The Medical Minute: The many causes of headaches

June 11, 2003

By John Messmer, M.D.
Penn State Milton S. Hershey Medical Center

Headaches have been around for a long time. Ancient Sumerian poetry from 3000 BC makes reference to headaches. However, centuries of expressing our concerns and feelings about the discomfort and causes of headaches hasn't served to eliminate misconceptions about them. For example, while headaches range from mild to severe and constant to intermittent, bad headaches are often incorrectly called migraines. A common fear for individuals who experience a new headache is that it may be caused by a brain tumor. Well, not all headaches are migraines -- the International Headache Society lists 20 different types of headache -- and only a very small percentage of new headaches are symptomatic of a brain tumor.

Migraine headaches tend to run in families. One in four Americans suffers from migraines, two-thirds of which are women. Research has improved our understanding and treatment of migraine pain which is fortunate as migraines cost U.S. companies and workers $13 billion annually in lost wages and productivity. Migraines seem to originate from a group of nerve cells in the base of the brain in susceptible people. Stress, hormones, foods, alcohol, lack of sleep, light, anxiety and motion can trigger migraines but they can occur for no apparent reason. The typical migraine develops on one side of the head, throbs, and is associated with nausea. Occasionally visual changes such as flashing lights or blurring occurs before the headache develops. Most times light and sound make the pain worse. Untreated migraines last from a few hours to most of a day, sometimes longer. With current therapies, treatment can result in little or no lost time from work or school.

Tension-type headaches
"Tension" or muscle contraction headaches are the most common type of headache occurring in 70 percent of men and 90 percent of women and were once thought to be due to tight muscles in the neck and head. Current research shows a more complicated explanation involving sensory nerves and brain chemistry. The term "tension-type headache" is now used to reflect the more complicated cause. Tension-type headaches can last from minutes to days. The muscles in the area of the pain are often tight and tender, but the person does not usually have nausea, throbbing or light and sound sensitivity. Stress can be a significant contributing factor, but tension-type headaches can arise from fatigue, poor sleep, illness, anxiety or depression. Tension-type headaches can be located in the neck, the back of the head, one or both sides of the head and the face. Usually these headaches come and go, but about 3 percent of the population has daily tension-type headaches.

Brain tumors are scary, but not a common cause of headaches. A headache caused by a brain tumor is more common in people who already have a history of headaches but it is usually more severe and constant. New onset headaches or a significant change in pattern should raise suspicion particularly in a person with a new neurologic finding or a prior history of cancer that can spread to the brain.

Bleeding in the brain typically causes a sudden onset headache, very severe and often described as "the worst headache of my life." Neck stiffness often occurs along with some degree of confusion and often symptoms such as weakness. In many cases, bleeding is from an aneurysm which is bulging of a weak area of a brain artery.

Cluster headaches occur in less than one percent of the population and are six times more common in men. Family history is rare. The name comes from the pattern of multiple, severe, disabling and intense headaches around the eye that come for several days often at change of season then go away for months or years at a time. They usually last less than two hours but can occur multiple times in a day. Clusters also cause one of several other signs such as, tearing, nasal congestion, eye redness, eyelid weakness, sweating and runny nose.

Neuralgia is another type of headache pain arising from the large nerves of the face and the neck. Trigeminal neuralgia causes severe facial pain triggered by touch, cold, eating and other stimuli. Cervical neuralgia stems from the spinal nerves in the neck and cause shooting pain up over the back of the head.

The jaw or temporomandibular joint has been associated with headaches as have sinus infections. Older people can have headaches from temporal arteritis, an inflammatory condition of one of the arteries in the scalp which can lead to blindness. Other causes of recurring headache include cough or exertion, intercourse, trauma, bony abnormalities, inflammation or tearing of the carotid artery and more.

Honestly, there are enough causes of headache to require a medical education to sort them out. What the Ancient Sumerians probably didn't know is that all that writing about headaches can actually prove useful. If you are having headaches, you can help your doctor determine the type and best treatment by keeping a headache diary. Note when you get headaches, how long they last, whether or not there are other symptoms, whether they are in one or more locations, whether they are associated with menstrual cycles, fatigue, alcohol or certain foods.

To reduce the likelihood of chronic headaches, be sure to eat balanced meals at regular intervals, maintain regular sleeping and waking patterns, and get regular exercise. If you seek a physician's care and treatment, keep the scheduled appointments and understand why medication is prescribed, taking it exactly as directed. As always avoid using someone else's medication which in the case of headache treatments can be particularly dangerous. If your headache pattern changes suddenly or you develop a new or severe headache, see your doctor.

Detailed headache information is available at http://www.ninds.nih.gov/health_and_medical/disorders/headache.htm and http://ahsnet.org/resources/headachefacts.php

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Last Updated March 20, 2009