Headache

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Headaches that occur suddenly (acute-onset) are usually due to an illness, infection, cold, or fever. Although headaches are rarely the symptoms of a serious illness, occasionally they may indicate a serious medical condition such as a tumor or aneurysm (blood vessel rupture). It is important to become familiar with your personal headache symptoms, so that you can judge which headaches require immediate medical attention.

Seek medical care immediately if you or your child has any of these headache symptoms:

  • A sudden, new, severe headache
  • A headache that is associated with neurological symptoms such as weakness, dizziness, sudden loss of balance or falling, numbness or tingling, paralysis, speech difficulties, mental confusion, seizures, personality changes/inappropriate behavior, or vision changes (blurry vision, double vision, or blind spots)
  • Headache with a fever, shortness of breath, stiff neck, or rash
  • Headache pain that awakens you at night
  • Headaches with severe nausea and vomiting
  • Headaches that occur after a head injury or accident
  • A new type of headache after age 55
  • Contact your healthcare provider if you or your child has any of the following symptoms:
  • Three or more headaches per week
  • Headaches that keep getting worse and won't go away
  • Need more than two or three doses of over-the-counter medications per week to relieve headache symptoms, or a dose higher than the recommended amount of those medications
  • Headaches that are triggered by exertion, coughing, bending, or strenuous activity
  • A history of headaches, with a recent change in your headache symptoms
  • This section contains more information on the symptoms of:

    • Tension headaches
    • Migraines
    • Transformed migraines
    • Cluster headaches
    • Sinus headache
    • Symptoms of tension headaches

      Most people with episodic tension headaches (those that occur less than 15 days in a month) have them no more than once or twice monthly. The headaches are classified as chronic if they occur more than 15 days per month. Often, the pain associated with a tension headache is difficult for the patient to describe. Tension headaches may affect the front, top, or sides of the head.

      Episodic tension headaches may be described as a mild-to-moderate, constant bandlike pain, pressure, or throbbing. They usually begin gradually, often occur in the middle of the day, and may last from 30 minutes to several days.

      Chronic tension headaches usually come and go over a prolonged period of time. The severity of a tension headache increases significantly with its frequency. This daily or almost daily pain is usually throbbing and affects the front, top, or sides of the head. Although the pain may vary in intensity throughout the day, the pain is almost always present. Chronic tension headaches tend to be more common in females. For many patients, these headaches get in the way of daily activities.

      Tension headaches are normally not associated with an aura, severe sensitivity to light or noise, stomach pain, or vomiting. They also do not cause neurological symptoms or affect vision, balance, or strength.

      Other symptoms associated with tension headaches:

      • Pain upon awakening
      • General muscle aches
      • Difficulty falling asleep and staying asleep
      • Chronic fatigue
      • Irritability
      • Disturbed concentration
      • Mild sensitivity to light or noise
      • Occasional dizziness
      • Occasional nausea
      • Symptoms of migraine

        A migraine, which is typically located on one side of the head behind the eye or in the temple, often begins as a dull ache and develops into throbbing or pounding pain. The pain often is accompanied by nausea and vomiting and sensitivity to sounds or lights.

        Other symptoms may include:

        • Sensitivity to odors
        • Abdominal pain
        • Loss of appetite
        • Sensations of being very warm or cold
        • Paleness
        • Fatigue
        • Dizziness
        • Blurred vision
        • Diarrhea (rare)
        • Fever (rare)
        • While migraine pain usually sticks to one side of the head, it may shift from one side to the other, be felt in the front of the head, or be felt all over the head. Migraine pain can be mild or severe and is usually aggravated by physical activity. Many people with migraines stop what they are doing and lie down in a dark, quiet room until the headache goes away.

          Most migraines last about four hours, although severe ones can last up to a week. The frequency of migraines varies widely among individuals. It is common for a migraine sufferer to get two to four headaches per month, but some people get them every few days, while others get a migraine only once or twice a year.

          Cyclic migraine, as its name implies, is a form of migraine that occurs in cycles. This type of headache has also been incorrectly called cluster migraine. Headache cycles range from one to six weeks in length. During the cycles, headaches can occur daily or several times per week. The headache cycles are followed by headache-free intervals lasting weeks to months.

          About 15 to 20 percent of migraine sufferers have headaches associated with "auras," neurological symptoms that sometimes precede the pain and signal that a migraine is about to begin. Migraines that occur with an aura used to be known as "classic" migraines and now are referred to as "migraines with auras." An aura can occur before, during, or after the pain and lasts 15 to 60 minutes. Visual auras include:

          • Bright flashing dots or lights
          • Blind spots
          • Distorted vision
          • Temporary vision loss
          • Wavy or jagged lines
          • Some auras affect the other senses. These auras can be described simply as having a "funny feeling," or the person may not be able to describe the aura. Other auras may include ringing in the ears or having changes in smell, taste, or touch.

            Eighty to 85 percent of migraine suffers have migraines without auras, formerly known as "common" migraines. Several hours before the onset of the headache, they may experience vague symptoms, including:

            • Anxiety
            • Depression
            • Fatigue or tiredness
            • This section also contains information on symptoms of rare migraines and migraine symptoms in children.

              Symptoms of rare migraines

              Rare migraine conditions include these types of neurological auras:

              Hemiplegic migraine: temporary weakness (hemiparesis) paralysis (hemiplegia) on one side of the body. The onset of the headache may also be associated with temporary numbness, dizziness, or vision changes.

              Retinal migraine: temporary, partial, or complete loss of vision in one eye, along with a dull ache behind the eye that may spread to the rest of the head.

