Common Headaches

Three Common Types of Headaches

Headaches are annoying and, depending on their severity, can prevent us from performing our daily tasks. There are many types of headaches, but the most common ones are tension headaches, cluster headaches, and migraines. In tension headaches, the pain begins in the back of the head and upper neck, and feels like a tight band or like pressure; it may spread to encircle the head. Usually, these are the simplest type of headaches and often allow most people to continue functioning normally. What causes tension headaches? The exact cause is actually unknown.^[1] Usually, muscles of the skull contract and when they become overstressed, they can become inflamed or go into spasm; that causes pain. The additional stress on these muscles can be caused by physical or mental stressors.

By comparison, cluster headaches are headaches that come in groups (or around the same time), and are separated by times that are pain-free. These types of headaches affect males more frequently. The symptoms include pain that usually happens a couple of times per day. The headaches last between 30 and 90 minutes, and the headache episodes usually occur at the same time each day. Unlike tension headaches, the pain of cluster headaches can be excruciating and is located behind one eye. As a result, there may also be visual symptoms. The eye may become red and watery, and nasal congestion may also occur. Cluster headaches appear to be caused by the release of histamine and serotonin in the brain.^[2] Abnormal brain activity can occur in the hypothalamus, the area of the brain usually associated with the brain’s ability to regulate temperature, as well as managing the body’s biologic clock. There is likely a genetic cause to cluster headaches. Cluster headaches can also be triggered by changes in sleep patterns, medications, and stimulants (such as tobacco smoking or alcohol use).Lastl y, we will discuss migraine headaches. We’ve previously discussed migraine headaches as its own topic, so in this article we will review the keynotes and also discuss new promising therapies. Migraines are usually one-sided and usually include additional symptoms. These additional symptoms can be things like intense pain, pulsating sensations, low tolerance to light and noise (called photophobia and phonophobia, respectively), and can also be accompanied by nausea and vomiting.^[3] Perhaps one of the most irritating aspects of migraines is their length; they can last up to three days. In this article, we will review some of the most important physical exams and lab tests to perform, and we will discuss conventional and natural treatments.

Diagnosis and Testing

Based on the symptoms of the three most common headache types we discussed, it is clear that if your doctor is asking you for detailed information about your headache, he or she can likely have a good idea of what type of headache you may be suffering from. In addition to the presentation or case history, your doctor may want to rule out more serious conditions. For example, meningitis may be present if you are also experiencing fever, a stiff neck, and confusion. The most important physical exams are likely palpation and range of motion: palpation just means touching and feeling various areas of the head and neck to assess for the areas of pain; range of motion means that your doctor may ask you to move your head in various directions to see if there are any restrictions. In terms of lab tests, blood tests may be considered. Blood tests may be able to identify if inflammation is occurring by detecting an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). Both of these tests are very general tests for inflammation. ESR, if extremely elevated, may also point to another potential cause of headache called temporal arteritis. If you have been using alcohol, medications, or other drugs, toxicology tests may be helpful. Imaging may be the most helpful in ruling out serious conditions and helping to narrow down the cause of the headache. A computerized tomography (CT) scan can detect almost all brain and skull structures: if there is any damage, bleeding, or masses, a CT scan should pick it up; it may also pick up a previous stroke. Similarly, magnetic resonance imaging (MRI) can identify the full anatomy of the brain. There are pros and cons to both tests. For example, a CT scan uses radiation, while an MRI does not. These types of imaging can rule out tumours.

Conventional Treatments

There are different treatments based on the type of headache that is being experienced. The most common treatments for tension headaches are over-the-counter pain medications. For example, Advil (whose generic name is ibuprofen), Tylenol (acetaminophen), and Aleve (naproxen). Lifestyle tools can also be helpful, such as stress management, which can take a number of different forms. For example, just taking time off to relax or lying down for a short time (and taking time away from staring at screens) can be helpful. Cluster headaches are more difficult to treat because the pain is more intense, but also we know that they will be coming back, so prevention of future episodes should be incorporated. There are specific medications called triptans that can be used (they are also used commonly for migraines). Other medications can also be used which cause blood vessels to constrict. Finally, many people find that caffeine can help with their cluster headaches. Prevention of cluster headaches is usually accomplished with cardiovascular drugs (such as calcium-channel blockers), antiseizure medications, anti-inflammatories, and even antidepressants. Migraines are treated conventionally using a combination of all of the above medications, as well as by staying away from aggravating factors. Patients may be advised to lie down in a dark and quiet room.^[4]

Natural Treatments Diet

The prevention of headaches is always preferred, if possible. Dietary triggers can be associated with headaches, particularly with cluster headaches and migraine headaches. Examples of high-risk foods include chocolate, cheese, wine, beer, and processed meats.^[5] For some people, gluten can be a common and large trigger. For others, aspartame or monosodium glutamate may be the trigger. Elimination diets, where foods are eliminated and then systematically reintroduced or “challenged,” can be extremely useful in identifying a plethora of dietary triggers. An elimination diet is usually quite complicated and takes a moderate amount of time to complete, so it’s recommended that you do this under the guidance of your naturopathic doctor. Aside from elimination diets, a specific food IgG test can be completed. These tests typically look at 100 foods and test them against your blood to see if there is an immune reaction. The only drawback to these tests is their cost, as they are usually several hundred dollars to run.

Supplements

There are a number of helpful supplements that can be incorporated into integrative treatments. Supplements that have anti-inflammatory actions can be particularly helpful. These include nutritional options like fish oil or omega-3 fatty acids, as well as botanical options like curcumin or Boswellia. Fish oil is usually recommended at doses around 1 g, but the dose may be increased depending on the individual case. The herbal options can be suggested in capsule or tincture form (alcohol extracts). All have shown efficacy in studies. In addition to anti-inflammatories, there are supplements that can help with muscle spasms and energy production. Magnesium is one of the most common supplements used for the treatment of headaches. Multiple trials of magnesium are available that show promising results in decreasing the frequency of headaches.^[6] Magnesium can be provided in tablet, capsule, or liquid form. The dose varies, but usually an entry dose is around 300 mg. There are also multiple types of magnesium: citrate, bisglycinate, and carbonate. They are all fairly equivalent in terms of absorption (citrate and bisglycinate are a little bit better than carbonate); however, they all have different side effect profiles — magnesium carbonate tends to cause looser stools. For energy production, the supplement coenzyme Q10 (CoQ-10) has been used in the treatment of migraines in particular, but could conceivably be used for all headache types discussed here.

Alternative Approaches

There is evidence that alternative therapies like massage and acupuncture can be useful in preventing and treating headaches. Acupuncture can be used medically (focusing on tight muscles and trigger points), or from the perspective of traditional Chinese medicine, where needles may be inserted at locations other than where pain is felt. Both perspectives have evidence supporting their use and should be considered in integrative treatment plans.

Conclusion

We’ve reviewed multiple types of headaches and the common features they share: they are painful and can impact quality of life. Diagnosis is usually made based on the presenting symptoms, but blood tests and imaging can also be useful in ruling out more serious causes. The conventional treatments focus on pain control (using over-the-counter medications), as well as more serious drugs like triptans. All of these approaches have side effects. The natural approaches include diet and lifestyle modification: identifying dietary triggers and removing them from the diet, as well as stress management. Supplements can be used in a number of ways, including acting as anti-inflammatories and helping muscles to relax. Alternative approaches like massage and acupuncture have also shown much promise. It is clear that with all of the information available, headache treatments should be individualized until suitable treatments are found.