Last updated on April 10th, 2021 at 05:34 am

MIGRAINE HEADACHES EXPLAINED.

@Neuralgroover

Migraines are a very intense type of headache that are often accompanied by other symptoms, including nausea, vomiting, sensitivity to light and sound, as well as neurological symptoms such as visual disturbances, numbness or tingling, speech disturbances (slurred speech, difficulty getting words out), weakness, vertigo, cognitive dysfunction or “cognitive fog”, among other things. Migraines tend to be more prevalent in women than in men, with a 3:1 ratio. A common risk factor for migraines often involves family history, but not for everyone.  People who suffer from migraines report intense feelings of pain, including a pulsating/throbbing sensation. This often occurs on 1 side of the head, but can also involve both sides. Exercise and activity during a migraine will often make it worse. Migraine is usually associated with nausea, and/or sensitivity to light (photophobia) and sound (phonophobia)  Migraines often come in different phases, which are called prodrome, aura, the headache phase, and postodome, but not everyone gets all 4 phases:

• The prodromal phase of a migraine often marks the beginning of a migraine attack and can happen over a period of a few hours ranging to a few days. Some of the symptoms include irritability and depression; food cravings; yawning and tiredness; and fatigue or muscle stiffness. Some patients report their prodrome as just a difficult to describe feeling that they recognize as an early warning sign of an impending migraine. Not every migraine attack includes the prodromal phase.
• The aura phase of a migraine doesn’t necessarily always happen in every migraine attack, and only about 25% of patients with migraine get aura. Historically, those that get aura are called “classical migraine”, whereas “common migraine” refers to the more common variety of migraine which isn’t associated with aura. A large number of people who have migraines report that during the aura phase, they experience loss of sight, numbness, and other symptoms. Visual aura (loss of vision, jagged lines, flashing, colors, shapes, wavy lines, kaleidoscope, shimmering, expanding blind spot, etc.) are the most common aura. This is followed by numbness and tingling on 1 side (especially face and arm), and then dysphasia (trouble speaking; slurred speech, getting words out). There are also less common types of aura such as hemiplegic migraine aura (1-sided weakness), and brainstem aura (previously called “basilar migraine”; slurred speech, vertigo, tinnitus, double vision, hearing impairment, decreased level of consciousness, ataxia/imbalance). The aura phase should last between 5-60 minutes per ICHD3 criteria. Hemiplegic migraine can be associated with 1-sided weakness which can last up to 3 days. If the other types of aura last longer than 60 minutes, it is called prolonged or atypical aura, and usually warrants a brain CT or MRI, although it is not too uncommon to see. .
• The headache phase of a migraine is often the longest and most intense period of a migraine. Symptoms include intensive throbbing, nausea, giddiness, irritability, stiffness, and soreness. According to ICHD3 criteria, an untreated or unsuccessfully treated migraine attack should last 4-72 hours. A headache lasting longer than 72 hours (3 days) is called status migrainosus. It is not uncommon for a refractory migraine to last days and sometimes weeks for some patients.
• The postdrome phase is the drawing down of a migraine attack. It can last for up to 48 hours and some of the lingering symptoms remain from the other phases of a migraine attack. Patients often report feeling wiped out, fatigued, and sore as if they were “hit by a bus”.

According to the American Migraine Foundation, more than 36 million people suffer from migraines (although now estimated to be closer to 39 million), but only one out of three people actually talk to their doctors about their pain.

Statistics About Migraines and Their Prevalence

According to several different sources, migraines are one of the most common types of illness in the world. More specifically, it is ranked as the 3rd most prevalent illness in the world. It is estimated that migraine affects about 39 million Americans, and 1 billion worldwide. For example, 1 in 4 households in the United States have an individual that suffers from migraine attacks. Migraines impact 18-20% of women (1 in 5) and 6% of men (1 in 16) in the United States and they are also fairly common in children.

Migraines are also a common cause for an emergency room visit. In fact, there are more than 1.2 million emergency room visits each year in the United States for someone who is suffering from an acute migraine attack. Patients with migraine have a greater than 1.5 fold increase in office visits, and a greater than 2 fold increase in ER visits and hospital admissions. Migraines can also diminish the quality of life for the people who suffer from them. More than 4 million adults suffer from chronic migraine pain, which is an individual who is experiencing more than 15 days of migraine pain each month. Approximately 3% of patients will transform from episodic migraine to chronic migraine each year. Overall, it is estimated that 3-5% of patients in the United States have chronic migraine. Also, 20% of people who suffer from chronic migraines are disabled. Disability due to migraine peaks between the ages of 15-49 years old, which are peak employment years. Thus, migraine now accounts for the 2nd leading cause of years lived with disability following low back pain! Migraine also accounts for 50% of all neurologic disability. All of this puts a very high price tag on migraine, with an estimated 36 billion dollars spent in migraine costs in the United States each year.

