Headaches & migraines

While very common and usually benign, frequent or severe headaches can be disabling and sometimes indicate a serious problem. Our specialists can provide you with the latest headache and migraine treatments. They will make sure your headaches are not being caused by a serious underlying health issue and, as needed, use state-of-the-art treatment technology to address both primary and secondary causes.

Categories of headaches & causes

Headaches are separated into two main categories: primary and secondary. At Advocate Health Care, our neurologists have the experience and expertise to identify and treat both primary and secondary headaches.

What are primary headaches?

A primary headache is generally triggered by nerves, blood vessels or muscles in your head and neck. Primary headaches can also be caused by diet and lifestyle including alcohol consumption, sleep deprivation, skipped meals and stress.

Primary headaches include:

• Migraine
• Cluster headache
• Tension headache

What are secondary headaches?

A secondary headache is a symptom of another medical issue, ranging from a sinus infection to a stroke. Secondary headaches can be caused by serious conditions, such as:

• AVM (arteriovenous malformation)
• Brain aneurysm
• Brain tumor
• Carbon monoxide poisoning
• Encephalitis
• Glaucoma
• Head injury
• Hydrocephalus (too much fluid around the brain)
• Hypertension (high blood pressure)
• Infections, colds, fevers
• Meningitis
• Narrowing tear, rupture or blockage of blood vessels near the brain
• Sinusitis (inflammation of sinuses)
• Sleep disorders
• Stroke
• Trigeminal neuralgia

When is a headache an emergency?

While most headaches are benign, sometimes a headache can be the only sign you’ll get of a serious condition. Go to the emergency room or call 911 if you notice any of these things about your headache:

• Causes severe pain in one eye along with redness in that eye
• Feels like the “worst ever” even if you get headaches regularly
• Gets worse over 24 hours
• Happens after a head injury
• Starts right after activities like weightlifting, jogging, aerobics or sex
• You have a history of cancer and notice a new headache

Other symptoms to take seriously are changes in vision, slurred speech, confusion, balance problems, memory loss, stiff neck, fever, nausea, vomiting, pain with chewing or a headache that starts suddenly.

Primary headaches & symptoms

Within the category of primary headaches, there are many different types. Each different type of headache has different symptoms and needs to be treated differently.

Migraine headaches

The pain associated with migraine headaches is often described as throbbing or pounding. Migraine attacks cause moderate to severe pain that:

• May last a few hours or a few days and usually happens from one to four times a month
• May include symptoms such as vomiting, nausea, dizziness, fatigue, light sensitivity or changes in vision
• Can be felt in the whole head or moves from one side to the other

Migraines also tend to run in families.

Migraine triggers

We don’t know what causes migraine headaches. You may notice that certain foods or ingredients tend to bring on migraines such as:

Migraines & aura

Migraines often include a symptom called an aura. Migraines with aura are more common than migraines without an aura.

A migraine aura happens before your headache starts and includes some sensory changes. Your hearing, speaking or vision may be affected, and you may notice weakness or tingling in your muscles at the same time.

Cluster headaches

Cluster headaches are extremely painful – painful enough to wake you up if one starts while you’re sleeping. The pain is described as an intense piercing or burning that:

• Is constant or throbbing
• Is located behind one eye or in the area of the eyes
• Occurs regularly, often at the same time of day or night
• Lasts minutes or hours, but may recur multiple times in one day

Men are more likely than women to have cluster headaches. Sometimes, cluster headaches go into remission (go away) for a long time. But they may come back later.

Tension headaches

Tension headaches come and go over time. They’re the most common type of headache among teenagers and adults. Tension headaches cause mild to moderate pain that usually begins gradually and may last only minutes or go on for days.

• Constant or dull pain
• May feel like tightness or pressure
• Can cause aches in your jaw or neck
• May affect both sides of your head
• May go around your head, feeling like a belt being tightened around it

Women are slightly more likely to have tension headaches than men.

What causes headaches?

We don’t really know what causes headaches. Blood vessels and muscles in the head appear to send pain signals to your brain. The cause of those signals isn’t clear.

Headache triggers

While we don’t know what causes headaches, several things seem to be related to the start of a headache. Here are some common signs of an oncoming headache or migraine attack:

Tracking your headaches

Keeping a record of your headaches may help you identify triggers that affect you. Having a record can also help your doctor diagnose your headache and choose effective treatments.

Keep track of the time of day, severity of pain on a scale from 1 to 10, description of the pain (e.g., pounding, burning, pressure), any triggers you noticed, and any medicine or other things that helped ease the pain.

Headache diagnosis

Your doctor will perform a complete physical examination and gather your health history – including your observations about your headaches. They may run some of the following tests to help diagnose your headache:

• Testing blood or urine to check for blood vessel damage, identify any infections or find toxins that may have affected your nervous system
• Testing your cerebrospinal fluid (fluid that surrounds your brain and spinal cord) to detect bleeding in your skull or infections, or to measure excess pressure in the skull
• CT or MRI to check if you have physical abnormalities that may contribute to your headache

Headache treatment options

Your doctor will recommend treatment based on your diagnosis. They may prescribe medication or recommend lifestyle changes for your headache care.

Make sure to tell your doctor about any other medical conditions you have. Conditions like depression, insomnia and anxiety can contribute to headaches, so it’s important for those conditions to be treated effectively.

Medications for headaches

Medications for headaches fall into three general categories: preventive, acute and rescue.

• Preventive medications are used to lessen the number of headaches and their severity. You may need to take them daily.
• Acute medications are used to stop a headache as quickly as possible.
• Rescue medications should be taken when your acute medication doesn’t work.

It’s important to keep all kinds of prescribed medication refilled. Acute and rescue medications need to be available as soon as you need them. Preventive medications need to be taken regularly in order to work. Making sure you have medications available lets you treat headaches early and aggressively.

Lifestyle changes for headaches

To help treat your headaches, you can try resting with your eyes closed and a cool cloth over your eyes or an ice pack on your forehead. Taking a nap can also help.

Make sure you drink enough water, particularly if you’ve been vomiting.

To prevent migraines or other types of headaches, we may recommend these lifestyle changes.

• Avoid anything that you know contributes to your headaches such as alcohol, certain foods or lack of sleep.
• Stick to a regular schedule for sleeping and eating. Try to eat, go to sleep and wake up at the same times each day.
• Reduce stress in your life.
• Practice relaxation techniques such as deep breathing or meditation.
• Try aromatherapy, biofeedback or other integrative medicine practices.
• Get enough exercise.