Patient Education - Lung Cancer Program at UCLA
yourself about lung cancer:
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches
are extremely rare. Most people with headaches can feel much better by making lifestyle
changes, learning ways to relax, and occasionally by taking medications.
- Tension headache
- Cluster headache
- Migraine with aura
- Migraine without aura
- Alternative Names
- Pain - head
Tension headaches are due to tight, contracted muscles in your shoulders, neck,
scalp, and jaw. They are often related to stress, depression, or anxiety. Overworking,
not getting enough sleep, missing meals, and using alcohol or street drugs can make
you more susceptible to them. Headaches can be triggered by chocolate, cheese, and
monosodium glutamate (MSG). People who drink caffeine can have headaches when they
don't get their usual daily amount.
Other common causes include:
- Holding your head in one position for a long time, like at a computer, microscope,
- Poor sleep position
- Overexerting yourself
- Clenching or grinding your teeth
Tension headaches tend to be on both sides of your head. They often start at
the back of your head and spread forward. The pain may feel dull or squeezing, like
a tight band or vice. Your shoulders, neck, or jaw may feel tight and sore.
Migraine headaches are severe, recurrent headaches generally accompanied by other
symptoms like visual disturbances or nausea. They tend to begin on one side of your
head, although the pain may spread to both sides. You may have an "aura" (warning
symptoms that start before your headache) and feel throbbing, pounding, or pulsating
For information on migraine, see migraine headache.
Other types of headaches:
- Cluster headaches are sharp, extremely painful headaches that tend to occur several
times per day for months and then go away for a similar period. They are far less
- Sinus headaches cause pain in the front of your head and face. They are due
to inflammation in the sinus passages that lie behind the cheeks, nose, and eyes.
The pain tends to be worse when you bend forward and when you first wake up in the
morning. Postnasal drip, sore throat, and nasal discharge usually occur with these
Headaches may occur if you have a cold, the flu, fever, or premenstrual syndrome.
If you are over age 50 and are experiencing headaches for the first time, a condition
called temporal arteritis may prove to be the cause. Symptoms of this condition include
impaired vision and pain aggravated by chewing. There is a risk of becoming blind
with this condition. Therefore, it must be treated by your doctor right away.
Rare causes of headache include:
- Brain aneurysm -- a weakening of the wall of a blood vessel that can rupture and
bleed into the brain
- Brain tumor
- Stroke or TIA
- Brain infection like meningitis or encephalitis
Keep a headache diary to help identify the source or trigger of your symptoms. Then
modify your environment or habits to avoid future headaches. When a headache occurs,
write down the date and time the headache began, what you ate for the past 24 hours,
how long you slept the night before, what you were doing and thinking about just
before the headache started, any stress in your life, how long the headache lasts,
and what you did to make it stop. After a period of time, you may begin to see a
A headache may be relieved by resting with your eyes closed and head supported.
Relaxation techniques can help. A massage or heat applied to the back of the upper
neck can be effective in relieving tension headaches.
Try acetaminophen, aspirin, or ibuprofen for tension headaches. DO NOT give aspirin
to children because of the risk of Reye's syndrome.
Migraine headaches may respond to aspirin, naproxen, or combination migraine medications.
If over-the-counter remedies do not control your pain, talk to your doctor about
possible prescription medications.
Prescription medications used for migraine headaches include ergotamine, dihydroergotamine,
ergotamine with caffeine (Cafergot), isometheptene (Midrin), and triptans like sumatriptan
(Imitrex), rizatriptan (Maxalt), eletriptan (Relpax), almotriptan (Axert), and zolmitriptan
(Zomig). Sometimes medications to relieve nausea and vomiting are helpful for other
If you get headaches often, your doctor may prescribe medication to prevent headaches
before they occur. Examples of these include:
- Antidepressants such as nortriptyline (Pamelor), amitriptyline (Elavil), fluoxetine
(Prozac, Sarafem), sertraline (Zoloft), or paroxetine (Paxil) for tension or migraine
- Beta-blockers such as propranolol (Inderal) for frequent migraine headaches
- Calcium channel blockers such as verapamil for frequent migraine headaches
- Anti-epileptic medicines such as topiramate (Topamax)
If you are using pain medications more than 2 days a week, you may be suffering
from rebound headaches. Rebound headaches are caused by a cycle of using pain medications
for short-term relief, followed by the headache pain returning for increasingly longer
periods of time despite taking more pain medications.
