Headaches

A headache is a sensation of pain or discomfort that can occur anywhere in the face, neck, or head. Headaches can vary in frequency, from occasional to chronic, and intensity, ranging from mild to severe pain. Left untreated, they can significantly impact a person’s daily life and well-being. Early diagnosis and intervention are key to preventing their escalation.

Tension, Migraine, and Cluster Headaches

Most headaches fall into one of three primary types. Symptoms can vary from person to person, but there are key differences that can help in identifying which type (or types) of headache a person experiences.

Tension Headaches

The most common type of primary headache, tension headaches typically involve mild to moderate pain that feels like a band of pressure or tightness around the head. They are typically not associated with neurological symptoms, such as visual disturbances or weakness, that are common with migraines.

Migraine Headaches

Migraines are typically characterized by recurrent episodes of throbbing or pulsating pain, often on one side of the head. The pain can be intense and debilitating. Not everyone with migraines will experience all these symptoms.

Cluster Headaches

Characterized by excruciating pain, cluster headaches are relatively rare but are often considered to be the most severe and debilitating type of headache. They typically occur in cyclical patterns or “clusters,” with frequent attacks happening over time, followed by periods of remission.

Tension Headache
Migraine
Cluster Headache
Pain experience
Dull aching or squeezing
Throbbing or pulsating
Stabbing or burning
Related symptoms
  • Muscle tension in shoulders, neck, and scalp
  • Light sensitivity
  • Tension in the neck
  • Fatigue
  • Light sensitivity
  • Sensitivity to sound
  • Nausea or vomiting
  • Visual aura (flashing lights, fogginess)
  • Dizziness or vertigo
  • Visual disturbances
  • Cognitive impairment
  • Restlessness
  • Autonomic symptoms (red or teary eyes; runny nose; drooping eyelids; dilated pupils)
  • Sweating
  • Sleep disturbances
  • Light sensitivity
Location
Both sides of the forehead and/or back of head, with pain extending to the neck
One side of the head
One side of the head commonly centered around one eye
Onset
Gradual
Staged, with symptoms building over the course of difference phases
Rapid, reaching maximum intensity within minutes
Intensity
Mild to moderate
Intense and debilitating
Severe and unilateral
Duration
Hours to days
Hours to days
Short – 15 minutes to an hour
Occurence
Frequent, episodic
Episodic

Frequent, with several attacks (“cluster periods”) happening within a day. Cluster periods can last for weeks or months and then go into periods of remission.

Symptoms

Pain experience

Dull aching or squeezing

Related symptoms

  • Muscle tension in shoulders, neck, and scalp
  • Light sensitivity

Location

Both sides of the forehead and/or back of the head, with pain extending to the neck

Onset

Gradual

Intensity

Mild to moderate

Duration

Hours to days

Occurrence

Frequent, episodic

Pain experience

Throbbing or pulsating

Related symptoms

  • Tension in neck
  • Fatigue
  • Light sensitivity
  • Sensitivity to sound
  • Nausea or vomiting
  • Visual aura (flashing lights, fogginess)
  • Dizziness or vertigo
  • Visual disturbances
  • Cognitive impairment

Location

One side of the head

Onset

Staged, with symptoms building over the course of difference phases

Intensity

Intense and debilitating

Duration

Hours to days

Occurrence

Episodic

Pain experience

Stabbing or burning

Related symptoms

  • Restlessness
  • Autonomic symptoms (red or teary eyes; runny nose; drooping eyelids; dilated pupils)
  • Sweating
  • Sleep disturbances
  • Light sensitivity

Location

One side of the head commonly centered around one eye

Onset

Rapid, reaching maximum intensity within minutes

Intensity

Severe and unilateral

Duration

Short – 15 minutes to an hour

Occurrence

Frequent, with several attacks (“cluster periods”) happening within a day. Cluster periods can last for weeks or months and then go into periods of remission.

Causes

While the exact causes of most headaches remain unknown, research has shed light on potential triggers for specific types. These triggers can vary from person to person, and it’s essential to identify and manage them to reduce headache frequency and severity.

