Almost all adults get a headache from time to time: Up to 75% of adults worldwide suffer from one at least once a year. But not all headaches are the same.
There are more than 100 different types of headache disorders. Each can cause slightly different symptoms and may have different triggers and treatment options.
Some headaches are caused by lifestyle or dietary factors. Others are due to underlying medical conditions. And some have no obvious cause or trigger.
Many common headaches can be alleviated with over-the-counter medications, while others require more specific treatment from a licensed healthcare provider.
A migraine headache is a common and potentially severe headache disorder that can require target treatment. If you are in pain, identifying whether you are suffering from a migraine or another kind of headache disorder can help you to address your symptoms and take the preventive steps you need to keep your pain from coming back.
In this article, I’ll explain what a headache is, and explore some different types of headaches. I’ll then describe what a migraine is, including the types of migraines, the phases of this type of headache, and what can trigger migraines. I’ll talk about the risk factors for these debilitating headaches, too.
Finally, I’ll outline treatment options for headaches and migraines, and talk about when it’s best to see a doctor.
What is a Headache?
Headaches are the result of a complex interaction between your blood vessels, nerve endings, and brain.
Although neurologists are still studying exactly how headaches are triggered, many headaches occur when blood vessels around your head, neck, and face expand, increasing blood flow to your face, head, neck, and jaw.
As these blood vessels get larger, they put pressure on nerves in the skin, bone, and muscle that surround them.
In response, your nervous system sends a signal to the brain that the back, top, or side of your head, face, sinus, skin, and sometimes your neck, back, and shoulders are experiencing distress. Your brain interprets those signals as pain, and you’ve got a headache.
Types of Headaches
There are two broad types of headache disorders: primary and secondary.
When someone is suffering from a primary headache disorder, headache pain is their main symptom; there is no other medical condition that is causing their discomfort. When someone has a secondary headache disorder, they are experiencing head pain as a symptom of an injury, sinus infection, or other underlying medical problem.
Some of the more common forms of primary headaches include:
Tension-type headaches are extremely common: more than 70% of adults will experience at least one tension headache at some point in their lives.
Often triggered by stress, physical tension or musculoskeletal issues, hunger, or lack of sleep, tension headaches can cause pain for as little as 20 minutes, or can last a few days.
Symptoms of a tension headache include:
- Dull, aching, or throbbing pain or pressure that wraps around your head
- Skin or scalp tenderness
- Sore, uncomfortable, or tense neck, shoulder, and jaw muscles
Most people have mild, intermittent tension headaches. A smaller percentage of people have more persistent pain; they have tension headaches 15 or more times a month and are more likely to become debilitated by their condition.
Researchers believe that, unlike other, more common headache disorders, cluster headaches may be caused by abnormalities in the part of the brain that controls your biological clock.
More common in men, cluster headaches are characterized by:
- Severe pain that strikes multiples times a day within a 1-3 month period.
- Sharp, shooting pain behind an eye or on one side of the head
- A drooping eyelid
- Nasal congestion
- Pupil constriction
- Eye tearing, puffiness, or redness
- Forehead sweating
Hemicrania is a primary headache disorder that affects an unknown number of Americans every year.
Most common in women, hemicranial headache symptoms can include:
- Continuous pain on the same side of the head or face for more than three months
- Pain that fluctuates in severity but never goes away completely
- Tearing or eye redness
- Drooping eyelid
- Runny nose or congestion
- Contracted iris
- Forehead sweating
- Nausea or vomiting
- Sensitivity to light and sound
There are two forms of hemicrania headaches: chronic and remitting. When patients have chronic hemicranial pain, they experience headaches every day.
When they have the remitting form of hemicrania, they will have painful episodes for more than three months, followed by pain-free periods for weeks or months at a time.
Thunderclap headaches come on suddenly and are excruciating.
While these can occur as part of a primary headache disorder, in some cases they can be a sign of a more serious underlying condition such as subarachnoid hemorrhage, life-threatening bleeding in the brain.
Thunderclap headache symptoms include:
- Sudden onset headache that strikes without warning
- Debilitating pain that peaks within 60 seconds of starting
- Nausea or vomiting
- Mental disorientation or confusion
Thunderclap headaches are not common, but are very serious and require immediate medical attention. If you or someone you know is experiencing pain you believe may be a thunderclap headache, call a healthcare provider or immediately go to your nearest emergency room.
Sinus headaches are a secondary headache disorder.
