Headaches: Relieving and preventing migraine and other headaches

By Harvard Health Publications
Content provided by the Faculty of the Harvard Medical School
Excerpted from a Harvard Special Health Report

Dear Reader,

Headaches are familiar to nearly everyone: in any given year, almost 90% of men and 95% of women have at least one. In the vast majority of cases, however, the pain isn't an omen of some terrible disease but instead a response to the realities of life: stress, fatigue, exposure to allergens, and lack of sleep. Of course, that doesn't make your headaches any less painful. The most severe forms — namely, migraine and cluster headaches — can be particularly vexing. But many effective strategies can relieve and even prevent headaches. Over-the-counter pain relievers, such as aspirin, acetaminophen, ibuprofen, ketoprofen, and naproxen sodium, often provide relief for occasional headaches, especially when combined with rest and a bite to eat. If this approach doesn't alleviate the pain, prescription medications are available.

This report offers in-depth information on the most common kinds of headaches and the treatment strategies that work best for each. For example, certain muscle relaxants ease pain while addressing the underlying mechanism of tension headache, while triptans can stop migraine headaches before they progress. And thanks to a broader understanding of the underlying causes of migraine pain, we now have a number of novel drugs in development for quelling these intense headaches.

This report covers the spectrum of headache-management techniques, including preventive strategies that may involve stress management, physical therapy, and exercise in tandem with medications. Another aspect of prevention is learning to recognize and change things that may trigger your headaches — for example, reducing emotional stress, changing your diet, or getting enough sleep. Advances in the medical management of headache mean that relief is no longer just possible, but probable. Although some form of head pain will occasionally visit most people, no one should have to live with headaches.

Sincerely,

Egilius L.H. Spierings, M.D., Ph.D. Medical Editor

Headache basics

Despite the fact that headaches are extremely common, doctors don't fully understand exactly why they occur. Neither the skull nor the brain is sensitive to pain, but both are surrounded by pain-sensitive membranes. Abnormalities in these membranes or nearby muscles, blood vessels, or nerves — either alone or in combination — are thought to be the source of most headache pain. Hormones such as estrogen can make headaches worse. This is why women, who undergo hormonal fluctuations as part of their monthly menstrual cycle, are twice as likely as men to experience moderate and severe headaches and more likely to experience certain types of headaches, such as migraine.

What type of headache do you have?

About 95% of headaches aren't caused by an underlying disease or structural abnormality. Instead, their origins lie in such common conditions as stress, fatigue, lack of sleep, hunger, changes in estrogen level, weather changes, or caffeine withdrawal.

The three most common types of headache are tension, sinus, and migraine. Table 1 offers brief descriptions of these, and each is discussed in greater detail later in this report (see the sections "Tension headache," "Sinus headache," and "Migraine headache"). Headache that occurs daily or almost daily is also addressed (see "Chronic daily headache"), as well as a rare but very painful type of headache known as cluster headache.

Table 1: Common types of headaches

Type

What it feels like

Who gets it

How often and for how long

Tension

Mild to moderate steady pain throughout the head, but commonly felt across the forehead or in the back of the head. Generally not accompanied by other symptoms.

Can affect children, but is most common in adults.

Frequency varies. Generally hours in length.

Sinus

Mild to moderate steady pain that typically occurs in the face, at the bridge of the nose, or in the cheeks. May be accompanied by nasal congestion and postnasal drip.

Affects people of all ages. People with allergies seem most vulnerable.

Frequency varies. Generally hours in length. Often seasonal.

Migraine

Moderate to severe throbbing pain, often accompanied by nausea and sensitivity to light and sound. The pain may be localized to the temple, eye, or back of the head, often on one side only. In migraine with aura, visual disturbance precedes the pain.

Typically occurs from childhood to middle age. In children, migraine is slightly more common among males, but after puberty, it's much more common in females.

Attacks last a day or longer. They tend to occur less often during pregnancy and with advancing age.


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Migraines always strike with little warning.