What are Headaches?
(Part 1 Classification, Causes and Triggers)
Headaches are one of the most common medical complaints; most people experience them at some point in their life. They can affect anyone regardless of age, race, and gender. The World Health Organization (WHO) reports that almost half of all adults worldwide will experience a headache in any given year.
Classification of headaches:
Headaches can be divided into Primary or Secondary headaches
Primary headaches are stand-alone illnesses caused directly by the overactivity of, or problems with, structures in the head that are pain-sensitive.
This includes the blood vessels, muscles, and nerves of the head and neck. They may also result from changes in chemical activity in the brain.
Common primary headaches include migraines, cluster headaches, and tension headaches.
Secondary headaches are symptoms that happen when another condition stimulates the pain-sensitive nerves of the head. In other words, the headache symptoms can be attributed to another cause.
A wide range of different factors can cause secondary headaches. These include:
- Eating something very cold can lead to a “brain freeze.”
- alcohol-induced hangover
- brain tumor
- blood clots
- bleeding in or around the brain
- carbon monoxide poisoning
- sinus headaches
- teeth-grinding at night
- overuse of pain medication, known as rebound headaches
- panic attacks
Causes of Primary headaches
There are several but 3 main causes of Primary Headaches
- Tension headaches
Tension headaches are the most common form of primary headache. Such headaches normally begin slowly and gradually in the middle of the day. The person can feel:
- as if they have a tight band around the head
- a constant, dull ache on both sides
- pain spread to or from the neck
Tension-type headaches can be either episodic or chronic. Episodic attacks are usually a few hours in duration, but can last for several days. Chronic headaches occur for 15 or more days a month for a period of at least 3 months.
A migraine headache is very many times genetic in nature and may cause a pulsating, throbbing pain usually only on one side of the head. The aching may be accompanied by:
- blurred vision and spots or sparklers in front of the eyes
- nausea and/or vomiting
- light and noise sensitivity
- sensitivity to certain smells.
- sensory disturbances known as auras
- sometimes weakness, numbness, speech and vision problems mimicking strokes
Migraine is the second most common form of primary headache and can have a significant impact on the life of an individual. According to the WHO, migraine is the sixth highest cause of days lost due to disability worldwide. A migraine can last from a few hours to between 2 and 3 days. Sometimes they can last days when they are called status migrainosis.
- Cluster headaches
Cluster headaches usually last between 15 minutes and 3 hours, and they occur suddenly once per day up to eight times per day for a period of weeks to months. In between clusters, there may be no headache symptoms, and this headache-free period can last months to years. The pain caused by cluster headaches is:
- very severe
- often described as sharp or burning
- typically located in or around one eye
The affected area may become red and swollen, the eyelid may droop, and the nasal passage on the affected side may become stuffy and runny. Usually people have tearing on the affected side.
There are multiple other primary headaches and include:
- exercise induced headaches
- orgasmic or sex headaches
- cough induced headaches
Most common foods that trigger migraines
- Chocolate, 75 percent
- Cheese, particularly aged cheese, 48 percent
- Citrus fruits, 30 percent
- Alcohol, particularly red wine and beer, 25 percent
An additional list of foods that trigger migraines
- Ham, hot dogs, other cured or lunch meats (prepared with nitrates)
- Monosodium glutamate, MSG, commonly found in Chinese foods, soy sauce and packaged foods
- Aspartame and other artificial sweeteners
- Asian foods
- Canned foods
- Snack foods
- Fatty foods
- Ice cream and other frozen foods
- Food dyes
- Coffee, tea, cola (other items containing caffeine and caffeine withdrawal)
- Dairy products, yogurt
Alcohol and migraines
Roughly a third of migraine sufferers say that alcoholic beverages can trigger their migraine attacks. A tenth of migraine sufferers say alcohol is a frequent or consistent trigger.
Migraines and stress
Emotions & Stress
Anxiety, stress, excitement, worry, anger and other emotions can spark a cascade of symptoms in most people. In those who suffer from migraines, these emotions can trigger a migraine attack.