Migraines in Children

Migraines are commonly undiagnosed in children. They are more commonplace in adolescent children, but 10% of school-age children suffer from migraines. Half of all migraine sufferers have their first migraine attack before they turn twelve and if a child has one parent who suffers from migraines, they have a 50% chance of developing migraines during their lifetime. Also, boys under the age of twelve tend to have migraines more often than girls, but that trend reverses in adolescence, typically with onset of menarche (which also highlights the hormonal influence on migraine).

What Causes Migraines?

There are a number of reasons that people suffer from migraines, but the true cause of them is not fully understood. Genetics and environmental factors play a role. In fact, around ⅔ of migraine cases run in families. Migraines also tend to happen in people who are prone to stress, bipolar disorder, and depression. There are also some common triggers for migraines, including:

• Drinks, such as alcohol and caffeinated beverages.
• Work stress or stress at home.
• Bright lights or strong smells.
• Drastic changes in one’s sleep cycle.
• Bouts of overexertion.
• Changes in the weather or other barometric pressure changes
• Certain foods and food additives such as MSG, nitrates, aspartame, and other substances such as artificial sweeteners.

Migraine Theories:

1) Vascular theory; “vascular headache” (outdated):

a) Lack of blood flow (ischemia) caused by vasoconstriction (narrowing) of the intracranial arteries (arteries inside the brain) caused migraine aura.

b) The vasoconstriction was then followed by rebound vasodilation (dilation) of the arteries. This dilation activated pain receptors on the arteries, and this was the cause of the pulsating headache.

c) This theory has since been disproven and outdated. Studies have also shown that the physical pulsations of the arteries did not correlate to the pulsating sensations of the headache pain.

2) Neurovascular theory (current):

a) Migraine is a neurogenic process with secondary changes in cerebral perfusion (related to neuronal dysfunction and hypometabolism during an attack). In other words, migraine is an electrical neurological event in the brain, not an event triggered by blood flow changes. This electrical event influences changes in brain metabolism such as hypometabolism and hypermetabolism. When the neurons are in a hypometabolism state, they have less oxygen and glucose requirement since they are not as active, and thus there is a lack of blood flow (not due to vasoconstriction of the brain arteries). This can be followed by hypermetabolism in which there is an increase in oxygen and glucose requirements and thus, increase in blood flow (so not necessarily simply rebound vasodilation).

b) Migraine aura is a good illustration of this phenomenon. Migraine aura is caused by an electrical wave spreading across the cortex of the brain moving at about 3 mm per minute (not by vasoconstriction as per the older vascular theory). At the front of this spreading electrical wave it causes hypermetabolism and an increase in blood flow. This hypermetabolism causes the “positive” migraine aura features (colors, flashing lights, kaleidoscope, shapes, zig-zags, tingling sensory changes, etc.). Following this electrical wave there is “neuronal depression” and hypometabolism, associated with a decrease in blood flow. This hypometabolism causes the “negative” migraine aura features (loss of vision, black spots, numbness, etc.). Depending on where this wave spreads, you may get different aura symptoms; visual aura as it spreads across the occipital (visual) cortex, sensory/numbness/tingling as it spreads across the parietal (sensory) cortex, dysphasia (trouble speaking, slurred speech) as it spreads across the frontotemporal (speech) cortex, one sided weakness in hemiplegic migraine as it spreads across the frontal (motor) cortex, brainstem symptoms such as vertigo, tinnitus, double vision, hearing loss, imbalance, decreased level of consciousness, slurred speech (previously called basilar migraine, now called migraine with brainstem aura) as it spreads across the brainstem.

c) The electrical event of migraine not only causes the changes in metabolism as described above, but the trigeminal nerves are also activated. Think of migraine as an electrical switch that gets turned on in the brainstem. It then turns on and activates the trigeminal nerves. The trigeminal nerves innervate all of the arteries in the brain and through the meninges surrounding the brain. When activated, the trigeminal nerves release a variety of inflammatory proteins (such as CGRP) and neuropeptides. The result of this is 3-fold:

–1st, these inflammatory peptides cause neurogenic inflammation around the brain. Think of it like a sterile (non-infectious) meningitis. So, when you’re having a migraine, exercise and activity, moving around, bouncing in a car, etc. often worsen the pain.

