Unified Health

Identifying Headache Type for Effective Treatment Strategies

Headaches are never fun. Having had my fair share of them, there are many different kinds of headaches. Knowing the details about things like the location of the pain – behind the eyes, top of the head, base of the skull, etc. – duration, frequency and intensity can help to identify if the cause of head pain is muscular (tension headaches), something more akin to migraines, nerve pain headaches, or something more serious. Knowing what kind of headache you have makes it easier to know what kind of treatment might be helpful for you. 

Tension Headaches: Often described as the feeling of a tight band around your head, tension headaches are often caused by stress and muscle tension. Pain is often felt as tenderness and tightness at the base of the skull, in the neck and shoulders, and across the temples and forehead. It is a common headache to see in people who work at a desk all day. Tension headaches are also often accompanied by neck pain and that nasty pain you get between the shoulder blades and it is often pronounced on one side.

Tension headaches are typically best managed through healthy lifestyle changes, stress management, and physical therapy such as massage, osteopathic or chiropractic treatment, and physiotherapy. Since tension headaches are often caused by cervical compression, they respond extremely well to cervical adjustment. The adjustment breaks the pain/tension cycle by removing the irritation of the 2nd cervical (sub occipital) nerve. 

Migraine Headaches: Words often used to describe migraine headache pain include throbbing, pounding, ‘boom boom boom’, etc. That’s because migraine headaches are usually caused from irritated blood vessels rather than from muscle tension or nerve pain. Often the pain is felt on one side of the head, can be quite severe, and is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. They can also frequently (but not always) be preceded by an ‘aura’ – visual disturbances such a wavery lines, white spots, blind spots, etc. 

These types of headaches are best helped through a mix of medication, learning coping skills, and identifying triggers such as dietary ones (aged cheese, chocolate, wine, caffeine, aspartame, processed foods, monosodium glutamate (MSG) and salty foods have all been shown to be common migraine trigger foods), hormonal fluctuations, bright lights or sun glare, weather changes, sleep pattern changes, and physical exertion (exercise can make migraines worse, but tension headaches better). Migraine headaches are often alleviated with Craniosacral Therapy.

Some other suggestions for helping migraine pain from the Mayo Clinic:

  • Create a consistent daily schedule. Establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.

  • Transcutaneous supraorbital nerve stimulation (t-SNS). Cefaly, a device recently approved by the Food and Drug Administration in the US and now available in Canada, has been shown to help reduce the number of migraine attacks. 

  • Learn to cope. Recent research shows that a strategy called learning to cope (LTC) may help prevent migraines. In this practice, you are gradually exposed to headache triggers to help desensitize you to them. LTC may also be combined with cognitive behavioral therapy. More research is needed to better understand the effectiveness of LTC.

Nerve Pain Headaches: Suboccipital neuralgia, greater occipital neuralgia, trigeminal neuralgia – generally anything that has a neuralgia at the end tells you that your headache pain is coming from an irritated nerve. These kinds of headaches are best helped through a mix of medication, physical therapy, and in extreme cases surgery. 

Keep a record of your headaches and how you treated them. Then make an appointment with your doctor or nurse practitioner to discuss your headaches. 

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

See your doctor or nurse practitioner immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate a more serious medical problem:

  • An abrupt, severe headache like a thunderclap

  • Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking

  • Headache after a head injury, especially if the headache gets worse

  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement

  • New headache pain if you're older than 50

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