When a headache comes on, sometimes you can just pop a pill and the pain goes away—end of story. But not all headaches quit that easily. If you’ve had a few that made you nauseous and foggy-brained, you might automatically assume that you have migraines. If you’re congested, you might assume sinus headache. But the truth is that it’s easy to misdiagnose the type of headache you’re having. This guide will better help you interpret what you’re feeling so you can take the right action.
THE GARDEN-VARIETY HEADACHE
A tension-type headache (TTH) is the most common headache, and more so among women than men. Typically, the pain is mild to moderate, feels like a tightness or vicelike sensation and affects your whole head—not just one side. This type of headache can last from 30 minutes to, quite surprisingly, a week. You might experience one only occasionally…or chronically—on 15 or more days a month!
While it’s possible to experience nausea on occasion with a TTH, this type of headache typically doesn’t interfere with ordinary activities—you can still go about your day, work, eat and even exercise. Still, easing the stress that often starts the chain reaction resulting in a headache can help you overcome it. And if you do need a pain reliever, acetaminophen or an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) should do the job.
MIGRAINE: THE HEADACHE MISNOMER
A migraine isn’t just a headache—it’s a disabling neurological disorder with a strong genetic component, and it interferes with your daily routine and your ability to concentrate. By definition, a migraine must last from four to 72 hours and have two of the following four pain characteristics—throbbing pain, moderate-to-severe intensity, pain on one side of the head and/or pain that gets worse with routine physical activity. It also must have at least one of these features—nausea (or vomiting) or sensitivity to light and sensitivity to sound.
So, for example, if you have a moderate headache that gets worse when you take a walk and find that it hurts to be in a brightly lit room, you meet the migraine criteria. About 25% to 30% of migraine sufferers also experience aura, a type of visual disturbance that precedes the actual pain.
The brains of people genetically predisposed to migraine are highly sensitive to stimuli. When you add in a trigger, such as a particular food, stress or a change in the weather, it seems to push the brain over the edge, leading to a migraine. Food triggers are very individual and include aged cheese, red wine, sugary processed foods, MSG and chocolate, among others. Dehydration or a change in barometric pressure, such as in the cabin of a jet, can set off a migraine. For women, the drop in estrogen right at the start of menstruation is a common trigger. (Three times as many women as men get migraines.) Note: About two-thirds of women whose migraines are related to their menstrual cycle see an improvement after menopause, but it’s also not unusual for a woman to get her first migraine after menopause.
Keeping a headache diary to track episodes and symptoms can help you pinpoint specific triggers to avoid. However, that alone may not be enough to prevent migraines.
There are abortive medications to reduce a current migraine and preventive ones to reduce headache frequency and severity. Depending on how often you get migraines and how disabling they are, you may need both. Until recently, drugs prescribed to prevent migraines had all been medications developed to treat other conditions. Then in 2018, the first migraine-specific drugs were introduced. They target a protein called calcitonin gene-related peptide (CGRP), which has been implicated in causing migraines.
But you can do a lot more than take medicine, starting with your posture. Next is engaging in regular, moderate aerobic exercise, such as a brisk 20-minute walk or cycling on a stationary bike. A healthy, protein-based diet that keeps your blood sugar steady, a regular schedule for eating and sleeping (going to bed and rising at set times) and stress-reduction techniques, such as meditation and biofeedback, all can help. Daily supplements, including magnesium, vitamin B-2 and CoQ10, have also been shown to reduce the frequency and severity of migraines.
PAINFUL YET RARE HEADACHES
Trigeminal autonomic cephalgias (TACs) represent a small group of distinct headaches. Best known among them are cluster headaches, so named because they come in clusters—say, three a day for two months—and then stop, often returning at the same time the following year. They cause excruciating pain, always on one side of the head, and can last anywhere from 15 minutes to three hours.
Notably, TAC headaches are accompanied by physical signs, such as tearing or red eye, facial flushing, a drooping eyelid or a feeling of fullness in the ear—in every case, on the same side of the head as the headache. Specific signs are key to identifying TAC headaches and distinguishing them from migraines. Each type of TAC has somewhat different symptoms, frequency, pain severity, underlying causes and treatment, and imaging tests usually are needed to make the right diagnosis.
THE HEADACHE THAT ISN’T
Yes, it’s possible to get a headache when you have a sinus infection or other sinus-related condition, but most people who think they have sinus headaches actually have migraines. If you get successfully treated for a sinus condition and find that your headaches don’t improve, see a headache specialist.
THE HEADACHE FROM HEADACHE MEDICATION
If you take pain relief medications for too many days in a row, you can get a rebound headache (also called “medication overuse” headache). The risk is that a rebound headache can lead to chronic headaches. Keep track of the amount of pain relievers you take, and limit your use to 10 days a month.
THE HEADACHE THAT’S A MEDICAL EMERGENCY
A headache that comes on very suddenly, feels like the worst pain you have ever had and is different from the headaches that you typically get should send you to the ER immediately, especially if you’re over age 50. It could be an extremely dangerous condition, such as a stroke, other blood vessel problems such as an aneurysm causing a hemorrhage or a brain tumor. Other warning signs are neurological symptoms that are different from your normal headaches, such as weakness or numbness on one side of your body or slurred speech.
Bottom line: If head pain is interfering with your life, talk to your doctor. Once the underlying cause of the pain is found, you can start the appropriate steps to make it stop or at least keep it under control.