 15 or more days per month are diagnosed with chronic tension-type headache.

The Importance of Achieving a Specific and Accurate Headache Diagnosis

Getting a specific headache diagnosis that is accurate is very important because it will have a major influence on matching your treatment plan to the type of headache and severity of illness.

Diagnosis influences the treatment plan by directing the type of medical tests that are run, type of medications recommended and long-term management goals you and your practitioner select.

More importantly, matching your beliefs about your headache type(s) to an accurate diagnosis is crucial, as otherwise test recommendations, medications and long-term behavioral management adherence is ly to decrease or not be started at all.

For example, the plan of care will be very different for headaches diagnosed as sinusitis than for headaches diagnosed as migraine.

However, if you believe your headaches are due to sinus headache, while your practitioner believes you have migraine—resolving the differences so you can comfortably put recommendations into action is critical.

For those with “chronic” migraine, a very different treatment regimen is ly to be offered than for those with less frequent “episodic” migraine.

Incorrect diagnosis leads to an inappropriate treatment plan and lack of relief for the patient. With chronic migraine, wrong treatment may even lead to a worsening of the headache condition.

An accurate diagnosis yields the best chance for appropriate treatment to relieve symptoms.

A diagnosis you believe to be incorrect causes you to ly distrust the treatment, so communication of your opinion about your headache beliefs is critical to resolve differences.

Headache diagnoses and treatment plans are made on the basis of:

  1. Accurate total of any days with headache in an average month and accurate duration of headache with or without treatment. This identifies the ly headache syndrome.
  2. Pain characteristics such as location, severity, pain quality, and response to routine physical activity.
  3. Associated symptoms nausea, sensitivity to noise (phonophobia) and/or light (photophobia), or visual changes.
  4. History of the illness—that is, when it started, how it has changed, and how long it takes to reach peak or worst pain/disability.
  5. Physical (especially exam of your head and neck muscles) and neurological exams (especially your eyes) make or change the diagnosis 5% or less of the time.

Because symptom patterns tend to change over time—especially in the case of chronic headaches—accurate history is the important stuff of diagnosis.

More often than the physical examination, the history helps determine the need for specialized tests—either to rule out progressive or life-threatening problems or to confirm a less worrisome diagnosis.

Be aware that imaging and lab tests do not diagnose migraine or other so-called primary headaches. An accurate diagnosis then guides physicians to a specific treatment approach, one that is most often scientific research.

Research shows that at least one-third to one-half of patients seen in specialty headache clinics began with occasional migraine attacks that gradually progress or transform into chronic migraine. Sometimes, the migraine symptoms themselves will also transform over time.

For example, the migraine symptoms might have initially involved severe throbbing pain on one side of the head accompanied by nausea and vomiting.

After progression of the condition, headaches might occur on both sides of the head (bilateral) as a constant dull pain with or without nausea.

To assess if headaches are progressing, accurate and detailed descriptions of the headache duration and frequency are very important. This history will help ensure an accurate diagnosis. An understanding of the specific causes or contributing factors that lead to progression, and then reversing them, is key to successful treatment.

What are common risk factors for progression from an episodic headache to a chronic headache condition?

There are several risk factors that put the headache patient at risk for exacerbation of their condition. Several of these are “modifiable” or conditions that the patient with their physician can work with to help prevent headaches from progressing.

Modifiable risk factors are:

  1. Medication overuse
  2. Stress
  3. Sleep disturbance
  4. Obesity
  5. Caffeine.

Some factors are not modifiable, such as a genetic predisposition. Therefore, it is important that patients work closely with their physician to help establish boundaries for those conditions that they have control over. Some modifiable risk factors are reviewed in detail below:

1. Medication overuse

An important and common cause of headache progression is overuse of certain headache medications. When taken often, the very medications used to treat tension-type and migraine headache attacks can cause episodic headache to progress into a chronic headache condition. The medications known to play a role in this process include:

  1. Combination analgesics combined with caffeine (over-the-counter or prescription)
  2. Caffeine
  3. Ergotamine
  4. Opiates
  5. Over-the counter or prescribed analgesics
  6. Triptans

All these medications can be effective in treating episodic headache when used on an occasional basis. However, when used more than two days a week, they may transform and aggravate headache. The result is called medication overuse headache (MOH), previously known as rebound or analgesic overuse headache.

