Headaches can often be more than a pain, making it hard to concentrate on anything but the pounding, throbbing, or dull ache inside your head. What kind of headaches do you suffer from and what causes them?
We asked Dr. Elizabeth Loder, chief of the Division of Headache and Pain in the Department of Neurology at Brigham and Women’s Hospital, to dissect seven common headache scenarios and their triggers.
“The cause of these headaches is not entirely clear,’’ Loder said. “The pain may come from inflammation or the effects of alcohol on blood vessels, but the specific cause is not very clear. Dehydration may also play a role in these headaches, while behaviors such as staying up later than usual or a lack of caffeine add to the circumstances triggering this headache.’’
“If you have a mild headache behind both eyes, that’s most likely to be tension-type headache or an ‘everyday’ headache, and it will usually respond well to over-the-counter medications,’’ Loder said. “But if the headache is behind just one eye, and is more severe, it could be a migraine or cluster headache. Cluster headaches are a rare type of headache that is more common in men.’’
Cluster headaches, Loder said, are also characterized by redness or tearing of the eye on that size or a drooping of the eyelid on that side. In most cases of headache, location, Loder said, is not all that helpful in determining the cause of the headache. Many people who are susceptible to migraines will also report eye strain, bad lighting, or flicker from a computer as triggers for these headaches.
“Ice cream headaches are a recognized type of headache,’’ Loder said. “We call it a cold-stimulus headache. They happen most commonly if someone rapidly ingests a large amount of something cold, and may be more likely to occur in people who have migraine headaches.’’ Loder said these headaches, which luckily don’t last terribly long, can be minimized or prevented by taking small bites of things that are cold and eating or drinking more slowly.
“Migraines are defined as headaches that are moderate to severe in intensity, often on one side of head, typically associated with other symptoms such as light sensitivity, nausea, or vomiting,’’ Loder said. “One interesting thing to note is that a hallmark of migraine is that it is more likely to happen after a stressful event — we call it a let-down headache or weekend headache.’’ Loder said this might happen because when a person is under stress their body produces cortisol to get through the event. As the cortisol wears off, the person becomes more vulnerable to an attack. “It’s quite unfair really to get through a stressful project for work and then get hit with a migraine when you’re about to go on vacation.’’
“If a person is waking up at their normal time and then notices a headache, most of the time after investigation we find that’s a migraine,’’ Loder said. But cluster headaches can also occur in relation to sleep, though Loder said these headaches usually awaken someone from sleep, very commonly during the first cycle of rapid eye movement sleep. A cluster headache can last anywhere from 15 minutes to 3 hours and is very, very severe. The second type of headache that can wake a person from sleep, she said, is a hypnic headache. “Hypnic headaches usually occur in older people, are moderate in intensity, do not have associated symptoms, and can last a couple of hours.’’
“These headaches often happen in the morning because overnight is when people go the longest time without caffeine — at least in the case of those who are really overdoing it,’’ Loder said. “It’s not a bad thing to try a cup of coffee to get rid of an occasional headache, if that works well for you, but if you have to do that very frequently (more than twice a week) you may want to seek additional advice or treatments.’’ When used too frequently, caffeine can become a cause rather than a treatment of headaches.
“There is something called an exertional headache, which is a situation where exercise or other physical exertion can trigger a headache,’’ Loder said. “High altitude, or exercising for quite a while may make these headaches more likely to occur.’’ Some people who have migraine also find that physical exertion can trigger a migraine attack. One way to relieve pain might be to modify or switch the type of activity you’re doing. Some people also benefit frmo taking an anti-inflammatory medication about an hour before physical activity. “Most people who occasionally have had this type of headache recognize they didn’t warm up properly or had a particularly hard workout,’’ said Loder.