They are a symptom of sinus infections that occur when someone has a cold or flu, allergies, nasal polyps, or other sinus condition.
You may have a sinus headache if you are experiencing:
- Dull facial pain behind your cheeks, nose, eyes, or forehead
- Pain that becomes worse with physical activity like bending over or moving your head
- Fullness in ears
- Nasal congestion or runny nose
- A puffy, swollen, or tender face
Sometimes people confuse sinus headaches with migraines, since migraine headaches can sometimes cause nasal or sinus pain.
If you do not have nasal or sinus congestion or discharge along with your pain, you may not be suffering from a sinus-related headache.
There are dozens of secondary headaches that are symptoms of other underlying medical conditions and environmental factors that irritate the nerves in and around the head.
External compression headaches, medication overuse headaches (rebound headaches), and ice cream headaches (brain freeze) are some of the more common secondary headache disorders.
A large variety of medical issues ranging from mild to severe can also cause head pain.
What is a Migraine?
Researchers do not know what causes the disorder, but they are more common in those with a family history of migraines. Migraine attacks are 2-3 times more likely to affect women than men.
Symptoms of migraine can include:
- Blind spots, blurred vision, or temporary vision loss
- Constipation or diarrhea
- Fatigue, depression, sluggishness, irritability, or restlessness
- Food cravings
- Frequent yawning
- Nausea or vomiting
- Neck stiffness
- Sensitivity to light, sounds, and smells
- Throbbing, pounding pain on one or both sides of the head
- Tingling or numbness in the extremities
- Visual disturbances, halos, flashing lights, or sparkles
- Watery eyes, runny nose, or congestion
Migraines are more than just powerful headaches. They can last anywhere from three hours to four days and include a range of physically uncomfortable symptoms beyond just head pain.
Unlike tension headaches, migraine pain can be so severe that it makes regular daily life difficult. In addition to other treatments, migraine sufferers must sometimes spend hours in a dark or quiet room to find relief.
Types of Migraines
There are four types of migraines, each with slightly different symptoms.
- Migraine with aura (classic migraine): According to the National Institutes of Health, roughly one-third of all migraine sufferers have visual disturbances before they experience any pain. Some patients with this type of migraine will see flashing lights, zig-zags, or sparkles; others will have blind spots, blurred vision, experience temporary blindness, or feel tingles. Most will have a headache after these symptoms, but some experience only these visual symptoms.
- Migraine without aura (common migraine): When migraine sufferers do not have visual disturbances along with their headache, they have migraine without aura, or common migraine. Usually, people with this type of migraine will experience pulsing or pounding pain around the eye and one side of the head that spreads to the back of the skull and neck. They may also experience nausea, vomiting, and light and/or sound sensitivity.
- Hemiplegic migraine: People with hemiplegic migraines experience muscle weakness or numbness on one side of their body along with visual disturbances, dizziness, and head pain. This type of migraine is very rare. If you are experiencing symptoms and have not been diagnosed with this disorder, seek medical attention to rule out a stroke or other more serious condition.
- Abdominal migraine: Unlike other types of migraine, which typically start in adolescence or young adulthood, abdominal migraines most often affect children between 3-10 years old. Abdominal migraines involve little to no headache. During a migraine attack of this nature, children will experience nausea, vomiting, loss of appetite, and stomach pain for up to three days.
Phases of Migraines
There are four distinct phases within a migraine episode, though not everyone with migraines experiences every phase.
If you suffer from migraines, it can be helpful to note the early symptoms so you can initiate your migraine treatments early.
In the premonitory or prodrome phase, patients begin to experience early migraine symptoms that often indicate that head pain is on the horizon.
Symptoms of this phase can include:
- Fatigue, sluggishness, or depression
- Food cravings
- Sensitivity to light, sound, and smell
- Shifting moods, irritability, or restlessness
- Neck stiffness
Some visual disturbances and physical symptoms will precede any headache pain for people who suffer from classic migraines, or migraines with aura.
Symptoms of this phase include:
- Blind spots that get larger over time
- Blurry vision or temporary loss of vision
- Difficulty making or understanding conversation
- Mental confusion
- Muscle weakness or tingling in the arms and face
- Slurred speech
- Visual aura, halos, sparkles, zig-zags, or flashing lights
Although some people have migraines without pain, the headache phase is the most uncomfortable for most migraine sufferers.
During this phase, you might experience:
- Nasal congestion or runny nose
- Nausea or vomiting
- Pain that worsens with light, sound, and certain smells
- Throbbing, pounding, or pulsing pain on one side of their face or head
- Watery eyes
The postdrome phase marks the end of a migraine episode.