–2nd, it causes cerebral vasodilation in the brain and meninges. The dilation itself does not cause the pain, but rather it triggers the trigeminal nerves which innervate the arteries, and this sends signals back to the brain that something is going on, which in turn causes more release of inflammatory proteins and causes the migraine to worsen. This is the basis of why it is called the neurovascular theory of migraine.

–3rd, it enhances and exaggerates the transmission of pain from the trigeminal nerves, into the brainstem, and into the cortex of the brain where the pain is recognized.

At baseline, a patient with migraine who is not having a headache always has a state of neuronal hyperexcitability in the cerebral cortex, especially in the occipital cortex (which is why the majority of aura symptoms tend to be visual aura). So, they have a much lower threshold to a migraine being activated and triggered as compared to someone without migraine. In other words, the neurological system in a patient with migraine can be thought of as always being in a hyperactive, hypersensitive, overdrive state with the “volume turned way up” compared to a person without migraine. Thus, I tell my patients the goal of preventive treatment is to “turn the volume down” and increase the threshold of migraine being triggered so easily.

What Are Some Common Treatments for Migraines?

There are two categories of treatment for any type of headache, including migraines. Migraines can be treated through abortive or preventive means. Abortive treatment for any type of headache includes medications such as aspirin, which treats the headache while it’s happening. Preventative treatments are intended to keep a headache or migraine from happening so frequently. Here are some of the different types of treatments for migraines.

Abortive Treatment for Migraines

The goal of migraine abortive treatments is to stop individual migraine attacks at onset so the migraine does not reach full severity, ends quickly, and your function is restored and maintained rather than having to go lay down and miss the whole day in bed.  Over-the-counter pain relievers for migraines, such as aspirin or ibuprofen, are fairly commonplace. Some more aggressive abortive treatments include prescription medications like triptans (such as Maxalt) that block pain pathways within the brain. Some people may also receive anti-nausea drugs and opioid prescriptions to deal with more intense migraine symptoms. The migraine specific abortive/acute (as needed) treatments include triptans, gepants (Ubrelvy, Nurtec), ditans (Reyvow) or neuromodulatory devices.

Preventative Treatments for Migraines

Medications that lower blood pressure, antidepressants, anti-seizure drugs, CGRP monoclonal antibodies, and even botox are some of the common preventative treatments for migraines. The classification of the preventive medicine typically has nothing to do with its purpose when it is used for migraine. For example, there are specific anti-blood pressure medicines that are good for migraine prevention. However, they do not work for migraine because of blood pressure changes, but rather they affect the electrical pathways of migraine. The same scenario goes for the antidepressant/anti-anxiety and anti-seizure categories. The medicines selected within each of these preventive categories are very specific and based on clinical trials and evidence. In other words, not all medicines within a specific medication class (such as all antidepressants) have evidence for migraine prevention, but rather very specific ones within that class. Medications that are designed to lower blood pressure can sometimes prevent migraines with aura and without aura. Certain types of antidepressants can help prevent migraines, but have some undesirable side effects in some individuals. Anti-seizure drugs, such as Topamax, can reduce the frequency of migraines in some individuals. The preventive migraine treatments should be used until the migraine and headache frequency is significantly improved consistently for several months. As mentioned above, this can be done with a variety of medications which may also include the CGRP monoclonal antibody (mAb) treatments (Aimovig, Ajovy, Emgality, Vyepti), Botox, natural supplements, herbals and vitamins, or neuromodulatory devices.

Alternative Treatments for Migraines

Some other types of treatment for migraines include acupuncture, cognitive behavioral therapy, supplements, essential oils, yoga, meditation, and other techniques designed to enhance relaxation. For some individuals, exercise can decrease the frequency of migraines. In fact, some studies have shown that a routine exercise program can be just as effective as some of the prescription preventive medications used for migraine. Neuromodulatory devices that are FDA cleared for migraine prevention are also available and include sTMS (SAVI, SpringTMS, sTMS mini),  eTNS (CEFALY), and nVNS (GAMMACORE), all of which are discussed in much greater detail here. There are also nutraceuticals and supplements which have good evidence for migraine prevention.

Finding Help For Migraines

Migraines remain a poorly understood medical condition, but there are treatments available. Only 4% of people suffering from migraines work with a headache specialist or a pain specialist. It is estimated that preventative treatment could benefit around 25% of people who suffer from severe migraines.

If you suspect that your headaches are migraines, you should see your doctor. Furthermore, any type of headache warrants at least one visit with your doctor to make sure there are no concerns by medical history or examination for any other worrisome causes of your headaches. They may refer you to a neurologist or other type of headache specialist. Oftentimes, a wide variety of tests may be given, including CT scans and MRIs, to see what is contributing to the cause of the migraine. The good news is that migraines can be successfully managed for the majority of patients, and that many people live with them thanks to the treatments that they receive.

