Headache – Causes, Symptoms, Diagnosis & Treatment

Headache – Causes, Symptoms, Diagnosis & Treatment

Headache is defined as the pain arising from the head or upper neck of the body. It involves inflammation or irritation of the muscles and bones that surround the skull, eyes, and ears, sinuses as well as thin tissues that cover the brain and spinal cord including arteries, veins, and nerves. It is one of the most common sites of pain in the body. The tissues and structures that surround the skull may result in a headache when they are irritated or inflamed. The range of pain may vary from a dull ache, sharp, throbbing, constant, intermittent, mild, or an intense headache.

A headache may be associated with exercise or activity or may arise spontaneously. It may be chronic with or without severity and may range from acute to chronic.

The International Headache Society, London released a classification for headaches in the year 2013. This classification enables the physicians to have specific causes and diagnosis of a headache and allows effective options for treatment. The guidelines suggest that those patients who have a persistent headache may have more than one type of headache at a time. The guidelines are extensive, and the physicians must consult these guidelines before they make a specific diagnosis for better classification of headaches.

Headaches are Classified into Three Types

  • A primary headache (tension, migraine and cluster headaches)
  • A secondary headache
  • Cranial neuralgias (facial pain and other headaches like a rebound headache).

Primary Headaches

Primary headaches can be treated with over-the-counter (OTC) medications used for pain and include rest. Cluster headaches, migraine, and tension are common primary headaches. Migraine headaches are often associated with nausea and vomiting.

Secondary Headaches

Secondary headaches usually have an underlying illness associated with them such as sinus headaches that occur when the pressure or infection in the sinuses increases. A migraine is a form of a headache that has a throbbing pain and typically occurs on one side of the head. It is often triggered by stress, hormones, sound, environment, and many other factors. Women are more commonly affected than men.

If a headache persists for a prolonged time and is associated with symptoms like neck stiffness, fever, vomiting, changes in vision, change in sensations on one side of the body it may be due to the development of serious infections.

Rebound Headaches

Rebound headaches are headaches that occur due to medication overuse. It occurs when frequent use of pain medications lead to persistent headache. The pain improves after taking medication for a short duration and may recur again.


A headache can be caused by many factors such as the following

  • Irritation or inflammation of structures present in the skull (including structures that surround the brain) and affects the function of brain,
  • Changes in the blood flow or circulation of blood due to nasal trauma,
  • Dehydration and systemic illness including infections,
  • Medication reactions and changes in the chemistry of brain activity,
  • Drug withdrawal and drug abuse,
  • Environmental factors such as exposure to strong odors from household chemicals or perfumes,
  • Exposure to certain allergens,
  • Severe physical activity,
  • Hormonal changes,
  • Lack of sleep or disturbed sleep,
  • Other factors include stress, women having menopause or menstrual period and, food habits.
  1. Tension headaches are the most common type among primary headaches, and the cause is usually unknown. It is presumed that they may be caused by various factors that cause inflammation or irritation of the structures present in the head and upper part of the neck. The most common sites of tension headaches are the forehead, the temples (muscles that move the jaw are located in this area), the area where the trapezius muscle of the neck gets inserted at the base of the skull. Physical stress (manual labor and sitting at a computer or desk for a prolonged time) and emotional stress can also cause this type of headache.
  2. Cluster headaches are usually caused by sudden release of the chemicals (serotonin and histamine). They occur frequently followed by long periods of time or may occur daily (periods of a week).
  3. Secondary headaches are often caused by underlying structural disease or infections. They may be life-threatening and must be diagnosed and treated effectively. Diagnostic testing can be done to identify the cause of underlying diseases. The other causes include:
    1. Trauma of the head and neck may cause edema and swell in the brain (without bleeding) may cause pain, bleeding inside the spaces in the brain (between the meninges), concussions without bleeding due to head injury, post-concussion headache and, pain due to a neck injury and whiplash injury.
    2. Systemic infections like pneumonia or influenza and, encephalitis, meningitis and HIV/AIDS.
    3. Problems in blood circulation (arterio-venous malformations) and head and neck injuries causing TIA (Transient ischemic attack) or stroke. Inflammation of the carotid and temporal arteries, aneurysm (a weakened area in the blood vessel causing bleeding) can also cause headaches.
    4. Seizures, brain tumor (cancers), hypertension (high BP) can also cause a significant headache.
    5. Medications that are used to treat cardiac problems, hypertension and drugs that are used in the treatment of erectile dysfunction, oral contraceptives can all lead to a headache. Pain medications, narcotics and some analgesics like ibuprofen and aspirin, can cause a headache.
    6. Infections of the teeth, nose, and eyes such as sinusitis, iritis, glaucoma and dental pain.
    7. Underlying diseases like hypothyroidism, dehydration, high blood pressure (hypertension) and, in kidney failure patients.
  4. Rebound headache: The headache medications that usually cause rebound headache are painkillers, combination pain relievers, migraine medications and opiates. If the recommended daily doses are exceeded, aspirin and acetaminophen may contribute to rebound headaches. The common culprits are pain relievers that combine aspirin, caffeine, and acetaminophen. High risk is seen in Butalbital-containing compound. Triptans (sumatriptan) and certain ergots such as ergotamine used in the treatment of migraine often cause this type of headache. Painkillers derived from synthetic opium compounds include combinations of codeine and acetaminophen, and they can also cause this type of a headache.