For medication overuse headache, the pain usually improves when the acute medication is tapered and then discontinued. Within two months (and frequently sooner), the chronic headache pattern will revert back to the earlier episodic headache pattern or will remit.

However, discontinuation of medications that are being overused should only be done under close supervision of your provider because serious side effects may occur.

Some of these side effects may include temporary worsening of headache, seizures, agitation and sweating, among others.

That said, typically to get the process initiated, reduction of one tablet per week of any over the counter medication overused is safe without risk—except for pain worsening, while waiting for advice. Your provider should probably direct changes in prescription medications.

In straightforward simple MOH, but not necessarily very complex MOH patients the number of headaches usually improves over weeks following removal of medications that are being overused. This improvement confirms that the medication was indeed part of the problem.

Even when episodic headache remains, it is often much more responsive to conventional treatment after the medication overuse has been eliminated. It is important to recognize that a history of medication overuse will put you at risk of future overuse.

Therefore, many benefit from a daily preventive therapy in order to reduce frequent use of acute medications.

2. Stress

Stress is the most commonly identified trigger for a headache in the average headache sufferer.

Therefore, it is not surprising that frequent life changes and chronic daily stressors or “hassles” are also implicated in the development of chronic headaches.

These stressors may result in anxiety or depression, or occur more ly due to either condition. Recognition of these relationships can be key to developing an adequate treatment plan.

3. Sleep disturbance

Headache may be aggravated by frequent sleep disturbance. The most common sleep problem for headache sufferers is insomnia, including difficulty falling asleep, difficulty staying asleep, or poor quality “non-restful” sleep.

Snoring is a specific risk factor for chronic headache in some patients. Though the cause is not known, snoring could disturb sleep quality or compromise breathing.

Chronic inadequate sleep of approximately 6 hours or less per night also creates risk for more headaches.

4. Obesity

Obesity is associated with increasing headache frequency. Obesity is diagnosed with a body mass index (BMI) greater than 30 or a waste of greater than 35 inches for a woman and 40 inches for a man. Although the mechanisms for this are not well understood, several factors ly play a role.

Diet and exercise are an important part of maintaining healthy headache hygiene. Discuss exercise and weight loss plans with your practitioner if you feel that this is something that you may be able to address in trying to control your headaches or keep your headaches from progressing.

Any weight reduction when may be of benefit so return to a normal BMI of less than 25 need not be the goal.

5. Caffeine

Caffeine is added to certain pain medications because it can be beneficial for migraine when used occasionally and in moderation, defined ideally as two days per week or less. Frequent use of caffeine can also be a risk factor for headache progression.

Caffeine is the most widely used, mood-altering substance in America. It is present in many beverages, dietary supplements, and in some foods, such as chocolate. Many Americans consume caffeine daily with very little awareness that they are ingesting a drug with potent effects.

For some headache sufferers, caffeine aggravates headache in much the same way that medication overuse can. If eliminating caffeine, decide whether to cold turkey or taper it. The former may be associated with severe temporary exacerbation of headaches.

A taper can be associated with failure to stop the caffeine and milder temporary mood variability.

Steps that can help reduce the risk of headache progression 

  • Avoid using over-the-counter and acute prescription headache medications more than two days a week, with rare exceptions. If this is difficult, a daily medication to prevent migraine attacks may be useful.
  • Minimize, better yet, eliminate use of caffeine.
  • Make lifestyle changes that help to manage stress including:
    • Routine exercise
    • Reduce stress
    • Eat healthily or lose weight, if needed
    • Try relaxation therapy, cognitive therapy or other non-drug approaches
  • Get sufficient sleep (a regular pattern of seven to eight hours of sleep per night).
    • Speak with your provider about persistently disturbed sleep- especially if you snore
  • Carefully follow your provider’s recommendations for any treatment plan
  • Make follow-up appointments and keep a routine headache diary so you have an accurate account of your headache frequency, medication taken and response to treatment.
  • Don’t drop out—keep seeking help if not succeeding in reducing headaches and ask for referral if need be to a specialist in headaches.

