Headaches

Headaches are an incredibly common condition. If you experience a headache randomly, then consider yourself lucky! There are some people who experience headaches very frequently and for a variety of reasons that could often be out of their control. On top of that, there are so many different headaches that a person can experience, as well as many different symptoms that can range from slightly bothersome to stopping a person from performing any form of daily activity.

While some headaches cause only minor disruptions to a person’s life and can remedied with at-home methods, there are other types of headaches that require medical attention as they might be the sign of an underlying medical condition. The Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas are well versed in all types of headaches and can accurately diagnose which headache(s) you suffer from so that the best and most efficient treatment method can be used with the goal to provide long-term relief. 

What is a Headache? 

A headache is essentially any pain felt in the head or face. Pain can throb, remain constant, feel sharp, or be dull, and it can last for minutes or even days. Headaches are actually one of the most common reasons a person will visit their healthcare provider, which speaks to how frequent and bothersome they can. 

Doctors classify headaches as either primary or secondary. Primary headaches are those not related to any other underlying health condition. These are the most common types of headaches. Secondary headaches, on the other hand, are related to an underlying health condition or disease. These are much more difficult to treat as there are many different causes, many of which can be life threatening, including: 

• Strokes
• Malignant tumors
• Malignant hypertension
• Hemorrhages or hematomas in the brain
• Meningeal infections
• Eye diseases, such as glaucoma or cataracts

Regardless of the type of headache, it’s important to seek the help of a trained medical professional who can diagnose and treat any and all conditions that are causing you head and face pain. 

What Causes Headaches? 

Let’s look at the three main types of primary headaches and why they happen. The subcategories of primary headaches are tension, cluster and migraine, and successful treatment is based on identifying which type you suffer from and treating that specific headache. 

Tension Headaches

Tension headaches are the most common headaches that adults experience. The most popular description of tension headaches is that it feels like there’s a tight band wrapped around your head that puts extreme pressure on both your forehead and temples. Most adults experience this type of headache toward the end of the day, most likely because they’ve spent the day staring at a computer screen, phone, subjected to bright lights and loud noises, and more. They are classified by how often you have one, and are either infrequent episodic (one day a month), frequent episodic (you have one to 14 headaches per month for at least three months), or chronic (more than 15 headaches per month for three months).

Symptoms of tension headaches include:

• Stabbing or throbbing pain
• Irritability
• Lack of sleep or poor sleep
• Inability to concentrate
• Depression

Tension headaches are directly related to stress, which is why they are generally experienced toward the end of the day after hours of work-related stress, eye strain from concentrating on a task, etc. They are also thought to be related to musculoskeletal (myofascial) irritations, like clenching the jaw and poor posture. 

Cluster Headaches

Cluster headaches cause severe pain that is usually felt on one side of the head, and usually behind the eye. They follow a pattern, so are generally felt on the same side of the head, around the same time of the day, during the same time of the year, which is why they’re referred to as “clusters.” 

A unique feature of cluster headaches is that they occur in repetitive bursts, which are referred to as cluster periods. A person could experience a headache attack for maybe 20 minutes, or even a few hours, of pain, then a period of no pain. The period of remission could continue for weeks or even months, although some patients experience chronic cluster headaches with no periods of remission. The pain is described as being worse than tension and migraine headaches, and often feels like a burning, stabbing or sharp pain. 

While anyone can suffer from cluster headaches, they most commonly affect men in their mid-20s. Additional risk factors include vasodilating medications (drugs that open blood vessels), illicit drug use and frequent alcohol use. In addition to intense periods of pain, those who suffer from cluster headaches could also experience tearing of the eye, nasal discharge and neurological complications in the head or face. 

Cluster headaches

Cluster headaches are difficult to treat as there isn’t a clear reason why they occur in the first place. One theory is that Vasodilation (opening) of the blood vessels in the brain causes cluster headaches, which is why people who are on vasodilating medications might suffer from attacks. The opening of the blood vessels could lead to compression and irritation of the cranial nerve, which is responsible for sensations and functions of the face, thereby causing acute and severe pain. Another belief is that changes in environmental pressure alters the hypothalamus’s normal control of the body’s circadian rhythm. Being that cluster headaches seem seasonal in nature, this could explain why increased light in the summer months could cause the headaches to occur. 

Migraine Headaches

Migraines are much more than just a common headache. They can be felt on one side of the head, or both, and can last anywhere from an hour to a few days. The headache intensifies with physical activity, bright lights, loud noises and strong odors. These triggers can cause additional symptoms like fatigue, nausea, vision changes, irritability and more. If you’ve experienced a migraine or know someone who has, you are sure to understand the importance of a quiet, dark room. 

While migraines can affect anyone, they are more common in adult females. There are several different types of migraines, but the two most common are classic migraine (migraine with aura) and common migraine (migraine without aura). An aura is a phase of the migraine headache before the pain begins. 

A classical migraine is most often felt on just one side of the head and preceded by visual disturbances.

