Catch some ZZZs. Feeling tired can trigger a migraine. Aim for 7 to 8 hours of rest each night.
Watch your diet. While caffeine can soothe your pain, stopping it suddenly is a common cause of migraine. Other common food triggers include MSG (monosodium glutamate), nitrates in cured meats like hot dogs, artificial sweeteners, and alcohol.
Manage your stress. Tension and worry are common triggers. Try to carve out a few minutes each day to do something you love, or learn to breathe deeply when you’re in the midst of a crisis. You might join a support group or talk to a counselor.
Have a meal plan. Fasting and skipping meals can trigger headaches. Try to eat around the same times each day.
Get moving. Exercise is a good way to ease your anxiety and stress. It can also help you get to, and stay at, a healthy weight. Since obesity raises your risk of chronic migraines, getting in shape is crucial.
Know your triggers. Not all migraines result from triggers. But if yours do, that set of triggers is unique to you. To learn what yours are, keep a headache diary. Each time you have an attack, write down details about what you were doing, how long the headache lasted, and how you felt before it started. This will help you begin to notice patterns — and avoid your triggers.
Be careful with your medicine. If you have chronic migraine, you’ll probably take preventive medications. If you get a headache anyway, you might be tempted to use what your doctor will call acute medicine. It’s designed to treat sudden attacks. But too much can lead to a problem called medication-overuse headache (MOH). The drug that’s supposed to stop headaches starts to cause them. You could wind up with a dull, constant pain every day.
To prevent this, try not to take any pain-relief drug more than two to three times a week or 10 times in the same month. If you think you’re having MOHs, talk to your doctor.
Don’t wait to seek help. If you can’t stop throwing up or you lose part of your sight during a migraine, call your doctor or get to a hospital as soon as possible. You should also get checked out if a headache lasts more than 72 hours or if you have any new symptoms that are frightening to you.
- Headaches in Adults
- Migraine Headaches
- What are the symptoms of a migraine?
- How prevalent are migraines?
- What triggers a migraine?
- How are migraines diagnosed?
- How are migraines treated?
- Headache: When to worry, what to do
- Cluster headaches
- Other types of headaches
- Headache testing
- Living with constant headaches
- Chronic Daily Headache
- Headache Triggers
- Sensitive Brain Cells
- Irregular Patterns
- Head Hormone
- Flashing Lights
- Lightning on the Brain
- Painful Perfumes
- Hunger Games
- Wine and Cheese
- Weird Air Pressure
Headaches in Adults
Multidisciplinary team takes new approach to headaches.
How common are headaches in adults?
Headache is one of the most common and debilitating pain conditions in the world. According to the World Health Organization, almost half of the adults in the world have had a headache in the past year. The World Health Organization also names headache the third leading cause of disability in the world and the number one cause of disability in individuals under the age of 50.
Headaches are a major cause of absenteeism from work and school. They also cause a heavy personal toll in terms of social life, family life, and anxiety and depression due to fear of the next headache. Headaches affect people of all races, ages, and geographical location.
What are the types of headaches?
A comprehensive headache classification guide was established by the International Headache Society and includes more than 150 headache categories.
Based on research, a practical headache classification divides headaches into two main categories primary and secondary headaches.
Primary headaches are those that are not the result of another medical condition. The category includes tension-type, migraine, and cluster headaches.
- Tension-type headaches are the most common type of headache. Tension-type headaches tend to be mild to moderate, non-throbbing, and occur on both sides of the head (bilateral). They usually do not get worse during routine activities (bending over, walking stairs, etc.) Because tension-type headaches tend to be mild, patients usually treat them successfully with over-the-counter medications. Patients should be aware that using over-the-counter medications too often can lead to long term (chronic) daily headache.
- Migraines are the second most common type of primary headaches. The exact cause of migraines is unknown, although they are caused by changes in the nerves and blood vessels. Migraines are also related to changes in the brain and inherited abnormalities in certain areas of the brain. Migraine pain is moderate to severe, often described as pounding or throbbing. Migraines can last from 4 hours to 3 days and usually occur less than 15 times per month. Migraine symptoms include sensitivity to light, noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain.
