Chronic headaches can keep you from living the life you want—and they can be a sign of a serious health issue. The experienced specialists and diverse treatment options at the Tulane Neuroscience Center can help you find answers—and lasting relief.
About Headaches and Migraines
Please note: Some headaches can be sign of a serious medical condition that requires prompt medical attention. Seek help immediately for:
- Sudden, severe headache or sudden headache with a stiff neck
- Headache with fever, convulsions, confusion or loss of consciousness
- Headache following a blow to the head, or with pain in the eye or ear
- Persistent headache in a person who was previously headache free
- Recurring headache in children
Headaches may seem like an everyday annoyance. But some people have severe, recurrent headaches that interfere with their daily lives and may not respond to over-the-counter pain relievers. Such headaches can have many different causes and triggers, so treating them successfully takes specialized knowledge and experience.
If you have tried over-the-counter remedies with little or no relief, you may start to feel that nothing will work. Take heart—many medications and advances with long safety records can dramatically reduce symptoms. After finding the right solution, people often say that they wish they had sought treatment sooner.
Types of Headache
If you have severe or recurrent headaches, it’s important to rule out possible causes that might be serious. Secondary headaches—caused by underlying conditions, such as tumors, aneurysms or certain diseases—are much more rare than other types of headaches. Our team has the experience and technology to diagnose underlying conditions so that you can get prompt care and treatment.
Other headaches are sometimes called primary headaches, meaning they are not caused by disease or an underlying condition.
Some common types of headache can include:
Migraines are the most common type of primary headache, affecting millions of Americans. Women are more likely to get migraines than men. The exact cause is not fully understood. It may be related to swelling of blood vessels in the head, due to unusual levels of certain substances in the brain. People who get migraines may have abnormalities in the genes that control certain brain cells.
Whatever the cause, the result is throbbing, moderate to severe pain, often on one side of the head. Some people feel sick to their stomach and might throw up. Migraines can last from a few hours to one or two days. When migraines happen frequently, they can interfere with work, family time and other activities.
Some people can tell they are about to have a migraine because they have visual signs, such as seeing flashes or lines across their field of vision. Many things can possibly trigger a migraine, such as:
- Sleeping too much or not enough
- Alcohol, especially red wine
- Certain foods, or certain chemicals in food
- Stress and anxiety
- In women, hormonal changes before, during or after your period
Treatment often includes medication to relieve the symptoms, usually in pill form. It’s best to take these drugs as soon as you realize you are getting a migraine. One commonly used drug is sumatriptan. Steroids or narcotics are used in some cases, with care taken to avoid side effects and complications.
If you get more than three or four migraines each month, you might need preventive medication, which might include certain kinds of cardiovascular, anti-seizure or anti-depressant drugs. These drugs are taken daily to prevent migraines or reduce their frequency. Regular OnabotulinumtoxinA (Botox) injections help some adults.
Stress management strategies, regular physical activity and other lifestyle changes may help prevent migraines or reduce their intensity. Therapy using biofeedback and other methods may reduce the number and severity of migraine attacks. Keeping a journal of your headaches can help you pinpoint possible triggers so you can make helpful changes.
In women, hormone therapy can be helpful if migraines are related to the menstrual cycle.
Cluster headaches are severe headaches that happen one to three times a day for a period of time, usually a few weeks. The headaches then disappear for two weeks or longer, only to return. Some people have cluster headaches so frequently that they have fewer than 14 pain-free days a year. Unlike migraines, cluster headaches are more common in men than women. It’s possible to have both cluster headaches and migraines. As with migraines, the exact cause is not known.
The pain from cluster headaches is severe and can last for from 15 minutes to three hours. Many people describe it as burning or stabbing pain. It is almost always on one side of the head, and seldom changes sides. The eye on that side may tear, and the eyelid may droop. People with cluster headaches may pace and become agitated while suffering an attack.
The pain of a cluster headache is hard to treat, partly because oral drugs may not work quickly enough. Drugs such as sumatriptan in nasal spray or injectable form may help. Injections are designed to be easy to give yourself during an attack, and relief usually comes quickly. Some people find quick relief from breathing pure oxygen. In some cases, narcotics or steroids can be helpful, with care taken to avoid side effects or addiction.
To prevent cluster headaches, many of the same drugs used to treat migraine can be effective. If you have chronic, frequent cluster headaches, nerve blocks to reduce the function of certain nerves (trigeminal or occipital nerves) may help.
Tension headaches are one of the most common types of headache. They are usually linked directly to stress or anxiety, and can interfere with daily life if they happen frequently. These headaches often respond to over-the-counter medication, but overuse can lead to more headaches as well as other complications.
Combination drugs designed especially for tension headaches can often relieve symptoms. Preventive drugs can include antidepressants, anticonvulsive medications and muscle relaxants. Stress management and relaxation techniques can be a vital part of preventing tension headaches.
Temporal arteritis causes inflammation and damage to the blood vessels that supply blood to the head, neck, upper body and arms. It usually affects people who are 50 or older. The exact cause is unknown, but it may be related to a faulty immune response.
Temporal arteritis can cause throbbing headaches on one side of the head, and the scalp may be tender. Other symptoms can include:
- Fever and feeling ill
- Jaw pain when chewing
- Pain and stiffness in the neck, upper arms, shoulders and hips
- Feeling weak or tired
- Vision problems, including blindness
- Hearing loss
- Tongue or throat pain
To diagnose the condition, doctors often use blood tests, as well as ultrasound, magnetic resonance imaging (MRI) and other imaging techniques so they can see the blood vessels.
Treatment is critical to help prevent severe problems such as blindness or stroke, and usually includes long-term treatment with corticosteroids. You may start to feel better in days, but you will need treatment for a year or two, with the dose being slowly reduced. You may need to take other medications as well.
Sinus headaches are not as common as many people believe. Experts now believe that most people who think they are having sinus headaches are actually having migraines. However, if your headaches turn out to be related to your sinuses, a referral to an ear, nose and throat specialist is the next step to treating your sinus condition.
Learning as much as you can about headaches and your specific type of headache can help you cope and learn ways to feel better. Here are some good places to start:
Medline Plus from the National Institutes of Health and the National Library of Medicine
National Institute of Neurological Disorders and Stroke headache information page