— Jeanetta Rains , PhD, Clinical Director, Center for Sleep Evaluation, Elliot Hospital. Manchester, NH –Frederick R.

Taylor, MD, FAAN FAHS, Clinical Professor of Neurology, University of Minnesota School of Medicine and former Director of the Park Nicollet Headache Clinic and Research Center, Minneapolis, MN Updated August 2015 from Headache, the Newsletter of ACHE, Winter 2004-2005, vol. 15, no. 4.

Source: https://americanmigrainefoundation.org/resource-library/chronic-daily-headache-an-overview/

Causes of headaches

Headache Causes and Risk Factors

It's hard to think about the causes of headaches when you're struggling with pain. Once you're feeling better, figuring out what leads to the agony can help you dodge it in the future. This requires you to pay attention to the environment, eating habits, and activities that spark headache discomfort.

Types and causes of headaches

The most common types of headaches are sinus, tension, and migraine headaches. Sinus headaches usually occur when there is infection or pressure in the sinuses. Tension headaches strike when the muscles in the head and neck tighten. Migraines come on when supersensitive nerve endings in the brain create pain.

But what makes the muscles tense, or causes some nerve endings in the brain to become so sensitive? That's not as well understood. Those causes of headaches can vary from person to person. But some triggers are common.

Tension headaches are often set off by:

  • stress
  • lack of sleep
  • fatigue
  • hunger
  • caffeine withdrawal
  • abrupt cessation of medications that contain caffeine, such as some pain-relieving medications ibuprofen (Advil) or acetaminophen (Tylenol)
  • weather changes
  • food and drinks, such as chocolate; processed foods that contain monosodium glutamate (MSG); or alcohol

Many of those triggers for tension headaches—especially stress, hunger, fatigue, and lack of sleep—can also set off a migraine headache. But nailing down causes of headaches in the migraine category is a little trickier; the headaches may stem from many factors, or combinations of factors. The particular combination is specific to an individual. Potential culprits include

  • being around smoke
  • certain smells
  • bright light, such as sunlight, or flashing lights
  • foods, such as aged cheeses, avocados, bananas, chocolate, peas, pork, sour cream, nuts, peanut butter, or yogurt
  • alcohol
  • changes in estrogen levels for women
  • taking certain prescription medications, such as nitroglycerin (Nitrostat), prescribed for a heart condition; and estrogen, prescribed for birth control or menopausal symptoms
  • abrupt cessation of caffeine
  • abrupt cessation of medications that contain caffeine, such as some pain-relieving medications ibuprofen (Advil) or acetaminophen (Tylenol)
  • food additives, such as monosodium glutamate (MSG) and nitrates (found in cured meats).

More serious causes of headaches

Some headaches are a symptom of an underlying physical condition. For example, sometimes a headache can signal that your blood pressure is above what's considered a normal reading of 120/80 mm Hg or lower.

High blood pressure is a risk factor for developing heart disease or stroke, so make sure to get your blood pressure checked on a regular basis, especially if you experience headaches, or suspect that high blood pressure is one of your causes of headaches.

Other health conditions that may be lead to headache pain include bleeding, infection, or a tumor, although headaches are rarely a sign of more ominous disease. Contact your doctor promptly if a headache is sudden, or accompanied by fever, convulsions, fainting, or pain in the eye or ear.

How to prevent headaches

When debating how to prevent headaches, the easy answer is to try to avoid the causes of headaches in the first place. But doing that takes careful planning. You'll have to note your triggers first, and write down the characteristics of your headaches, including their frequency, duration, intensity, as well the circumstances surrounding your headaches, including:

  • your medications
  • diet
  • sleep patterns
  • activities
  • alcohol intake
  • menstrual cycle, for women
  • environment
  • stress levels
  • physical problems.

After you've pinpointed these causes of headaches, you'll begin to see a pattern, and you'll develop a better idea of how to avoid your triggers and how to prevent headaches.

By Heidi Godman
Executive Editor, Harvard Health Letter

image: © Dunca Daniel | Dreamstime.com

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Source: https://www.health.harvard.edu/staying-healthy/causes-of-headaches

Prevalence and risk factors associated with headache amongst medical staff in South China

Headache Causes and Risk Factors

  1. 1.