- Cluster headaches are the most severe, type of primary headache. The pain of a cluster headache is intense and has a burning or stabbing quality that is throbbing or constant. The pain is so severe that most patients with cluster headache cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term “cluster headache” refers to headaches that come in a group, or cluster. Cluster headaches occur one to eight times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into “remission”) for months or years, only to recur.
- New daily persistent headaches (NDPH) start abruptly as a headache that is new to the patient. The patient is able to pinpoint the brief period of time (within 72 hour) when the headache appeared. While these headaches may not be related to other diseases, they tend to be constant or persistent without any remission, located on both sides of the head (bilateral), and don’t respond to many medications.
Secondary headaches, or those that result from another medical or neurological condition, include sinus headaches, medication overuse headaches, or headaches that occur because of an infection, disease of the blood vessels in the brain, head injury, trauma, or more serious condition such as a tumor.
- Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually gets worse with sudden head movement or straining and occurs with other acute sinus symptoms, such as nasal discharge, foul taste in the mouth, a feeling of fullness in the ears, fever, facial swelling, and pain over the involved sinus.
- Medication overuse headaches occur as a result of the overuse of either readily available over-the-counter analgesics or prescribed painkillers such as opiates and sedative hypnotic tablets designed for headache management (butalbital-containing headache remedies). This is among the most common type of chronic headache seen in specialty headache centers and is referred to as a “transformed” headache. Tension-type or migraine headaches that recur can transform into a chronic headache from the inappropriate “overuse” of medications. These headaches can also happen without the overuse of analgesics. It is believed that 4 percent of the population worldwide has chronic daily headaches of some type, and a good percentage of this population includes headaches caused from medication overuse.
Are headaches hereditary?
Yes, headaches, especially migraines, have a tendency to run in families. Children who have migraines usually have at least one parent who also suffers from the condition. Headaches also can be triggered by certain environmental factors that are shared in a family’s household, such as:
- Second-hand tobacco smoke
- Strong odors from household chemicals or perfumes
- Exposure to certain allergens
- Eating certain foods
Stress, pollution, noise, lighting, and weather changes are other environmental factors that can trigger headaches for some people.
People with migraines may inherit abnormalities in certain areas of the brain, as well as the tendency to be affected by certain migraine triggers, such as fatigue, bright lights, weather changes, and others.
What causes headaches?
Headache pain results from signals interacting among the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels are activated and send pain signals to the brain. It’s not clear, however, why these signals are activated in the first place.
There is a migraine “pain center,” or generator, in the mid-brain area. A migraine begins when overactive nerve cells send out impulses to the blood vessels. This causes the release of prostaglandins, serotonin, and other substances that cause swelling of the blood vessels in the vicinity of the nerve endings, resulting in pain.
Headaches that occur suddenly (acute onset) are usually caused by an illness, infection, cold, or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat), or otitis (ear infection or inflammation).
In some cases, the headaches may be the result of a blow to the head (trauma) or, rarely, a sign of a more serious medical condition.
Common triggers of tension-type headaches or migraine headaches include:
- Emotional stress related to family and friends, work, or school
- Alcohol use
- Skipping meals
- Changes in sleep patterns
- Excessive medication use
Other causes of headaches include eye strain and neck or neck and back strain caused by poor posture.
When headaches become progressive and occur along with other neurological symptoms, they can be the sign of a disease process in the brain, such as:
- Hydrocephalus (abnormal buildup of fluid in the brain)
- Meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
- Encephalitis (infection/inflammation of the brain)
- Hemorrhage (bleeding within the brain)
- Blood clots along the surface of the brain
- Head trauma
- Toxins (overexposure to chemicals, including certain medications)
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What are the symptoms of a migraine?
Individual migraines are moderate to severe in intensity, often characterized by a throbbing or pounding feeling. Although they are frequently one-sided, they may occur anywhere on the head, neck and face — or all over. At their worst, they are typically associated with sensitivity to light, noise and/or smells. Nausea is one of the most common symptoms and it worsens with activity, which often results in patient disability. In many respects, migraines are much like alcohol-related hangovers.
Migraine pain can be felt in the face, where it may be mistaken for sinus headache — or in the neck, where it may be mistaken for arthritis or muscle spasm. Complicating the diagnosis of migraine is that the headaches may be accompanied by other “sinus like” symptoms, including watering eyes, nasal congestion and a sense of facial pressure. Most patients who think they have sinus headache in fact have migraines.