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING TO ASK QUESTIONS TO A HEADACHE SPECIALIST OR OTHER HEADACHE, MIGRAINE, AND FACIAL PAIN WEBSITE MEMBERS, VISIT OUR FREE DISCUSSION FORUMS HERE.

Last updated on April 10th, 2021 at 05:29 am

TYPES OF HEADACHES – 2021

@Neuralgroover

According to the World Health Organization, headaches are a global problem, affecting people of all races, income levels, and regional areas. Headache disorders impact about 50% of people worldwide. Moreover, it is estimated that 50% to 75% of adults aged 18 to 65 have suffered from a headache or a migraine within the last year. A smaller percentage of people worldwide, 1.7% to 4%, have headaches that last for two weeks or longer. Let’s take a look at the four different types of headaches, what causes them, and some common treatments that may relieve them.

The Four Different Types of Headaches

There are, in fact, 150+ different types of headaches. However, the four most common types of headaches are: tension headaches, migraine headaches, sinus headaches, and cluster headaches.

What Are Tension Headaches?

Tension headaches typically are moderate to mild in nature and can be best described as feeling like a tight band around one’s head. By and far, these are the most common types of headaches and their origins are not well understood. Common symptoms include a dull, aching, pressure pain in both sides of your head; tightness in your forehead, sides, and back of your head; and muscle soreness in your shoulder, neck, and scalp. They can not be a throbbing pain. If there is any throbbiness to the headache, it takes it out of tension type headache criteria and moves it into migraine criteria. Tension type headaches are not worsened by physical activity, in contrast to migraine which are. Tension type headaches should not be associated with nausea or vomiting, in contrast to migraine which can be. There may be some mild sensitivity to light (photophobia) or sound (phonophobia), but tension type headache should not have both. In contrast, migraine requires both features.

What Are Sinus Headaches?

Sinus headaches are usually indicated by pressure around your eyes, cheeks, and forehead. You may also experience a throbbing forehead. However, these features can also be consistent with migraine because in general, any type of throbbing pain places the headache into the migraine category. In fact, there was a large study done in the past in which almost all of the patients with either self-diagnosed or physician-diagnosed sinus headache turned out to actually be migraine headache.  Migraine also activates the sinus pathways and cavities and can cause referred pain into the teeth and TMJ areas. So for many patients, their migraines include a lot of sinus type symptoms. Therefore, it is easy to see how migraine often gets mistaken for sinus headache. For some people with true sinus headache, they feel like a sinus infection. Historically, the existence of true “sinus headaches” has been a debatable topic, and it’s presence generally revolves around whether there is an ongoing sinus infection or not. If there is, this can certainly be a source of headache, and it is typically associated with fevers and drainage (often colored, purulent discharge).  Some common symptoms include:

• Fatigue
• A stuffy sensation in your nose
• Pain and pressure in your cheeks, brows, and forehead.

What Are Cluster Headaches?

Cluster headaches are called as such because they happen over cyclic time frames or “clusters.” These types of headaches can wake you up in the middle of the night and they frequently happen on one side of your head or near an eye. The pain of cluster headaches is severe, and they have been termed “suicide headaches” because of the severity of the pain. Cluster headaches are more rare than other types of headaches. Some symptoms include:

• Pain that is situated around or behind one eye
• One-sided pain, versus other headaches where the sensation of pain is often more global
• Stuffy or runny nose on the side of your head that hurts
• Red and tearing eye on the side of the head that is impacted
• Restlessness

What Are Migraine Headaches?

Migraine headaches, according to some patients, are the worst type of headache. These types of headaches are characterized by a throbbing sensation, most commonly one one side of the head, but can also be both sides. Additionally, they often come with nausea, sometimes vomiting, and a sensitivity to light and sound. Migraines come in stages, but not everyone goes through all the stages.

The stages of migraines include:

• Prodrome: Some mild symptoms that indicate an oncoming migraine attack, including neck stiffness, moodiness, food cravings, and other subtle symptoms. This may occur even a day or more before the attack starts.

• Aura: Seeing bright lights or various shapes, numbness and tingling, speech disturbances, overall weakness, and other symptoms that happen right before or during the onset of a migraine. About 25% of patients get aura (classic migraine), while 75% get no aura (common migraine).

• Attack: During a migraine attack, migraine sufferers typically experience the worst symptoms, including pain on one side of the head, nausea, and other symptoms. A migraine attack itself can last for up to 72 hours.