    Lj S, Hagen K, Jensen R et al (2007) The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 27(3):193–210

  2. 2.

    (2018) Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 17(11):954–976

  3. 3.

    Yu S, Liu R, Zhao G et al (2012) The prevalence and burden of primary headaches in China: a population-based door-to-door survey. Headache 52(4):582–591

  4. 4.

    Saylor D, Steiner TJ (2018) The global burden of headache. Semin Neurol 38(2):182–190

  5. 5.

    (2016) Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388(10053):1603–1658

  6. 6.

    (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388(10053):1545–1602

  7. 7.

    Delaruelle Z, Ivanova TA, Khan S et al (2018) Male and female sex hormones in primary headaches. J Headache Pain 19(1):117

  8. 8.

    Pinhas-Hamiel O, Frumin K, Gabis L et al (2008) Headaches in overweight children and adolescents referred to a tertiary-care center in Israel. Obesity (Silver Spring) 16(3):659–663

  9. 9.

    Straube A, Heinen F, Ebinger F (2013) von KR. Headache in school children: prevalence and risk factors. Dtsch Arztebl Int 110(48):811–818

    • PubMed
    • PubMed Central
    • Google Scholar
  10. 10.

    Lebedeva ER, Kobzeva NR, Gilev DV, Olesen J (2016) Factors associated with primary headache according to diagnosis, sex, and social group. Headache 56(2):341–356

  11. 11.

    Friedman DI, De ver Dye T (2009) Migraine and the environment. Headache 49(6):941–952

  12. 12.

    Yu S, Liu R, Yang X et al (2012) Body mass index and migraine: a survey of the Chinese adult population. J Headache Pain 13(7):531–536

  13. 13.

    Luo N, Qi W, Tong W et al (2014) Prevalence and burden of headache disorders in two neighboring provinces of China. J Clin Neurosci 21(10):1750–1754

  14. 14.

    Huang Q, Yu H, Zhang N et al (2019) Body mass index and primary headache: a hospital-based study in China. Biomed Res Int 2019:4630490

    • PubMed
    • PubMed Central
    • Google Scholar
  15. 15.

    Wang Y, Xie J, Yang F et al (2015) The prevalence of primary headache disorders and their associated factors among nursing staff in North China. J Headache Pain 16:4

  16. 16.

    Tai MS, SXE Y, Lim TC, Pow ZY, Goh CB (2019) Geographical differences in trigger factors of tension-type headaches and migraines. Curr Pain Headache Rep 23(2):12

  17. 17.

    Li W, Bertisch SM, Mostofsky E, Buettner C, Mittleman MA (2019) Weather, ambient air pollution, and risk of migraine headache onset among patients with migraine. Environ Int 132:105100

    • CAS
    • Article
    • Google Scholar
  18. 18.

    Yu SY, Cao XT, Zhao G et al (2011) The burden of headache in China: validation of diagnostic questionnaire for a population-based survey. J Headache Pain 12(2):141–146

  19. 19.

    Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain (1988) Headache Classification Committee of the International Headache Society. Cephalalgia 8(Suppl 7):1–96

  20. 20.

    Yancey JR, Sheridan R, Koren KG (2014) Chronic daily headache: diagnosis and management. Am Fam Physician 89(8):642–648

  21. 21.

    Hughes MD, Wu J, Williams TC et al (2013) The experience of headaches in health care workers: opportunity for care improvement. Headache 53(6):962–969

  22. 22.

    Kuo WY, Huang CC, Weng SF et al (2015) Higher migraine risk in healthcare professionals than in general population: a nationwide population-based cohort study in Taiwan. J Headache Pain 16:102

  23. 23.

    Steiner TJ, Stovner LJ, Vos T (2016) GBD 2015: migraine is the third cause of disability in under 50s. J Headache Pain 17(1):104

  24. 24.

    Sokolovic E, Riederer F, Szucs T, Agosti R, Sándor PS (2013) Self-reported headache among the employees of a Swiss university hospital: prevalence, disability, current treatment, and economic impact. J Headache Pain 14:29

  25. 25.

    Onwuekwe I, Onyeka T, Aguwa E, Ezeala-Adikaibe B, Ekenze O, Onuora E (2014) Headache prevalence and its characterization amongst hospital workers in Enugu, South East Nigeria. Head Face Med 10:48

  26. 26.