You should seek the advice of your physician if you have the following symptoms:

  • If a headache is aggravated by coughing, bending over, exertion or sexual activity,
  • If it is associated with fever and neck stiffness, with vomiting or nausea, with seizures and changes in speech and changes in behavior,
  • If it is related to any recent trauma or injury,
  • If it is persistent and affect the quality of life,
  • If a headache is worsened even with the use of medications.

Tension Headaches

The common signs and symptoms are

  • Pain associated with band-like tightness or pressure and may encircle the head. The pressure is felt at the temples and all over the forehead. Bilateral pain (pain on both the sides) is usually seen.
  • Nausea and vomiting are not seen in this type and is not aggravated by sound and light.
  • The quality of life is not affected much and the patient can follow normal daily routine.

Cluster Headaches

  • The pain comes in groups (as clusters) separated by pain-free periods. The pain can last from months to years and no headache is seen for a few months to years. They often wake the patient in the middle of the night,
  • Each episode of the pain may last from 30-90 seconds. It is excruciating pain and usually occurs behind or around the eyes. The nose on the affected side may become runny or congested and eyes may be watery, swollen or inflamed.
  • They may be hereditary and may be triggered by sleep pattern changes, medications such as nitroglycerin, alcohol consumption, cigarette smoking and, some foods like smoked meats and chocolate.
  • According to a study done in the midst of a cluster headache, brain scans were performed on patients and, abnormal activity was observed in the hypothalamus.
  • These patients must regularly be counseled as they might develop suicidal tendencies (due to excruciating and throbbing pain).

Rebound Headaches

They wake the patient during sleep in the early hours. A such headache occurs almost every day. They can be relieved by painkillers, but the headache rebounds as the medication wear off. The common signs and symptoms seen are:

  • Nausea
  • Restlessness
  • Irritability
  • Difficulty in concentration
  • Memory problems
Risk factors

The common risk factors of a headache are:

  1. Tension headaches: These risk factors are caused by the tightening of muscles in the neck like teeth clenching and grinding, anxiety, depression, gum chewing in children, spondylosis or arthritis in the neck and overweight. Emotional stress, anger, fatigue, smoking, little physical activity and, disturbed sleep are other risk factors.
  2. Migraine: Loud or sudden noises, disturbed sleep, emotional events, skipping meals, excessive alcohol use, and hangovers. Food products such as aged cheeses, fermented or pickled foods, chocolate, and processed foods. Other risk factors include medications like birth control pills, changes during menstruation, glaring lights, perfumes, and odors.
  3. Cluster Headaches: The major risk factor is smoking as this type is often seen in smokers. Another risk factor is a head injury.
  4. Sinus Headache: In these headaches, major risk factors include allergies, persistent ear and nose infections, nasal deformations, nasal polyps, deviated nasal septum, previous sinus surgeries and a weakened immune system.