Migraines and stress
Some sufferers consider stress the most common cause of migraines. Several studies place stresses near the top of the list as the trigger most often named by migraine sufferers. Many studies show that 60 percent to 70 percent of those with migraines cite stress as a regular trigger.
Stress can come in many forms: pressure at work to complete a project, excitement about an upcoming wedding, a traffic jam making you late for an appointment or a family conflict. During stressful moments, the brain releases chemicals, including adrenaline, as the body goes into self-preservation mode. When the brain senses stress it prepares for “fight or flight.” These chemicals cause a range of changes in the brain and body, including muscle tension and dilation of blood vessels. These chemicals are activated in the brain when you have a migraine. For a person who suffers from migraines, these reactions to stress can trigger a painful migraine.
Stress can come in many forms, both negative and positive. Events that are taxing and worrisome, surprisingly have similar effects on some migraine sufferers as events that are happily stressful such as a big job promotion or anticipation of an exciting date. Stress can also make an existing migraine worse.
For some people who battle migraines, the attack doesn’t start during the stressful or emotional event. Instead, the migraine symptoms may start after the stressful event has passed, during what is called the “let-down period.” This occurs after a period of high stress or pressure ends and the individual relaxes. These migraines happen often on the weekend or at the beginning of vacations when everything has calmed down.
Environmental migraine triggers
Different factors in the environment – some which the migraine sufferer is unable to control – may lead to a migraine attack. As with many issues related to migraines, it is unclear how these changes in the surroundings lead to migraines. Some researchers believe that people with environmentally-induced migraines are more sensitive to influences in the atmosphere. Changes in the environment have also been blamed on allergies, pain and fatigue.
How do weather changes cause migraines?
For ages, people have reported being able to “feel” an oncoming thunderstorm. This, researchers believe, is a result of a buildup of positive ions in the air which may raise the body’s serotonin. Serotonin is known to be linked to migraines. There are also people who experience seasonal migraines, which means they have far more migraines during certain times of the year.
Types of environmental triggers
- Weather changes including: temperature changes, extreme heat or extremely cold weather, humidity, barometric pressure changes and storms
- Odors, pollution and smells including: smog, cigarette smoke, perfumes and chemical odors
- Lights, such as: bright lights or glaring lights, fluorescent lights, flashing lights or screens
- High altitude
- Flying, jet lag, travel or motion
- Dusty conditions
- Dry conditions
- Patterns, including: stripes, checkers or zigzag lines
Exercise – Physical Activity
One of criteria for diagnosing migraines is that the pain and discomfort worsens with physical activity. For people with tension headaches, the head pain is not aggravated by routine physical activity. Also, physical activity triggers migraines. Sometimes it is everyday activities that launch an attack, other times heavy activity is to blame. Terms such as “weight-lifter’s headache” or “sports-related migraine” are used to describe it because the pain and symptoms arise after physical exertion or effort. Many people who suffer from persistent migraines avoid certain physical activities hoping to prevent migraine attacks.
Types of physical activity that triggers migraine attacks
- Walking up and down stairs is a common complaint. Many migraine sufferers say this trigger aggravates their migraines.
- Head movement commonly makes migraines worse. In some people, abrupt head movements can trigger an attack.
- Bending over or rising can also worsen head pain. Some people describe throbbing pain, or explosions of pain.
- Exerting a lot of energy may also trigger migraines in certain sufferers. Lifting heavy objects or working out vigorously
- Changes in sleep schedules can also trigger migraines. This can be a problem if you get too little or even too much sleep. The best way to manage this is to stick to a regular sleep schedule, so your body is properly rested but not too much so. This means maintaining the same sleep routine on the weekends and on vacation. Jobs that require irregular shift work should probably be avoided to prevent migraine attacks. Even so, for some who suffer from migraines, sleep is the only way to stop the symptoms.
