Most people have likely suffered from a headache at one point or another. In fact, says Summit Health neurologist Dr. Lisa Coohill, "headaches are fairly common and affect three quarters of adults." It's important to understand the type of headache you have— and what the cause might be—to properly treat your pain and determine if there is another underlying problem.
Not all headaches are the same. In fact, the medical community divides them into two overarching categories—primary and secondary. "Primary means there is no serious underlying etiology or set of causes," explains Dr. Coohill. These types of headaches include:
- Tension headaches
- Cluster (rare)
In contrast, says Dr. Coohill, secondary headaches have an underlying cause. These include:
- Sinus infection
- Arterial inflammation
- Intracranial hypertension
- Cerebral hemorrhage
- Cerebral venous thrombosis
- Brain tumor
- Neck-related causes
When it comes to preventing secondary headaches, the key is identifying the underlying cause and treating that. For primary headaches, lifestyle changes can have an impact on prevention. "Diet affects headaches, especially migraines," notes Dr. Coohill, pointing to the following as potential causes:
- Aged cheese
- Alcohol (in particular red wine)
Other important contributing factors are:
- Lack of sleep
- Not staying well-hydrated
- Skipping meals
If lifestyle changes don't help, work with your doctor to discuss other options for ongoing treatment or preventative steps. Dr. Coohill points to migraines as an example. They can be treated as they occur with triptan drugs or the CGRP receptor blockers. But if migraines are quite frequent, getting ahead of them helps. "If the frequency of migraines is greater than four times per month, a patient may benefit from preventive medication" she says. "This includes beta-blockers (like propranolol), seizure medication (including topiramate and gabapentin), or antidepressants (such as amitriptyline)."
If you have a family member who also suffers from headaches, it's possible that they run in the family. "Migraines and cluster headaches can be hereditary," notes Dr. Coohill. It's also important to note that certain secondary headaches could be due to family history. "Headaches from cerebral aneurysm rupture can be hereditary," says Dr. Coohill. "So if you have a first-degree relative who has had an aneurysm rupture, you should be screened for aneurysm."
"You should seek medical attention immediately for severe and sudden-onset headaches," says Dr. Coohill. "What is usually referred to as, 'the worst headache of my life' could indicate a subarachnoid hemorrhage from an aneurysm rupture."
Other notable symptoms to look out for:
- Headache with stiff neck and fever, which could indicate meningitis
- Headache that is worse lying down, which could indicate a tumor or intracranial hypertension
If you don't need emergency medical treatment, you should still discuss your headaches with your doctor to review and address any potential health problems.
It is very helpful to keep a headache diary with details of your headache episodes, including timing, frequency, duration, severity, trigging factors, alleviating factors, associated symptoms, and response to mediations. This information will help your provider and you gain additional insights about headache type, prevention, and treatment.