    Dong Z, Chen X, Steiner TJ et al (2015) Medication-overuse headache in China: clinical profile, and an evaluation of the ICHD-3 beta diagnostic criteria. Cephalalgia 35(8):644–651

  27. 27.

    Luvsannorov O, Tsenddorj B, Baldorj D et al (2019) Primary headache disorders among the adult population of Mongolia: prevalences and associations from a population-based survey. J Headache Pain 20(1):114

    • CAS
    • Article
    • Google Scholar
  28. 28.

    Bartolini M, Viticchi G, Falsetti L et al (2014) Migraine in health workers: working in a hospital can be considered an advantage. Neurol Sci 35(Suppl 1):27–29

  29. 29.

    Yeh WZ, Blizzard L, Taylor BV (2018) What is the actual prevalence of migraine. Brain Behav 8(6):e00950

  30. 30.

    Wang J, Huang Q, Li N, Tan G, Chen L, Zhou J (2013) Triggers of migraine and tension-type headache in China: a clinic-based survey. Eur J Neurol 20(4):689–696

    • CAS
    • Article
    • Google Scholar
  31. 31.

    Vetvik KG, MacGregor EA (2017) Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol 16(1):76–87

    • CAS
    • Article
    • Google Scholar
  32. 32.

    Peroutka SJ (2014) What turns on a migraine? A systematic review of migraine precipitating factors. Curr Pain Headache Rep 18(10):454

  33. 33.

    Fernández-de-Las-Peñas C, Fernández-Muñoz JJ, Palacios-Ceña M, Parás-Bravo P, Cigarán-Méndez M, Navarro-Pardo E (2018) Sleep disturbances in tension-type headache and migraine. Ther Adv Neurol Disord 11:1756285617745444

  34. 34.

    Jensen HI, Larsen JW, Thomsen TD (2018) The impact of shift work on intensive care nurses' lives outside work: a cross-sectional study. J Clin Nurs 27(3–4):e703–e709

  35. 35.

    Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Pareja JA (2006) Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study. Cephalalgia. 26(3):314–319

  36. 36.

    Fernández-de-Las-Peñas C, Cuadrado ML, Pareja JA (2007) Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache 47(5):662–672

  37. 37.

    Pavlovic JM, Buse DC, Sollars CM, Haut S, Lipton RB (2014) Trigger factors and premonitory features of migraine attacks: summary of studies. Headache 54(10):1670–1679

Source: https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-020-1075-z

What Is Causing My Headache?

Headache Causes and Risk Factors

The cause of headaches, or why headaches develop, is complex, often involving an intricate web of pain receptors, abnormal brain processes, genetics, and a neurological phenomenon called sensitization. Outside or environmental factors are also commonly involved, serving as headache triggers—the factors that unmindfully activate pain signals within the brain.

By understanding the biology behind your headaches (at least what experts know so far), you can hopefully tease out what parts of your head pain you can perhaps control ( various environmental triggers), and which ones you cannot ( your genetic makeup).

Headaches are unpleasant experiences, so treating them promptly is key. But in order to effectively treat your headaches, you must understand them.

The vast majority of headaches fall into three categories:

  • Migraine
  • Tension-type headache
  • Cluster headache

These three headache types are primary headache disorders, meaning they exist on their own and are not due to some other condition (called secondary headaches).

Migraine may be the most complicated headache disorder and feels a moderate to severe throbbing sensation on one or both sides of the head. Nausea, vomiting, sensitivity to light (photophobia), and/or sound (phonophobia) commonly co-occur with a migraine headache.

Research suggests that migraine headaches develop as a result of the activation of the trigeminovascular system—a complex pathway that links trigeminal nerve fibers to blood vessels of the brain.

Once the trigeminal nerve fibers are activated, they release various peptides, calcitonin gene-related peptide (CGRP) and substance P. These peptides induce a phenomenon called neurogenic inflammation, which is connected to the prolongation and intensification of pain in migraine.

Eventually, neurogenic inflammation may lead to a process called sensitization, whereby your nerve cells become more and more responsive to stimulation.