The diagnosis of a headache is often made by the history given by the patient. Your physician may ask you questions regarding the

Duration and, quality of pain,

Whether it is accompanied by nausea or vomiting and

Location of the pain (Other associated symptoms)

  1. Tension headaches: The diagnosis of a tension headache is done when the patient’s complaints of pain that is mild-to-moderate, worsens with activity and located on both the sides of the head. The pain usually tightness in the head (non-throbbing in nature) and, not associated with symptoms like light sensitivity, vomiting/nausea.
    1. Neurological examination is usually done and the results are often normal.
    2. When pressure is applied to the scalp or neck muscles, some tenderness may be observed.
  2. Cluster headaches: The diagnosis is done by the patient’s history and the description of episodes of pain. During the attack of this headache, redness and swelling of an eye on the affected side can be observed. The nose on the affected side may be runny or congested.
  3. Secondary headaches: The diagnosis is done on the basis of the patient’s history followed by physical examination.  Laboratory and radiology tests can also be done. If a headache is caused due to the underlying infections or diseases, then your doctor may decide to start the treatment even before the diagnosis is confirmed.

Laboratory Investigations Include

  • CBC (Blood Tests): Rise in the white blood cell count, the erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP) is seen when infection or inflammation in the body is observed.
  • Toxicology Tests:  It may be helpful in the patients suspected of abusing alcohol, other drugs of abuse or prescription drugs.
  • CT Scan (computerized tomography): Used to detect swelling, bleeding and, some tumors within the skull and brain and also aneurysms.
  • MRI (magnetic resonance imaging) of the head (shows the anatomy of the brain and the layers that cover the brain and the spinal cord) and,
  • Lumbar Puncture (spinal tap is done in cases suspected of meningitis).
  • EEG is helpful only if the patient passes out during a headache.

Physical Therapy

Tension Headaches

Stress management can also be used to treat tension headaches.

Over-the-counter medications are to be used with precaution and are advised to be taken only when your physician prescribes the medications. Some over the counter medications have side effects. Aspirin increases the risk of Reye’s syndrome and should not be used in teenagers and children. Kidney damage can be caused by overuse of aspirin, ibuprofen, and naproxen. If acetaminophen is taken in large doses, it can cause liver damage or failure.

When painkillers are used for a prolonged period, headache may recur when the medication wears off. This type of headache was referred to as a “rebound headache,” and is classified as a secondary headache.

Cluster headaches

The treatment of a cluster headache is aimed at controlling the pain of a headache and preventing the episodes of a headache that follows them. They do not have a definite protocol for the treatment and your physician may suggest many treatment options before a specific treatment is confirmed.

Other Treatment Options to Treat Headache
  • High concentrations of oxygen are inhaled,
  • Spraying of a local anesthetic (lidocaine) into the nostril,
  • Using medications like dihydroergotamine (medication that causes constriction of blood vessels)
  • Injection of sumatriptan and rizatriptan (triptan medications) that are used commonly in a migraine and,
  • Drugs that contain caffeine,
  • Drugs such as calcium channel blockers, prednisone, lithium and anti-seizure medications (valproic acid and topiramate) can prevent cluster headaches.
Home Remedies

They can also be used in the treatment of a headache.

Staying well hydrated and getting good sleep is helpful in tension headaches.

Rubbing or massaging the muscles of the back and temples may relieve a headache.

Humidifying air may be helpful (in sinus problems).


It includes identifying the triggering factors and duration of your headache. Additional causes like eating certain foods, having caffeine, not having proper meals at regular times and, stress patterns have to be identified to treat a headache.

Stress Management

The cause of stress that triggers a headache has to be identified and treated accordingly. Deep breathing exercises, progressive muscle relaxation and relaxation to music can relieve stress and headache.


Coping techniques such as group therapy, one on one sessions and counseling can be taken to identify the risk factors causing headache.


It is the equipment that includes sensors connected to your body. The equipment examines the involuntary physical response (physical reaction of the body in stressful conditions that triggers headache) to headaches such as breathing, heart rate, pulse, brain activity and muscle tension.


A Headache can be prevented by taking certain precautions like

  • Avoid triggering factors like severe physical activity, stress, certain foods (smoked meat).
  • Take prescribed medications at the right time (Do not overuse the medications and do not take less than the prescribed dosage)
  • Cluster headaches cannot be prevented but can be minimized by lifestyle changes such as avoiding alcohol and smoking.
  • Exercise regularly (can reduce stress and pain)
  • Maintain good sleeping habits (a regular sleep pattern is important for reducing the risk of a headache).
  • Quit smoking and lose weight to reduce the risk of a headache.
  • Consult your physician if there is a change in the pattern of your headache.
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