- Coughing and sneezing are thought to increase pressure inside the head, which can lead to migraines. This increase in pressure is called the Valsalva’s maneuver, which is sometimes done deliberately by closing the mouth, pinching the nose and exhaling. It is done to equalize pressure in the ear, for example, if pressure builds while flying. However, there is the risk of applying too much pressure to the middle ear and causing damage.
There are several possible reasons for why physical activity can lead to a migraine. For heavy activity, the reasons might be:
- Extreme exercise
- Altitude, which might prompt migraines because of low oxygen
- Low blood sugar
Hormones, the powerful chemicals that send signals throughout the body, play a large role in women with migraines. Hormones serve as migraine triggers in numerous stages of hormonal activity throughout a woman’s menstrual cycle and throughout her life.
Women experience hormonal changes when they:
- first begin menstruating
- begin their monthly menstrual cycle
- end their monthly menstrual cycle
- take oral or other hormonal contraceptives
- are pregnant
- first enter menopause
- take any form of hormone therapy
- are further along in menopause
Since migraines and hormones are related and because women have several fluctuations in hormones, it’s no wonder that some 70 percent of migraine sufferers are women. Migraines can be triggered by or made worse by the hormonal changes a woman experiences. Studies show that women complain of more severe head pain, migraines that last longer and cause more disability than men with migraines.
What causes migraines in women
Changes in the hormone estrogen are thought to trigger reactions in the brain the lead to migraines in women. The amount of estrogen circulating in a woman’s drops right before the start of the monthly menstrual cycle. Some women have migraines that are closely tied to their period. These are called menstrual migraines. They usually occur right before or in the very first days of the menstrual cycle and improve after menopause. In one study, 62 percent of women reported that their migraine symptoms improved after they stopped having their monthly menstrual cycle. However, in 18 percent in that study said the migraines got worse.
Pregnant women and migraines
Pregnancy offers a reprieve for most women who suffer from migraines. Because estrogen levels gradually rise during pregnancy, many women say their migraine symptoms improve. However, after the pregnancy ends, when the hormone levels drop suddenly, the migraine symptoms can return immediately.
How to prevent hormonal migraines
Keeping a migraine journal will help you discover when during your cycle the migraines occur. For some women, taking an over-the-counter or prescription pain reliever a few days before the start of their menstrual cycle helps prevent the migraine attack. Consulting a migraine expert will help determine what’s best for your migraines.
Sex stirs up lots of emotions, chemicals and other reactions within the body. Therefore, it’s understandable how sexual activity can be a migraine trigger. It is sometimes called “coital headache.” Sex-related migraines are usually unpredictable and don’t occur with each sexual experience. This type of migraines occurs most often in people ages 20 to 60, and most commonly first occurring around age 40.
Migraine sufferers and sexual intercourse
The head pain and other migraine symptoms can sometimes arise with sexual activity and with masturbation. Men get migraines after sex. Sexual activity triggers migraines in men four times as often as it does in women. because of the alterations in blood pressure.
Migraines and other types of head pain may occur:
- During the escalation of activity lead up to sexual intercourse
- During sexual intercourse itself, pre-orgasmic
- After climax, which is called orgasmic
- In the base, occipital region of the head
- Gradually and increase along with sexual excitement
- With throbbing pain
For head pain to be blamed on sex, the International Headache Society says the pain must:
- Be brought on by sexual arousal
- Have pain on both sides
- Be prevented or lessened by stopping sexual activity before orgasm
- Not be caused by any other disorder
Possible reasons for sexually – induced migraines
The reason behind the head pain may be related to contracting muscles during sex. The attacks may be avoided by working on relaxing neck and jaw muscles during sexual activity. The explosive pain has been blamed on the rapid increase in blood pressure and heart rate during sexual climax.
If the head pain is the worse ever experienced or resembles a “thunderclap” of pain, seek immediate medical attention. The pain may be a symptom of an un-ruptured aneurysm.