              Basilar type migraine: Dizziness, confusion, or loss of balance can precede the headache. The headache pain may affect the back of the head. These symptoms usually occur suddenly and can be associated with the inability to speak properly, ringing in the ears, hearing loss, simultaneous numbness on both sides of the body, vertigo, and nausea and vomiting. This type of migraine is strongly related to hormonal changes and primarily affects young adult women.

              Status migrainosus: a rare and severe type of migraine that can last 72 hours or longer. The pain and nausea are so intense that people who have this type of headache often need to be hospitalized. Certain medications, or medication withdrawal, can cause this migraine syndrome.

              Ophthalmoplegic migraine: pain around the eye, including paralysis in the muscles surrounding the eye. This is an emergency medical condition, as the symptoms can also be caused by pressure on the nerves behind the eye or an aneurysm. Other symptoms of ophthalmoplegic migraines include droopy eyelid, double vision, or other vision changes.

              Symptoms of migraines in children

              In early childhood and before puberty, migraines are more frequent among boys. In adolescence, migraines affect young women more than young men. As adults, women are three times more likely to suffer from migraines as are men.

              Some migraines are accompanied by an aura, a warning sign that a migraine is about to begin. An aura usually occurs about 10 to 30 minutes before the onset of a migraine. The most common auras are visual and include blurred or distorted vision; blind spots; or brightly colored, flashing, or moving lights or lines. Other auras may include speech disturbances, motor weakness, or sensory changes. The duration of an aura varies, but it generally lasts less than 20 minutes. Migraine without aura is the most frequent type in children and adolescents, accounting for 70 to 85 percent of all migraines.

              In young children, migraine often begins in the late afternoon. As the child gets older, the onset of migraine may change to early morning. Although symptoms can vary from person to person, the general symptoms of migraines with and without auras are:

              • Pounding or throbbing head pain. In children, the pain usually affects the front or both sides of the head. In adolescents and adults, the pain usually affects one side of the head.
              • Pallor, or paleness of the skin
              • Phonophobia or sensitivity to sound
              • Photophobia or sensitivity to light
              • Loss of appetite
              • Nausea or vomiting
              • Symptoms of a transformed migraine

                Many people with a history of migraine will suddenly report that the headaches are less severe but are more frequent, until they begin occurring daily. This change may be caused by the daily use of analgesics (pain-relieving medications). These chronic, daily headaches are known as transformed migraines. People usually start getting daily transformed migraine headaches during their 20s and 30s.

                Some people report having occasional severe episodes accompanied by nausea and vomiting, much like migraines. Often, it is difficult to differentiate between tension-type headaches and transformed migraines.

                Symptoms of cluster headaches

                Cluster headaches are the most severe headaches. They can be many times more intense than a migraine attack.

                Cluster headaches occur one to three times per day. They occur very regularly, generally at the same time each day, and generally reach their full force within five or 10 minutes. The pain of a cluster headache can last anywhere from 15 minutes to three hours, then completely disappears only to recur later in the day. In some people, an "alarm clock headache" occurs at the same time each night. These nocturnal attacks can be more severe than the daytime attacks, awakening a person after an hour or two of sleep.

                In any individual, attacks usually vary only slightly from one to the next. The pain is almost always one-sided and doesn't switch sides during a headache period. (It may rarely switch sides for a new headache period.) The pain is located behind one eye or in the eye region. It may radiate to the forehead, temple, nose, cheek, or upper gum on the affected side. The scalp may be tender, and the pulsing in the arteries often can be felt.

                The pain of cluster headaches is generally very intense and severe and is often described as having a burning or piercing quality. It may be throbbing or constant, and most people cannot sit still but must pace during an attack. Although the pain of a cluster headache starts suddenly, a minimal warning of the oncoming headache may occur, such as a feeling of discomfort or a mild one-sided burning sensation.

                During an attack, the affected eye may become swollen or droop. The pupil of the eye may get smaller and the conjunctiva (the tissue that lines the inside of the eyelid) may redden. There may be nasal discharge or congestion and tearing of the eye, all on the same side as the pain. The person may have excessive sweating, and the face may become flushed on the affected side. Cluster headaches are not typically associated with nausea or vomiting. But as is true for people with migraines, people with cluster headaches may develop severe sensitivity to light and sound.

                Most people experience cluster periods at the same time each year, during a specific season. In about 20 percent of people with cluster headaches, the attacks are chronic: The series of headaches are not separated by periods of remission.

                People who suffer from cluster headaches—especially people who feel pain in the teeth or cheeks during an attack—have an increased risk of developing a stomach ulcer.

                It is possible for someone with cluster headaches to also suffer from migraines.

                Symptoms of sinus headache

                Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually intensifies with sudden head movement or straining and is typically accompanied by other sinus symptoms, such as nasal discharge, a feeling of fullness in the ears, fever, and facial swelling.

                Common symptoms of sinusitis include:

                • Pressure or pain around the face, forehead, eyes, or cheeks
                • Thick, discolored, foul-smelling nasal discharge
                • Nasal obstruction
                • Congestion
                • Post-nasal drip (the drop-by-drop release of nasal fluid into the back of the throat)
                • A cold that won't go away
                • Bad breath
                • Fatigue
                • Fever
                • Redness and tenderness over the infected sinus
                • Whether the symptoms of headache can actually be attributed to the sinuses will need to be determined by a physician. If your headache is truly caused by a sinus blockage, such as an infection, you will very likely have a fever. CT scans or MRI, along with a physical examination, are usually conducted to determine if there is inflammation and infection localized to the sinus.

                  Last reviewed on 07/06/2006

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