Muscle tension in the head, neck, and shoulders plays a significant role in causing this most common form of headache. There is a confirmed association between tension headaches and TMJ disorder. Potential triggers include:

  • Stress
  • Poor posture
  • Eye strain
  • Lack of sleep
  • Hunger or dehydration
  • Caffeine consumption
  • Physical overexertion
  • Bruxism (teeth grinding and jaw clenching)
  • Environmental factors, such as lights and odors
  • Medication overuse

A complex neurological condition, migraines are caused by a specific brain dysfunction — a neurological disorder involving a combination of genetic, environmental, and neurochemical factors — that is not fully understood. Potential triggers include:

  • Hormonal changes
  • Stress
  • Sleep disturbances, including excessive sleep
  • Hunger or dehydration
  • Certain foods and food additives
  • Weather changes
  • Sensory stimuli
  • Physical exertion
  • Sensitivity to medications
  • Hormonal birth control
  • Caffeine consumption

While the exact cause of cluster headaches is not fully understood, certain triggers have been identified that may play a role in precipitating the intense pain commonly localized around one eye or temple. Potential triggers include:

  • Circadian rhythms
  • Alcohol consumption
  • Smoking
  • Certain foods
  • Heat and high altitude
  • Vasodilators
  • Bright light
  • Physical exertion
  • Changes in sleep patterns
  • Hormonal changes
  • Stress

It’s important to note that each person’s headache triggers can be unique, and some individuals may have multiple triggers. Keeping a diary to track potential headache triggers, patterns, and associated symptoms can be helpful in identifying and managing headaches effectively. Lifestyle modifications, stress management techniques, and avoiding specific triggers can be part of a comprehensive headache management plan.

Associated Risks

Untreated or inadequately managed headaches and migraines can significantly impact a person’s life in the short term and beyond. Risks include:

  • Development of chronic conditions
  • Reduced productivity
  • Impaired social functioning
  • Development of mood disorders
  • Medication overuse
  • Increased medical costs
  • Missed diagnosis of underlying conditions

If you are experiencing severe headaches, it’s essential to consult a healthcare professional or headache specialist for personalized guidance and treatment options to help avoid escalating risks.

Tinnitus

Tinnitus is a noise in the ear when there is no actual sound outside the ear. Constant or recurring tinnitus can be stressful and disruptive.

Symptoms

Often called “ringing in the ears,” tinnitus may sound like loud or soft blowing, buzzing, humming, or sizzling.

Causes

As with headaches, the causes of tinnitus can vary. They include:

  • Ear problems such as infections or blockage, hearing loss, or damage or disease that impacts the inner ear
  • TMJ disorders
  • Medication side effects
  • Medical conditions such as high blood pressure, allergies, or anemia

Diagnosis

When diagnosing headaches, healthcare providers will look for specific symptoms and patterns to differentiate between different types and accurately identify the underlying cause. It is essential to take a comprehensive medical history, conduct a thorough physical examination, and consider specific diagnostic criteria to arrive at an accurate diagnosis. Keeping a headache journal to identify potential triggers unique to your situation will assist in the diagnosis.

  • Characteristics of the headaches, including their location, intensity, and quality (e.g., throbbing, pulsating, squeezing)
  • The frequency of headache episodes (occasional, episodic, or chronic)
  • Headache duration, ranging from minutes to hours
  • The time of day or month when headaches typically occur, to aid in detecting possible patterns
    Specific triggers or factors that precede or worsen headaches, such as stress, certain foods, hormonal changes, or weather changes
  • Accompanying symptoms, such as nausea, vomiting, sensitivity to light (photophobia), sensitivity to sound (phonophobia), visual disturbances including aura, and autonomic symptoms like nasal congestion or tearing
  • A family history of headaches, especially migraines
  • Any neurological abnormalities that may suggest an underlying condition
  • A review of past medical history, including any head injuries, surgeries, or other relevant medical conditions
  • Use or overuse of medications, including over-the-counter pain relievers
  • Lifestyle factors such as sleep patterns, exercise, dietary habits, and stress levels
  • For suspected cluster headaches, a pattern of frequent attacks within a cluster period, followed by periods of remission
  • Previous headache treatments, the response to which can help guide future management

Treatment

The specific treatments for headaches, including migraines, depends on the type, severity, and frequency of the episodes. Treatment for tinnitus likewise depends on its characteristics and underlying causes. If your condition is frequent or severe, or if it significantly impacts your daily life, it’s important to consult a healthcare provider.

Our Approach

For our patients with headaches, we provide preventative therapies and pain relief, beginning with a comprehensive evaluation to uncover contributing factors and diagnose the type of headache. Our providers are experts in caring for people with head pain, using a multimodal approach to treatment that includes therapeutic injections, medication management, and oxygen therapy.