All types of pain pills (including over-the-counter drugs), muscle relaxants,
some decongestants, and caffeine can cause this pattern. If you think this may be
a problem for you, talk to your health care provider.
When to Contact a Medical Professional
Take the following symptoms seriously. If you cannot see your health care provider
immediately, go to the emergency room or call 911:
- Your headache comes on suddenly and is explosive or violent.
- You would describe your headache as "your worst ever", even if you are
prone to headaches.
- Your headache is associated with slurred speech, change in vision, problems
moving your arms or legs, loss of balance, confusion, or memory loss.
- Your headache gets progressively worse over a 24-hour period.
- Your headache is accompanied by fever, stiff neck, nausea, and vomiting.
- Your headache occurs with a head injury.
- Your headache is severe and localized to one eye with redness in that eye.
- You are over age 50 and your headaches just began, especially with impaired
vision and pain while chewing.
See your provider soon if:
- Your headaches wake you up from sleep.
- A headache lasts more than a few days.
- Headaches are worse in the morning.
- You have a history of headaches but they have changed in pattern or intensity.
- You have headaches frequently, and there is no known cause.
What to Expect at Your Office Visit
Your health care provider will obtain your medical history and will perform an examination
of your head, eyes, ears, nose, throat, neck, and nervous system.
The diagnosis is usually based on your history of symptoms. A "headache diary" may
be helpful for recording information about headaches over a period of time. Your
doctor may ask questions such as the following:
- Is the headache located in the forehead, around the eyes, in the back of the head,
near the temples, behind the eyeball, or all over?
- Is the headache on one side only?
- Is this a new type of headache for you?
- Would you describe the headache as throbbing?
- Is there a pressure or band-like sensation?
- When does the headache occur? How long have you had headaches? How long does
each headache last?
- Does the headache awaken you from sleep? Are the headaches worse during the
day and better at night?
- Did other symptoms begin shortly after the headaches began? Do headaches occur
- Does the headache reach maximum intensity over 1 to 2 hours?
- Are the headaches worse when you are lying down? Standing up?
- Are the headaches worse when you cough or strain?
- Do they occur at a specific time related to your menstrual period?
What home treatment have you tried? How effective was it?
Diagnostic tests that may be performed include the following:
- Head CT scan
- Head MRI
- Sinuses x-rays
- Temporal artery biopsy
- Lumbar puncture
If a migraine is diagnosed, medications that contain ergot may be prescribed.
Temporal arteritis must be treated with steroids to help prevent blindness. Other
disorders are treated as is appropriate.
The following healthy habits can lessen stress and reduce your chance of getting
- Getting adequate sleep
- Eating a healthy diet
- Exercising regularly
- Stretching your neck and upper body, especially if your work involves typing
or using a computer
- Learning proper posture
- Quitting smoking
- Learning to relax using meditation, deep breathing, yoga, or other techniques
Lipton RB, Bigal ME, Steiner TJ, Silberstein SD, Olesen J. Classification of primary
headaches. Neurology. August 10, 2004;63(3):427-35.
Snow V. Pharmacologic management of acute attacks of migraine and prevention of
migraine headache. Ann Intern Med. 2002; 137(10): 840-849.
Kaniecki RG. Migraine and tension-type headache: an assessment of challenges in
diagnosis. Neurology. 2002; 58(9 Suppl 6): S15-20.
Review Date: 5/16/2006
Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience
Institute, University of Florida Health Science Center, Jacksonville, FL. Review
provided by VeriMed Healthcare Network.
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