Prevention & Recovery

What you need to know about five types of headache

What you need to know about five types of headache

Getty Images Author: Lisa van de Geyn

Prevention & Recovery

What you need to know about five types of headache

Headaches are one of the most common health complaints for Canadian women. Here's the rundown on five types of headaches: what causes them, how to proven them and how to feel better faster.

Headache type: Tension
If you've ever experienced a headache—and who hasn't?—this is probably one you've had. "It's your regular garden-variety headache, with aching around your whole head and more steady pressure than migraines," says Dr. Michael Zitney, the director of the Headache & Pain Relief Centre in Toronto. You're not likely to have any nausea, and there won't be sensory sensitivity. "You can usually still watch TV or work at your computer, for example, through a tension headache," he explains.

Why they happen: Doctors used to think tension headaches were caused by too-tight muscles in the neck, shoulders, face and head, but experts now believe they might be due to inflammation of the lining and main nerve areas in the brain. "Some of the triggers can be similar to migraine triggers," says Dr. Farnaz Amoozegar, a neurologist in Calgary. These include stress, sleep and dietary factors.

Treatment options: Most tension headaches will go away on their own, but taking ibuprofen, acetaminophen or acetylsalicylic acid (Aspirin) can help. There are also preventive medications that can help reduce the frequency or severity of chronic tension headaches, ones that occur more than 15 days a month; your doctor might recommend a muscle relaxant or an antidepressant (amitriptyline and nortriptyline are a couple of the common forms), though the latter needs to be gradually increased and can take a few weeks to start working.

Headache type: Migraine
These headaches, which typically last four to 72 hours, are one of the most common in women—about one-quarter of us suffer from them, compared to about eight percent of men. The diagnostic criteria are very specific, says Dr. Sian Spacey, a neurologist, physician and director of The University of British Columbia's Headache Clinic in Vancouver. Patients must have two of the following characteristics: throbbing, moderate to severe pain, unilateral pain (on one side of your head) and pain that worsens with activity. They must also experience nausea and vomiting, or sensitivity to light and sound.

Why they happen:  Frustratingly, it can be hard to pinpoint the cause, but it seems to be a mix of genetics and environmental factors. If you have a family history of migraines, you might be more prone to them. And there are common triggers, says Dr. Zitney. These include substances found in foods (MSG, nitrates and other preservatives, aspartame, alcohol and ca eine), lifestyle factors (skipping meals, dehydration and getting too much or too little sleep), weather changes, stress and fluctuating hormone levels thanks to our menstrual cycles.

Treatment options: Dr. Zitney recom-mends three stages of treatment. "The simplest and easiest thing to use is an anti-inflammatory," he says, adding that over-the-counter ibuprofen is a good option, as are prescription medications such as naproxen. If those don't o er relief, the second stage is triptans, migraine-specific medications that target pain at its source. "Migraine pain develops from a circuit of neuronal pathways and molecules in the brain,"says Dr. Amoozegar. "Once these path- ways were discovered, scientists began working on medications that specifically target them." There are seven triptans approved for use in Canada. They're available by prescription and come in oral, injectable and nasal-spray forms— but they're not an option if you have heart problems, as they can increase your risk of a serious cardiac event. You can also use a triptan and an anti-inflammatory in combination, as they approach pain in different ways. The last stage is a stronger painkiller, used sparingly—and only if you aren't at risk for addiction.

It's also worth asking your doctor about preventive meds, like antiseizure medication, beta-blockers and even Botox (which works by inhibiting the release of pain-related molecules). And if your menstrual cycle triggers migraines, you can also look into hormonal manipulation. "If it's safe for you to use the birth control pill or the hormonal IUD, you can fool your body into not having periods, which stops menstrual-related migraines," says Dr. Zitney.

Headache type: Medication-overuse
Formerly known as rebound headaches, these tend to occur in patients who have a high frequency of headaches and take a lot of painkillers, says Dr. Amoozegar. Folks who get migraines tend to be more prone to this type of headache, especially those who take medication for their migraines more often than they should.

Why they happen: It's the headache we cause ourselves due to regular, long-term use of painkillers, says Dr. Zitney. "If you take medications too often, they can turn around and bite you," he adds. "The head- aches start to come more often. Then, when the medication wears off, you have to take more, which brings on another headache. It's a pattern that's very hard to get out of once you're in it." As a general rule, it's OK to use medication (either over-the-counter or prescription) to treat headaches about 10 out of every 30 days. But if you find your-self using drugs more than 15 days out of the month for three consecutive months, see your doctor.

Treatment options: Education is key. "People need to know that their meds are the culprit," says Dr. Amoozegar. "Depending on what they're using, they need to gradually stop taking painkillers and start taking preventive medication." Beta-blockers and antiseizure medication aren't painkillers, but they can help reduce the frequency of migraines.

Headache type: Cluster
This is a rare, distinct type of headache. Cluster headaches are often seasonal or occur during the same time every year (or every couple of years). "These are shorter headaches that last from 15 minutes to three hours. They're unilateral and accompanied by symptoms like tearing, a droopy eyelid, a change in pupil size and nasal congestion on the side of the face where the pain is," says Dr. Spacey. This is the most severe type of headache you can get, and it's been dubbed the "suicide headache" because of the sufferers who have either committed suicide or thought about it during a cluster attack. Though they're more common in men than women, a 2012 study in the Journal of Neurological Sciences found that when women do get cluster headaches, they tend to have more daytime attacks and worse pain during nighttime attacks.

Why they happen: Causes haven't been pinpointed, but there's evidence that suggests abnormalities in the hypothalamus (the part of the brain that regulates sleep- wake cycles) could be part of the problem. Cluster headaches usually occur in the spring or fall, and triggers vary widely. Alcohol can worsen an attack.

Treatment options: Over-the-counter drugs won't make a dent in treating a cluster headache, nor will triptans (the attack is usually over before they kick in). For the drugs that do offer relief, opt for injections or nasal sprays, which are often faster acting. Giving the sufferer oxygen via a mask can also help some patients.

Headache type: Sinuses
You know those throbbing headaches where you also have a fever, a runny nose, congestion, an icky green discharge and pain in your face? That sounds like a sinus headache, says Dr. Amoozegar. But, she adds, they're often misdiagnosed. Many headaches that occur in the face are actually migraines; it can only be a sinus headache if you also have a sinus infection or another serious sinus issue.

Why they happen: Blame inflammation of the sinuses (a.k.a. sinus- itis), which is caused by anything that stops them from draining properly, such as a cold or flu, allergies or respiratory infections.

Treatment options: The first step is a visit to the doctor's office to confirm you have a sinus infection. If you do, you'll likely get a prescription for antibiotics. Ibuprofen, acetaminophen or acetylsalicylic acid can help ease the pain while you're waiting for the meds to kick in.

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What you need to know about five types of headache

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