Other variables linked to migraine development include structural brain changes and serotonin release. Lastly, a phenomenon called cortical spreading depression—where waves of electrical activity spread across the brain—is believed to be the culprit behind migraine aura.

Tension-type headache is the most common headache type and is often described as a squeezing or tight sensation around the head. Along with this pressure or “rubberband-around-the-head” sensation, tension-type headaches may be associated with muscle tenderness in the muscles of the head, neck, or shoulders.

Experts believe that tension-type headaches result from the activation of myofascial (the tissue that covers muscles) pain receptors. Once activated, pain signals are transmitted to the brain.

As with migraines, experts also believe that the sensitization of pain pathways in the brain occur with tension-type headaches. This sensitization is thought to play a pivotal role in the transformation from episodic to chronic tension-type headache.

Cluster headaches are uncommon and often begin without warning. These headache attacks are often short-lived, lasting between 15 and 180 minutes, and they are excruciating—causing a burning, piercing, or stabbing pain located in or around the eye or temple.

The pathogenesis, or the “why” behind cluster headache development, is not fully understood. Experts suspect that the cause is ly linked to the hypothalamus—a gland located within your brain that helps regulate sleep and circadian rhythm.

In addition to the hypothalamus, trigeminal nerve stimulation, histamine release, genetics, and activation of the autonomic nervous system may contribute to the development of cluster headaches.

Head injuries or trauma or an acute illness, ranging from a run-of-the-mill viral or sinus infection to more serious infections, meningitis, may cause headaches.

In addition, serious underlying (non-infectious) health conditions may cause headaches.

Examples include:

Headaches, especially migraine headaches, tend to run in families. In fact, according to the American Migraine Foundation, if one or both of your parents suffer from migraine, there is a 50% to 75% chance that you will too.

That said, the genetic basis for migraines is complicated. For most migraine types, in order for a person to develop migraines, they must have inherited one or more genetic mutations.

But having a certain genetic mutation(s) is not necessarily a slam dunk case for developing migraines. Rather, that genetic mutation may make you more vulnerable to getting migraines, but other environmental factors, stress, hormone changes, etc, need to be present for the migraine disorder to manifest.

The good news is that researchers are working tirelessly to identify genetic mutations that increase migraine risk. So far, 38 single nucleotide gene mutations have been discovered, although how these discovered mutations can translate into migraine therapies remains unclear.

When linking migraines and genes, it's important to mention a rare but severe type of migraine called familial hemiplegic migraine. With this migraine type, a person experiences temporary weakness on one side of their body during the aura phase.

Mutations in four specific genes have been linked to familial hemiplegic migraine. These four genes include:

  • CACNA1A gene
  • ATP1A2 gene
  • SCN1A gene
  • PRRT2 gene

In addition to migraines, keep in mind genetics ly plays a role (albeit more minor) in the pathogenesis of cluster headaches and tension-type headaches. Overall, the research into these specific genetic patterns is less robust than with migraines.

Numerous lifestyle-related and environmental factors have been found to trigger primary headache disorders, especially migraines. It's believed that these triggers are the factors that signal the brain, nerve, muscle, and/or blood vessels to go through changes that ultimately create head pain.

Some common triggers for migraines include:

  • Stress
  • Hormone fluctuations, that seen just prior to menstruation (called menstrual migraine)
  • Weather changes
  • Certain foods or beverages (e.g., nitrates, alcohol, caffeine, aspartame, to name a few)
  • Sleep disturbances
  • Odors
  • Skipping meals

The two most common triggers are:

Some common triggers for tension-type headaches (of which there is a large overlap with migraines) include:

  • Stress
  • Intense emotions
  • Abnormal neck movement/position
  • Lack of sleep and fatigue
  • Fasting or not eating on time

Various lifestyle and environmental factors have been linked to other types of headaches. For example, missing your morning coffee can precipitate a caffeine withdrawal headache, which is located on both sides of the head, worsens with physical activity, and can be quite painful.

Another common type of headache is medication overuse headache, also called “rebound headache.” This headache occurs after frequent and excessive use of a headache or migraine medication—for example, a triptan or a nonsteroidal anti-inflammatory (NSAID).

Some daily activities strenuous exercise, sex, or coughing can trigger headaches; although these primary headache disorders are uncommon and warrant investigation by a headache specialist.

