Consumer Reports

‘Oh my aching head’ — painful headaches are the real deal

Many people brush off a headache as being an excuse for getting out of daily activities or commitments. But if it is you who is suffering, you can vouch for the fact that headache pain is a real and legitimate condition. Across America, there are 45 million people who suffer from chronic, recurring headaches, and of that number, nearly 30 million have migraine headaches. In San Diego, about 120,000 people have headache most days!
There are many different kinds of headaches including tension, cluster, sinus, rebound and migraine. With so many people suffering from headaches, and because treatment is sometimes difficult to pinpoint, a new classification system has been developed that allows health care practitioners to understand a specific diagnosis more completely, to provide better and more effective treatment regimens. The classifications are primary; secondary; and cranial neuralgias, facial pain and other headaches.
Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache. Secondary headaches may indicate that there is a structural issue in the head and neck, and should be treated by a neurologist.
Tension headaches are the most common type of primary headache. As many as 90 percent of adults have had or will have tension headaches. This type of headache is slightly more common among women than men.
Causes of tension headache are debated. While they may be in part due to contraction of the muscles that cover the skull, with resulting spasm and pain, increased brain sensitivity also appears to play a role. Pain is usually dull, generalized, and mild to moderate in severity.
There is little research to confirm the exact cause of tension headaches. Half of people with tension headache identify stress or hunger as triggers. Physical stresses that may provoke tension headaches include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time.
Emotional stress may also cause tension headaches by causing the muscles surrounding the skull to contract.
Migraine headaches are the second most common type of primary headache, but are the most common disabling headache. An estimated 30 million people in the United States (more than 12 percent of the population) will experience migraine headaches. Children can get migraine. Women are affected three times as often as men. Many people who believe they have sinus headaches are actually suffering from migraines.
Migraine characteristics can include:
• Pain typically on one side of the head
• Pain that is pulsating or throbbing
• Nausea or vomiting
• Sensitivity to light or sound
• Visual disturbances or aura
• A worsened condition with exertion, such as climbing stairs
Approximately one-fifth of migraine sufferers experience aura. It is the warning associated with migraine, prior to the onset of the actual headache pain. This can include visual disturbances with wavy lines, or flashing lights, tingling, or numbness, beginning from about 20 minutes to one hour before the actual onset of headache. Treatment for migraine may include over-the-counter or prescription medications, as well as self-help techniques such as relaxation training, yoga and biofeedback.
Cluster headaches are a rare type of primary headache, affecting one in 1,000 in the population. Men are affected four times as often as women. Cluster headaches typically come in groups, or clusters, lasting weeks or months at a time, and often awaken people from sleep.
Cluster headache is one sided, and is often described as “like a hot poker in the eye.” Cluster headache sufferers are typically restless, and may experience a red, watery eye and a congested or runny nose as well. Prescription medications and breathing oxygen are beneficial.
Cranial neuralgia literally translated means nerve pain and it describes a group of headaches that occur because the nerves in the head and upper neck become irritated. Most common is trigeminal neuralgia, which causes intense, electric shock like pains, and may be triggered by touch or a breeze.
Bottom line, headaches affect quality of life. It is difficult to predict their onset. Yet when they do occur, it is sometimes difficult to manage their symptoms. Some people have occasional headaches that resolve quickly by using acetaminophen or other over-the-counter pain relief medications. Others are so debilitated that normal function can be interrupted for days on end. If you are experiencing recurrent headaches, or simply have questions about why your head is hurting, don’t be afraid to tell your doctor that you have a headache!

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