People most often describe these disturbances as:

• Sports or vision loss
• Wavy lines
• Flashes of bright light
• A particular smell
• Facial numbness
• weakness/unsteadiness
• Altered level of consciousness

Common migraines are generally felt on both sides of the head and are not preceded by any visual disturbances. 

Regardless which type of migraine headache you experience, the headache typically happens in four stages, although not everyone could experience all four stages.

These stages include: 

1. Prodromal: a warning sign that a migraine is coming, usually featuring fatigue, nausea, anxiety or mood changes
2. Aura: visual disturbances that happen with classical migraines
3. Attack: the migraine itself, accompanied by pain and related symptoms, such as nausea and vomiting
4. Postdromal: the final stage after the attack, usually leaving the person feeling drained. It’s also referred to as a “migraine hangover.”

There are many reasons why a person might experience a migraine. This is why they are the most researched type of headache. Similar to cluster headaches, medical professionals believe there is a neurological component to migraines. It is thought that migraines are experienced due to changes in brain activity that heighten a person’s sensitivity to pain. They could also be genetic in nature, so you could have a higher chance of experiencing migraines if your parents or siblings do.   

When a person experiences a migraine, specific nerves in the blood vessels send pain signals to the brain, which releases inflammatory substances into the head’s nerves and blood vessels. This inflammation can affect the peripheral nervous system (PNS), which sends signals through the spinal cord to the brain, as well as the central nervous system (CNS) and have them operate in high reactivity. This can lead to central sensitization, which is when pain hypersensitivity leads to nerves that transmit pain signals not to react properly. This leads to a person overreacting to normal sensations, such as touch, sensations or temperatures, and experiencing pain when they shouldn’t. 

These sensations, or triggers, could include any type of sensory input, such as: 

• Bright lights
• Loud noises
• Strenuous physical activity or exercise
• Emotional or mood disorders (depression or anxiety)
• Certain medications
• Certain foods (processed meats that contain nitrates, MSG, aged cheese, chocolate, fermented or pickled foods, etc.)
• Menstrual cycle irregularities

The best way to treat your specific type of headache is to track your triggers and symptoms and partner with a pain management specialist who can both properly diagnose and treat your headache. The goal of treatment is to either prevent the headaches from happening in the first place, or lessen the duration and frequency. 

What are the Best Treatments for Headaches?

The best way to prevent a headache from happening in the first place is to make sure you’re getting enough rest, eating enough food, drinking enough water, limiting alcohol intake, not smoking or using tobacco products, and practicing stress management techniques. Beyond that, you can try and mitigate the occurrence of your triggers, like making sure you are taking breaks at work, avoiding strong/new smells at home, eating a healthy diet, etc. 

Pain medications can also help to reduce the severity of headache symptoms, but most healthcare providers recommend additional treatment methods so that a person doesn’t over use or create a dependency on medications. In addition to pain medications used to lessen painful symptoms, there are also medications taken to prevent headaches from happening in the first place. These include antidepressant medications, antiseizure medications, antihistamines, and cardiovascular drugs. There is, too, a link between depression and anxiety disorders and migraines, so treating both the physical and mental aspect of the headache can improve a person’s quality of life.  

Depending on the type and severity of a person’s headaches, a pain management specialist could recommend the below treatment options: 

Behavioral Modifications:

• Biofeedback training: learning how to recognize and manage some of the body’s responses, such as pain, blood pressure, etc., help a person to better deal with stressful situations and hopefully lessen the frequency of headaches
• Yoga, acupuncture and massage: all of these alternative therapies help a person to reduce stress, which is one of the main causes of all headaches, as well as restore health and balance within the body
• Exercise: maintaining a healthy weight and enjoying regular activity can help to prevent migraines as well as encourage the release of endorphins, which makes people happy

Interventional Procedures:

• Occipital nerve block: a minimally-invasive procedure that involves an injection of anesthetic medication near an occipital nerve to provide temporary pain relief and help inflammation from headaches and other conditions. Most patients experience temporary or permanent pain relief and reduction of inflammation of the affected nerves in the head. 
• Cervical epidural steroid injection: an injection of anti-inflammatory medication into the epidural space around the spinal nerves that reduces swelling and inflammation in the location of the compressed nerves, improving pain
• Transnasal sphenopalatine Ganglion block: an injection of a local anesthetic into the sphenopalatine ganglion (SPG), which is a group of trigeminal nerve cells located in the back of the nasal passages, to relieve headache pain
• Peripheral nerve block: Supratrochlear, supraorbital and infraorbital blocks focus on relieving pain that from the nerves around the eye and eye socket, as well as through the lower portion of the forehead, by administering an anesthetic that helps to reduce inflammation

Conclusion 

The first step in reducing the frequency, intensity and duration of your headaches is knowing what your triggers are and avoiding them as best as possible. Partnering with a pain management specialist can also help as they are trained in the best treatment methods, and can include a multi-step approach to help you manage your headaches. If you are suffering with headaches, or your headache symptoms are becoming worse, please schedule an appointment with the Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas. While headaches are common, our team is here to help you experience less frequent and less painful headaches with the most comfortable and effective treatment options as possible.