Lastly, while alcohol can trigger a person's underlying primary headache disorder, it can also cause its own headache, either as a cocktail headache or as a hangover headache. A hangover headache is throbbing, a migraine, but is usually located on both sides of the forehead and/or temples, a tension-type headache.

If your headaches are new or becoming more severe or frequent, a diagnosis by a healthcare professional is important.

In the end, remain dedicated and empowered in your journey to learning more about headaches—but also, be good to yourself and seek out guidance from your primary care physician or headache specialist.

Source: https://www.verywellhealth.com/headaches-causes-4685674

A Closer Look at Headaches

Headache Causes and Risk Factors

Last Updated: August 12, 2019 Was this helpful?

Headache is discomfort or pain around the head, face or neck area. A headache can happen because the nerves, muscles, or blood vessels throughout your face, scalp, or brain are irritated, inflamed, or not functioning properly.

The American College of Physicians reports that seven 10 people suffer from at least one headache a year. And 45 million Americans suffer from chronic headaches. Headaches vary greatly in severity, location of the pain, and duration. Because of the range of possible causes of headaches, a correct diagnosis is important.

Most headaches are not a cause for concern. But headaches due to a serious underlying disorder require urgent medical attention. Pay close attention when a headache is different than usual. Seek immediate medical care under these circumstances:

  • Excruciating headache or a headache that does not respond to typical treatment

  • Severe or sudden headache with a stiff neck, fever, convulsions, confusion, or pain in the eye or ear

  • Persistent headache in a person with no previous history of headaches

Recurring headaches in children are also cause for concern. A severe headache that wakes you in the night or develops on waking in the morning needs evaluation as well.

If there is any doubt, seek medical help as soon as possible.

There are over 150 different types of headaches. However, there are two main categories of headache—primary and secondary. Primary headaches have no underlying cause. Secondary headaches are due to another medical condition.

The three most common types of primary headache include:

  • Cluster headaches occur in groups or clusters daily or several times a day for weeks or months. Headache-free periods, which can last for months to years, separate episodes.

  • Migraine headaches are intense headaches that may last several hours to days. There are four phases of migraine headaches—prodrome, aura, attack and postdrome. About 25 to 30% of migraineurs will have an aura before the headache.

  • Tension headaches are the most common type of headache. They are usually short-lived and may recur periodically.

Most headaches are harmless and last only a few hours. However, a headache can be a symptom of numerous diseases, disorders or conditions affecting the neck, eyes, brain, jaw or teeth. This includes conditions ranging from the common cold, flu, and stress to severe conditions, such as meningitis, stroke, or a brain tumor.

Headache symptoms vary with the type of headache.

Cluster headaches often develop during sleep. They typically last 30 to 90 minutes at the same time each day. Common symptoms can include:

Migraine headaches can last from a few hours to a few days. Common symptoms can include:

  • Prodrome with subtle symptoms a day or two before the headache, such as constipation, difficulty concentrating, fatigue, mood changes, and sleep problems
  • Aura, which usually involves such visual symptoms as flashing lights, sensitivity to light, and seeing halos, bright spots, shapes or zig zags
  • Headache ‘attack’ with severe pain that can be throbbing, pulsating or pounding usually on one side of the head and often spreading to both sides
  • Postdrome with fatigue, confusion, low mood, and problems concentrating or comprehending

Tension headaches are usually short-lived, but can last for hours and become chronic. Common symptoms can include:

  • Dull, aching or squeezing mild or moderate pain that typically affects both sides of the head
  • Feeling of tightness or pressure in the scalp, forehead, neck, jaw or shoulders
  • Tenderness in the muscles of the head, neck or shoulders

In some cases, headache occurs with other symptoms that may indicate a serious or life-threatening condition. Seek immediate medical care (call 911) if you, or someone you are with, have a headache with any of these potentially life-threatening symptoms:

  • Nausea, vomiting, fever, and stiff neck
  • Seizures
  • Slurred speech, vision problems, confusion, or difficulty moving one side of the body
  • Sudden or explosive headache pain
  • Worst headache pain of your life or headache pain that worsens with time

You should also get immediate medical attention for a head injury with or without a headache.