In up to 25 percent of patients, the migraine headache pain may be preceded by an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins. While the most common type of migraine aura involves visual disturbances (flashing lights, zigzags, blind spots), many people experience numbness, confusion, trouble speaking, vertigo (spinning dizziness) and other strokelike neurological symptoms. Some patients may experience auras without headaches.
How prevalent are migraines?
Migraines are about three times more common in women than men, and may affect more than 12 percent of the U.S. adult population. Migraines often run in families, and can start as early as elementary school but most often in early adulthood. They often fade away later in life, but can strike at any time. The most common cause of recurring, disabling headache pain, migraines are also the most common underlying cause of disabling chronic, daily headache pain. While migraines are the No. 1 reason that patients see a neurologist, most cases are handled by primary care physicians.
What triggers a migraine?
Things that can make the headaches more likely to occur include:
Lack of sleep
Teeth grinding at night
How are migraines diagnosed?
Despite their dramatic symptoms, migraines are almost never due to an underlying problem that will show up on any testing, even on brain MRIs. Many experts do not recommend brain imaging at all, even in severe cases, as long as the patient’s symptoms are typical for migraines and a thorough neurological examination is normal.
There are extremely rare families that have migraines as a result of a single genetic mutation in one of four known genes that can lead to the condition called familial hemiplegic migraine. There are no genetic tests for the vast majority of patients. Because the condition cannot be diagnosed by scan or blood test, the diagnosis is “clinical” — made by an experienced physician.
How are migraines treated?
Migraines that are severe, frequent or accompanied by neurological symptoms are best treated preventively, usually with a combination of dietary modification, lifestyle changes, vitamins and daily prescription medications. Most of our best preventive medications are often used for other medical purposes as well; the majority are blood pressure drugs, antidepressants or epilepsy medications. Individual headache attacks are best treated early, often with one or more of the following types of medications: triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), anti-emetics (anti-nausea), and sometimes narcotics or steroids.
Migraines typically last a few hours to a couple of days and respond well to specific treatments. However, in some patients, the migraine is particularly severe and long-lasting — and may even become chronic, occurring continuously for weeks, months or even years. If improperly managed or left untreated, intermittent migraines may essentially transform into a chronic daily headache, with continuous and smoldering symptoms that periodically erupt into a “full-blown” migraine. This condition is extremely difficult to treat.
Other patients may develop increasingly frequent headaches as a result of overusing their short-acting headache medications. See medication overuse headache. While they are considered primary headaches, meaning they have no known underlying cause, migraines are associated with an increased risk of stroke, brain scarring as seen on MRI scans, a heart defect called a patent foramen ovale (PFO) and other medical conditions.
At the Johns Hopkins Headache Center, located at the Johns Hopkins Bayview Medical center, we have expert physical therapists, nutritionists and psychologists who work closely with our neurologists to help manage patients with frequent migraines. Biofeedback and relaxation techniques are available to complement our standard medical treatments.
Headache: When to worry, what to do
Cluster headaches are uncommon but very severe headaches, and they occur five times more often in men than women. Although anyone can get cluster headaches, the typical patient is a middle-aged man with a history of smoking.
The problem gets its name because the headaches tend to come in clusters, with one to eight headaches a day during a one- to three-month period every year or two, often at the same time of year. The pain always strikes one side of the head and is very severe. The eye on the painful side is red and watery, the eyelid may droop, and the nose runs or is blocked. The attack starts abruptly and lasts for 30 to 60 minutes. Most sufferers become restless and agitated during the attack; unable to sit still, they pace, jog in place, or beat their head against a wall. Nausea and sensitivity to light and sound may accompany the pain.
Inhaling high flow oxygen soon after the onset of the headache can often stop the attack. Sumatriptan is often effective for cluster headaches, particularly when given by injection. Other triptans may also help. Some patients favor lidocaine nose drops, dihydroergotamine injections, or other treatments. The most effective medication for preventing cluster headache attacks is verapamil, a calcium-channel blocker. Other drugs that may help include divalproex, topiramate, and lithium.
