May 14, 2010— -- Millions of Americans get headaches, which doctors say can signal a health problem or be problems in themselves.
Headaches can be either primary or secondary. While the pain caused by secondary headaches is a symptom of another problem -- such as a hangover, the flu, a sinus infection or in some very dangerous cases a stroke, a primary headache is a medical problem all its own.
For those who get headaches so often that they're chronic, recent studies have found that they may be caused by the very medications used to treat the pain.
People who take analgesics two or three days a week, or people who often take triptans for migraines may begin to get headaches from these medications, according to the American Headache Society.
In a large study of 160,000 people, Dr. Richard D. Lipton, a professor of neurology and director of the Montefiore Headache Center at Albert Einstein College of Medicine in New York City, found that about 2 percent of people who take medications to stop migraine pain three times a month can become dependent on the medication. They end up getting more migraines more frequently. They may need to switch medications or try other approaches to get relief from their pain.
Research suggests that more than 4 million Americans may suffer daily from medication-overuse headaches, or MOHs. Additionally, "rebound headaches" can occur when medication wears off.
Tension-type headaches are the most common headaches. Between 30 percent to 78 percent of the population experiences tension-type headaches at some time, according to the American Headache Society.
Tension type headaches are "primary" headaches -- and are often caused by stress, fatigue or sitting in one position for a long time, as when in front of a computer. They can last for as little as 30 minutes or as long as seven days, according to the American Headache Society.
"Tension headaches are often defined in opposition to migraine headaches," said Lipton.
While a migraine brings pain to one side of the head, a tension headache hurts on both sides.
"Migraine is throbbing pain. Tension headache is pressure pain, or a steady ache," said Lipton, who is former president of the American Headache Society.
Migraines are a less common but often a more debilitating type of primary headache. They can last four to 72 hours, usually affect only one side of the head and, by definition, come with other symptoms besides pain.
"The pain is always accompanied by something else -- unusual sensitivity to light, sound or nausea or vomiting, or sensitivity to movement," said Lipton.
About 60 percent of people feel nauseated with a migraine, he said, and about 20 percent of people vomit.
While the pain of a tension headache is usually "mild to moderate," migraine pain is "moderate to severe," according to Lipton.
The American Headache Society estimates that 29.5 million Americans get migraines.
Cluster headaches are the rarest and often the most severe form of primary headache. According to the American Headache Society, only about 1 percent of the population gets cluster headaches.
Migraines affect women more often than men, but men suffer more from cluster headaches.
"Hallmarks of a cluster headache are that it's short-lived, and exclusively around the eye, with symptoms around the eye," said Lipton.
Often, a person with a cluster headache will get a runny nose on the side of the pain, their eye might droop and they might sweat.
The headaches may last from 15 minutes to three hours, and often occur every other day in "clusters" for several weeks in a row, according to the American Headache Society.
The majority of patients might experience a remission for several months before the clusters come back, but about 10 percent of people don't have any remission from the headaches.
A very well-known secondary headache is the sinus headache. Just as the name implies, the pain is caused by the pressure of a sinus infection.
The American Rhinologic Society says sinus headache pain is located over the sinuses -- forehead, corners of the eye, and cheek areas -- with occasional pain behind the eyes and in the back of the neck.
But for it to be a genuine sinus headache, it must also stem from a sinus infection, and so will be accompanied by nasal congestion, nasal drip and often discoloration of the mucus.
The pain patterns on the face and behind the eyes that accompany sinus infections can be similar to the pain of a less severe migraine. But unlike migraines, sinus headaches aren't likely to strike a person several times a month or year.
"Most people who show up in my practice think they have a sinus headache, and they have a migraine," said Lipton. "It's unlikely that you're getting a sinus infection three times a month."
The American Rhinologic Society recommends oral decongestants or a nasal spray, which will relieve true sinus headaches for a few days. If symptoms persist, the society recommends seeing a doctor.
Tension-type headaches and migraines might be different, but Lipton said doctors follow the same three approaches in treating them: behavioral, acute therapy and prevention.
"Behavioral treatment means learning to manage whatever your trigger is," said Lipton, who mentioned stress, red wine, skipping meals or not exercising as common culprits.
"If your trigger is sleep deprivation, then getting enough sleep helps," said Lipton.
Acute therapy involves taking medicine "when the headache begins to stop the pain," said Lipton.
Many medications are used for acute therapy from over-the-counter nonsteroidal anti-inflammatory drugs to barbiturates to opiates and, more often for migraine, triptans.
Aside from behavioral and acute therapy, Lipton said people who have migraines 10 percent of the time could benefit from medicine taken every day to prevent migraines.
Unfortunately, the agony of a severe headache such as a migraine can be challenging to control without medication, despite the risk of medication-overuse headaches.
Below are some helpful tips from Dr. Joel Saper, founder and director of the Institute and the inpatient Head and Pain Treatment Unit at Chelsea Community Hospital, in Ann Arbor, Mich., to help avoid over-reliance on medications.
For additional information, visit our On Call Pain Management Center.
1. Keep a consistent schedule. Migraine patients need "sameness" -- same time to bed, same time to wake up, same time to eat on weekends and weekdays. Avoid changes whenever possible.
2. Don't sleep late on weekends or on days off. Get up at the same time.
3. Women should maintain normal menstrual periods (they may need the help of a physician).
4. Eat meals at the same time every day -- don't delay meals for very long and don't skip meals.
5. Avoid foods likely to provoke headache. Patients can obtain food lists from the American Council on Headache Education, Michigan Head Pain and Neurological Institute and the American Headache Foundation.
6. Exercise moderately, within your health parameters.
7. For neck pain, try a "neck pillow."
8. If jaw tenderness or bruxism is a problem, obtain a well-fitted bite splint.
9. Biofeedback and stress management techniques can be very helpful for many patients.
10. Avoid "shift" work. Headache patients do poorly when they do not go to bed when it's dark and wake up when it's light.
11. Stop smoking or breathing ambient smoke.
12. At first sign of a headache, apply ice to the top of the head or temples, and heat to the neck.
13. Limit the use of painkillers or migraine-specific acute medications to no more than two times a week.
14. Avoid needless stress whenever possible; if you cannot avoid stress, then obtain professional help to cope with the stress.
15. Avoid extremes in everything. Migraine-prone patients do not adapt well to extremes.
16. If headaches don't go away, try to induce sleep.
17. If you have migraine, do not nap during the day.
18. Avoid excessive caffeine. A cup or two of coffee a day is OK, though.