Primary headaches are not associated with any other disease or condition. However, the exact cause is not well understood. It is ly a combination of genetic and environmental factors that affect pain-signaling nerves in the brain. Certain events, things you sense (smell, taste, feel, see, hear), and substances you eat or drink may trigger the headache.

Cluster headaches may be related to abnormal activity in the hypothalamus, an area of the brain that helps regulate key body processes, including the body’s internal clock. Typically, there are no triggers with cluster headaches. However, during a cluster period, smoking and even small amounts of alcohol can set off a headache.

Migraine headaches may involve imbalances in brain chemicals, such as serotonin, that regulate pain. Changes in brain activity may also affect pain pathways and blood vessels in the brain.

A wide variety of triggers are known to bring on a migraine. Common ones include alcohol, caffeine, certain foods, hormonal changes, stress, and weather changes.

Some medications can also trigger a migraine.

In the past, the theory behind tension headaches was that muscle tension brought on the headache. However, research does not support this idea.

Today, experts believe changes in pain-sensing nerves in the head, neck and shoulders play a role. Changes in the way the brain interprets pain signals from the area may also be a part of the cause.

All of these changes may cause muscular tension, not the other way around. Stress and depression can act as triggers.

These headaches are related to an underlying disease, disorder or condition. Possible causes of secondary headaches include:

  • Concussion and head or brain injury

  • Infection, sinusitis and meningitis

  • Low blood sugar and dehydration

  • Stroke, brain aneurysm, and bleeding in the brain

  • Trigeminal neuralgia and dental problems, such as TMJ (temporomandibular joint) disorder

  • Tumors, carbon monoxide poisoning, and panic disorders

Tension headaches can happen to anyone. Most people have experienced a tension headache at one time or another. However, there are a number of factors that increase the risk of developing migraine headache and cluster headache. A family history of these headaches increases the lihood of developing them. Other risk factors include age and sex:

  • Age: Both migraines and cluster headaches can develop at any age. However, migraines most often start during adolescence and peak in the 30s. Cluster headaches usually start between ages 20 and 50.

  • Sex: Migraines are three times as common in women as in men. In contrast, 80% of cluster headache sufferers are men.

It is not always possible to reduce your risk of headaches. However, you may be able to prevent them or reduce their frequency by avoiding known triggers. Keeping a headache diary can help you identify your triggers. Talk with your doctor, as well, to discover what could be triggering your headaches and how to avoid them.

The goals of headache treatment are to relieve the pain and other symptoms and prevent or reduce their occurrence or at least the frequency. The strategies can vary with the type of headache.

In general, pain relievers are useful for all types of headaches. Several other types of medicines can help relieve pain and other symptoms with cluster headaches and migraine headaches.

Examples include triptans and ergot drugs.

Preventive medicines are available for chronic tension headaches, cluster headaches, and migraines. The specific medicines vary with the type of headache. In general, antidepressants, antiseizure medicines, and drugs that treat high blood pressure can be helpful. Several other options are available, depending on the type of headache.

Home remedies can also help relieve and prevent headaches. This includes applying heat and ice, drinking plenty of fluids, and avoiding alcohol. Managing stress, practicing relaxation techniques, keeping a regular sleep schedule, and exercising regularly may help reduce headache frequency.

Fortunately, most headaches are a brief interference daily life. However, in some cases, the degree and frequency of headaches can become overwhelming and affect everyday functioning. This can lead to poor quality of life and absenteeism from work or school. In addition, migraine headache is a risk factor for stroke in both men and women. 

If headaches are affecting your quality of life, talk with your doctor. Find out about the most effective management and try it out. If you have migraines, ask about your risk of stroke and what you need to know to prevent it.

Was this helpful? Sarah Lewis is a pharmacist and a medical writer with over 25 years of experience in various areas of pharmacy practice. Sarah holds a Bachelor of Science in Pharmacy degree from West Virginia University and a Doctor of Pharmacy degree from Massachusetts College of Pharmacy. She completed Pharmacy Practice Residency training at the University of Pittsburgh/VA Pittsburgh Healthcare System.  Last Review Date: 2019 Aug 12

Source: https://www.healthgrades.com/right-care/migraine-and-headache/headache