After the head pain subsides, most people are left feeling:
- Confused or disoriented
- Depleted, tired, or exhausted
- Sluggish and generally unwell
Researchers don’t fully understand what causes a migraine or why some develop them more readily than others.
What we do know is that certain environmental and emotional factors can trigger migraines or make them worse.
The most common migraine triggers include:
- Aged cheeses
- Alcoholic drinks
- Anxiety and stress
- Aspartame (artificial sweetener)
- Certain prescription medications
- Changes in caffeine intake
- Changes in weather
- Flickering or bright lights
- Hormonal birth control
- Hormonal changes
- Lack of sleep
- Loud noises
- Menstrual cycle
- Monosodium glutamate (MSG)
- Physical and sexual activity
- Salty, processed foods
- Strong odors
If you are suffering from migraines, keep careful track of the environmental and emotional factors that might triggering your pain.
Some people find keeping a “headache diary” helpful in identifying what might be causing them. Understanding and avoiding migraine triggers can help you manage your headache disorder.
Some people are more prone to developing migraines than others. You may be more likely to develop migraines if you are:
- 35-45 years of age
- Someone with a family history of migraine headaches
Research has also shown that people with mood disorders like depression, anxiety, and bipolar disorder are more likely to develop migraines.
Similarly, people with sleep disorders or who have recently changed their sleep schedules run a greater risk of developing the condition.
Treatment for Headaches
For most people, treating a headache is relatively straightforward.
For tension headaches and other milder episodic headaches, including mild migraine headaches, over-the-counter medications and lifestyle changes can help relieve your pain.
There are several over-the-counter medication options that most patients can safely use to alleviate mild to moderate headache pain.
- Acetaminophen (Tylenol)
- Acetylsalicylic acid (Aspirin)
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Combination migraine medications (Excedrin Migraine), which typically contain acetaminophen, aspirin, and caffeine, and may be more effective than a single OTC medication
- Magnesium supplements, which can help with muscle tension and may help prevent or treat some headaches
Taking steps to reduce stress, increase physical exercise, stretch, drink enough water, practice deep breathing, and make other healthy lifestyle adjustments can help prevent and treat headaches.
Some people find aromatherapy, massage, yoga, or physical therapy helpful.
Treatment for Migraines
There is no cure for chronic migraines, but there are steps you can take to treat your symptoms and reduce the chances of another episode.
In addition to using over-the-counter pain relievers, patients may use several prescription drugs to help address migraine pain.
- Anti-seizure medicines
- Blood pressure medicines, such as beta-blockers
- Botulinum toxin A (Botox) injections
- Erenumab (Aimovig)
- Lasmiditan (Reyvow)
- Sumatriptan injection (Zembrace Symtouch)
- Ubrogepant tablets (Ubrelvy)
If you suffer from migraines, you can take preventative steps to avoid having to endure another episode.
- Eating healthy, balanced meals at regularly scheduled intervals
- Practicing meditation and mindful breathing
- Reducing and managing stress
- Avoiding alcohol and illicit drugs
- Drinking enough water
- Sleeping eight hours per night
- Tracking environmental triggers and avoiding them as well as you can
Talk to your provider if you believe you would benefit from hormone therapy or changing your prescription medication.
They will work with you to find the right treatment option for your specific symptoms.
When to See a Healthcare Professional
Chronic headaches, even mild ones, can feel debilitating. If you are having headaches that are frequent, intense or are regularly interfering with your daily life, you don’t need to suffer. Make an appointment with a healthcare provider.
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Frequently Asked Questions
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Hemicrania Continua Information Page. (2019). https://www.ninds.nih.gov/Disorders/All-Disorders/Hemicrania-Continua-Information-Page
Migraine Glossary. (n.d.) https://migraineresearchfoundation.org/about-migraine/migraine-glossary/
Migraine Information Page. (2019). https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page
Headache Disorders. (2016). https://www.who.int/news-room/fact-sheets/detail/headache-disorders
The International Classification of Headache Disorders 3rd Edition (2017). https://ihs-headache.org/wp-content/uploads/2020/05/ICHD-3-Pocket-version.pdf
Migraine Facts. (2021). https://migraineresearchfoundation.org/about-migraine/migraine-facts/
The Timeline of a Migraine Attack. (2018). https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack/
Cluster headaches cause years of needless pain. (2020). https://www.nature.com/articles/d41586-020-02866-5