Other types of headaches
Doctors have diagnosed hundreds of conditions associated with headaches. Here are just a few:
Medication headaches. Many drugs number headaches among their side effects. And although it seems paradoxical, many medications used to treat headaches can also cause medication overuse headaches or rebound headaches. Migraine sufferers are particularly vulnerable to a vicious cycle of pain leading to more medication, which triggers more pain. If you have frequent headaches and use medication, OTC or prescription, or both, for more than 10 to 15 days a month, you may have medication overuse headaches. The way to find out is to discontinue or taper your medication — but always consult your doctor first. A corticosteroid such as prednisone may help control pain during the withdrawal period.
Sinus headaches. Acute sinusitis causes pain over the forehead, around the nose and eyes, over the cheeks, or in the upper teeth. Stooping forward increases the pain. Thick nasal discharge, congestion, and fever pinpoint the problem to the sinuses. When the acute infection resolves, the pain disappears. Sinusitis is not a common cause of chronic or recurrent headaches.
Ice cream headaches. Some people develop sharp, sudden headache pain when they eat anything cold. The pain is over in less than a minute, even if you keep eating. If you are bothered by ice cream headaches, try eating slowly and warming the cold food at the front of your mouth before you swallow it.
Headache from high blood pressure. Except in cases of very high blood pressure, hypertension does not cause headaches. In fact, most people with high blood pressure don’t have any symptoms at all, and a study of 51,234 people reported that hypertension was associated with a reduced incidence of headaches. But that’s no reason to neglect your blood pressure. Hypertension leads to strokes, heart attacks, heart failure, and kidney disease, so all men should have their pressure checked, and then take steps to correct abnormalities.
Headache from exercise and sex. Sudden, strenuous exercise can bring on a headache. Gradual warm-ups or treatment with an anti-inflammatory medication before exercise can help. Sexual intercourse may also trigger headaches; some men note only dull pain, but others suffer from severe attacks called orgasmic headaches. Some people can prevent orgasmic headaches by taking an NSAID 30 to 60 minutes before intercourse.
Modern medicine depends on tests to diagnose many problems. For most headaches, though, a good old-fashioned history and physical will do the job. In fact, CT scans, MRIs, and EEGs (brain wave tests) look normal in tension-type headaches, migraines, and cluster headaches. Still, these tests can be vital in patients with warning signs or other worrisome headaches.
Living with constant headaches
For most of us, an occasional headache is nothing more than a temporary speed bump in the course of a busy day. Even so, most men can ease the problem with simple lifestyle measures and nonprescription medications. Relaxation techniques, biofeedback, yoga, and acupuncture may also help. But for some of us, headaches are a big problem. Learn to recognize warning signs that call for prompt medical care. Work with your doctor to develop a program to prevent and treat migraines and other serious headaches. And don’t fall into the trap of overusing medications; for some gents, rebound headaches are the biggest pain of all.
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Chronic Daily Headache
A patient who has headaches as many days as not — at least 15 days per month — is said to have chronic daily headache (CDH). Not a specific type of headache, CDH is rather a descriptive term applied to any number of headache types. Headaches that can occur on a daily or near daily basis include:
- Hemicrania continua
- Idiopathic intracranial hypotension
- Mixture of types (most commonly migraine and tension)
While tension-type headaches are the most common CDH, they are relatively mild and tolerable. The majority of CDH cases fall into one of two categories, both related to migraine.
Medication overuse headache (rebound) is a CDH caused by the patient’s use of pain relievers. While the condition is frustrating and disabling, it is potentially curable.
An extremely difficult to treat — and all too common — type of CDH is a transformed migraine. This is a migraine that over time becomes more and more frequent, blurring together until there is a 24-hour-a-day continuous background headache with occasional superimposed, more severe migraine symptoms. A transformed migraine headache acts more like a chronic pain syndrome than a migraine in terms of its poor response to typical migraine drugs. Some researchers believe that years of chronic, frequent migraines can cause permanent scarring or other changes in the brain, creating this type of intractable CDH that may not be curable. While there is not a “magic bullet” for such cases, many patients can be effectively managed with a variety of treatments to substantially reduce pain and disability.
Because out of control migraines can transform into a CDH that is difficult to treat, it is very important to establish a good preventive regimen as early in life as possible.
