Headache

Headache is a common condition affecting nearly everyone sometime during their lifetime. Headaches are classified in two categories: primary and secondary. Primary headaches are those without an identifiable organic cause. Most common in this category are tension headaches and migraine headaches. Secondary headaches arise as a symptom of another medical disorder, such as flu, sinus infection, or brain tumor. While most secondary headaches are harmless, some may be an indication that there is a serious underlying problem.

Tension Headache and Chronic Daily Headache

Tension headache sufferers usually describe their headaches as a pressure or gripping sensation that starts in the back of the head and wraps around both sides like a vise. Sometimes muscle strain of the neck or upper back may contribute to the problem. Anxiety and stress are thought to be the leading causes of tension headache. You may feel better if you try relaxation techniques, massage, stretching, and heat applied to your neck area. If you experience tension headaches daily, check to see if you are dependent on medication or are experiencing “the rebound effect” from stopping caffeine or medication.

Secondary Headaches that are Common and Usually Not Serious

Many travelers experience headaches during their trips. They are often caused by excessive alcohol consumption, tobacco use, lack of sleep, poor diet, or excessive sun exposure, among other things. Sinusitis may cause headache in the mid-face, upper teeth, or around the eyes. When a headache comes on, it is best to use discretion, rest, increase fluid in-take, and, if necessary, take Ibuprofen or Tylenol. (Aspirin is not recommended because it can cause internal bleeding).

Many medications, both prescription and over the counter, have the side effect of causing headache. Common drug classes that may cause headache include allergy medications, hormones, birth control pills, and blood pressure medications such as hydralazine, nitroglycerin, or calcium channel blockers. There are many other kinds of medication for which headache is a side effect, so we recommend that you read the package insert of any medication before you use it.

Some foods can induce headaches, many of which can contribute to migraine (see below. Monosodium glutamate (MSG), often used in Chinese food, is a notorious cause of headache. Many preserved and processed foods such as cheese, chocolate, and wines can also cause headaches.

Secondary Headaches that are Less Common and Potentially Serious

Some headaches are a sign of something serious, such as a tumor or an aneurysm (abnormal blood vessel of the brain). Listing all the dangerous causes of headache is unnecessary for this page. However, knowing how to recognize when to seek help is important.

Headache Warning Signs

Seek immediate medical attention if your headache is:

• “The worst headache of my life”
• Associated with symptoms such as numbness, tingling, or weakness
• Associated with severe high blood pressure
• Associated with neck stiffness


• Associated with acute personality changes
• Associated with fever, chills, nausea, and vomiting
• Caused by bowel movement, straining, exercise, or orgasm
• Associated with rash
• Associated with muscle weakness or slurred speech
• Worse when bending over forward
• So bad it wakes you from sleep
• Not improved with standard medications

Migraine Headaches

Migraine headaches can be severe and incapacitating. The typical migraine sufferer prefers to sit still in a dark, quiet room, as light and sound may aggravate the condition. They often feel a pulsing sensation on one side of the head only, though it may also be on both sides. Often, nausea or vomiting may occur.

Symptoms: Some sufferers (about 30 percent) say that the pain may be preceded by what they describe as an aura, a strange, eerie sensation accompanied by flashes of light, visual disturbances, or light tingling or numbness of an extremity. Since these symptoms may also be present in serious causes of headache, it is fortunate that most patients who have had migraines for a long time recognize the characteristic aura and do not seek unnecessary medical attention.

Treatment: If you experience migraines, you may manage a minor version with Ibuprophen, Tylenol, or other combination pills that contain analgesics, barbiturates, and caffeine. There is a relatively new class of drugs called the “triptans” that has revolutionized migraine treatment. Common triptan brands include sumatriptan (Imitrex), pilatriptan (Maxalt), zomitriptan (Zomig). Use triptans with extreme caution if you have a history of, or are at high risk for, heart disease. Patients who have double vision, slurred speech, paralysis, or imbalance associated with their headaches cannot use triptans.