Over 90 percent of patients with CDH have coexisting psychiatric problems, most often anxiety or depression (or both). This makes an already challenging condition even harder to treat. In general, such patients will not improve without some sort of coexisting psychiatric care, counseling, biofeedback or the like. Unfortunately, few patients choose to undergo this necessary step toward improving their condition and reducing their disability.
No one knows exactly what causes migraines, but when the painful attacks happen, those afflicted must pull down the blinds, cover their heads and wait for the pounding to pass. Some people see flashing lights and get nauseated, while others only get a throbbing head pain.
But while the roots of the disease are mysterious, there’s no shortage of factors that can cause the painful headaches. From red wine and sex to lightning, here are 10 surprising triggers for migraines.
Sensitive Brain Cells
(Image credit: ktsdesign | )
Despite how common they are, scientists don’t fully understand what actually happens during migraine headaches. But one theory holds that the brains of migraineurs are fundamentally more sensitive than those of other people, said Frederick Freitag, the director of the headache clinic at the Baylor University Medical Center in Texas. When people get a migraine, over-excitable brain cells may trigger an electrical wave that spreads across the brain. This wave seems to trigger the release of prostaglandins and serotonin and dilated blood vessels — all of which can cause a killer headache.
(Image credit: stockxpert)
While many people identify triggers, such as certain cheeses, red wines or hunger, that seem to set off the throbbing pain, it’s tricky to figure out because headache frequency is so variable and can by caused by multiple triggers interacting, Freitag said. So while that throbbing head pain may be caused by the glass of Merlot with dinner, it’s also possible that other factors play a role as well.
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Many migraine sufferers are women, and that’s no surprise: Hormonal shifts may play a role in triggering migraines. A 2012 study in the Journal of Headache and Pain found that nearly half of women who suffered from migraines were likely to experience the pounding pain during their periods. But while hormones may be the cause, they could also be a cure: Another study found that the love hormone oxytocin may reduce headache frequency.
(Image credit: Mike Theiss / National Geographic)
Nearly 85 percent of migraine sufferers say they are extremely sensitive to bright or flashing light during their attacks. But a recent study found that trigger wasn’t as strong as suspected: When patients were subjected to flashing lights, they had a small uptick in headache frequency, but not enough to prove the lights reliably triggered the headaches.
Lightning on the Brain
(Image credit: Thechemicalengineer, via aCreative Commons license.)
Another kind of flashing light may also trigger a pounding head — the lightning from a thunderstorm. A 2012 study published in the journal Cephalagia found that patients were about 28 percent more likely to suffer migraines on days when lightning struck near their homes. Though it’s not clear how exactly the lightning strikes could cause throbbing headaches, one possibility is that changes in the charge in the air could disrupt the brain’s electrical waves.
(Image credit: stockxpert.com)
While that Chanel No. 5 may smell sexy to some, for migraine sufferers, it can be a ticket to a day spent in bed. A 2011 study in Cephalalgia found that many patients say perfumes and other strong odors reliably triggered attacks.
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While going without that pretzel roll may sound like a good idea, many people say that hunger causes their migraines. A 2005 Cephalalgia study found that hunger was often tied to migraines, especially migraines with aura, or flashing lights. By contrast, going without food didn’t reliably cause the everyday tension headaches that most people have occasionally.
Wine and Cheese
(Image credit: Creative Commons Attribution-Share Alike 3.0 Unported | Arnaud 25)
A romantic dinner with wine, chocolate and cheese can be a minefield for a migraine sufferer. Many patients report that certain foods trigger splitting headaches. But while food-based triggers are common, with red wine, chocolate and cheese being the most frequent culprits, experts haven’t figured out which chemicals are actually responsible, according to a 2012 study in the journal Neurological Sciences.
Weird Air Pressure
Lightning isn’t the only weather-related phenomenon that can cause a throbbing headache. Past studies have shown that rapid changes in barometric pressure can change the charge concentration in the air and in turn flood the brain with serotonin, Freitag said. That serotonin release could cause head pain.
(Image credit: Stressed worker image via )
What doesn’t cause migraines? Among the most commonly cited triggers, simply being stressed can spur the flashing lights and head pain of a migraine, several studies suggest. In a 2012 study in the Journal of Health Psychology, personal stress was listed as the most common cause of migraine pain.