• Post-Drome: After the migraine, people tend to experience tiredness and sudden head movement can bring on some pain. At this stage, people report excess fatigue, generalized soreness, and commonly report feeling like they were “hit by a bus”.

Migraines can be read about in much more detail here.

Common Questions About the Various Types of Headaches

What causes the various different types of headaches?

There is not a singular known medical cause for headaches. Primary headaches are when the headache itself is the primary health issue that the sufferer is dealing with. Secondary headaches are those that are caused by a medical condition (such as a brain tumor). Let’s take a look at what the most common causes are for the various types of headaches:

• Tension headaches: These can be caused by stress, depression, injury, or other issues.

• Sinus headaches: These headaches are most commonly caused by sinusitis and allergies.

• Cluster headaches: The exact cause of cluster headaches are unknown, but it may have something to do with biological processes since cluster headaches are cyclical.

• Migraines: As with other types of headaches, there migraines don’t have a clear cause. Common suspected causes include hormones, diet, dehydration, and other physical or lifestyle factors.

When should you seek medical attention/advice for any type of headache?

You should seek medical attention/advice when you have any type of headache. Sometimes, a headache may be indicative of a larger medical problem. At least one visit with your doctor is recommended for any type of headache because even secondary headaches (caused by a medical condition) can sometimes present as a standard primary type of headache. A visit with your doctor may uncover additional information from a more detailed history during questioning and neurological physical exam. Repeat headaches can impact the quality of your life and should be treated. Sometimes, your regular doctor may not know how to adequately deal with a headache. Some doctors are especially trained to deal with headaches, specifically headache specialists.

What type of headaches should a headache sufferer worry about?

Generally speaking, any type of headache should be a cause for concern. However, there are certain situations where headaches may be indicative of a larger, more serious medical issue. Headaches associated with the following symptoms should be a cause for concern:

• A high fever, chills, night sweats, neck stiffness
• The sudden onset of very intense headache pain (thunderclap headache) with peak headache intensity in less than a minute
• Fainting, disorientation, or loss of balance or equilibrium
• Weakness on any side of the body or any other neurological symptoms including visual loss or vision changes, double vision, trouble swallowing, numbness, tingling, speech disturbances (slurred speech, trouble getting words out, trouble understanding speech), vertigo, behavioral or personality changes
• Nosebleeds
• Pulsatile tinnitus or papilledema (swelling of optic nerve on eye exam)
• Other issues, such as weight loss, vision issues, jaw cramping, and other factors
• History of cancer, immunosuppression, HIV
• New onset headaches under age 5 or over age 50
• Headaches triggered by Valsalva maneuvers (coughing, straining, laughing, bending forward, exertion, exercise, sexual activity, bearing down such as during a bowel movement)
• Progressive worsening and changing of headaches into a higher frequency or daily frequency
• Postural worsening of headache (worsens when standing and improves when lying down, or worsens when lying down, improves when standing up)

What are some common tests for the more serious types of headaches?

Some headaches, such as cluster headaches, are not commonly understood. Other types of headaches may have an underlying cause. If you see a neurologist or other medical specialist, you might experience some of the following tests for them to better diagnose and understand the underlying cause of your headache:

• Eye & ear exam
• CT scan
• MRI scan
• EEG scan
• Blood and spinal fluid tests

A headache specialist will often try and get access to your medical records and history so that they can better treat your condition.

Which type of doctor commonly deals with the various types of headaches?

Neurologists are the most common type of specialized doctor that headache sufferers see. However, they will often refer to a headache specialist for more complex headache and facial pain disorders, or if treatments are not helping the patient. General medical practitioners may be able to make a referral and provide some basic treatment, as they are often the first line of headache evaluations. On occasion, an ENT doctor may provide treatment for secondary headaches that are related to sinus and ear issues.

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING TO ASK QUESTIONS TO A HEADACHE SPECIALIST OR OTHER HEADACHE, MIGRAINE, AND FACIAL PAIN WEBSITE MEMBERS, VISIT OUR FREE DISCUSSION FORUMS HERE.

Last updated on April 10th, 2021 at 05:31 am

TENSION HEADACHES – 2021

@Neuralgroover

Tension headaches are the most common types of headaches that people suffer. In fact, tension headaches afflict three out of every four Americans from time to time, according to Harvard Medical. Chronic tension headaches are very infrequent, but they do persist in some individuals on occasion.

What Are Tension Headaches?

Tension headaches produce a dull pain on both sides of the head and on occasion may cause some additional aching sensations in the shoulders and neck. Achy, pressure, or tightness are the most common pain descriptions. If there is any level (even if very low level) of throbbing, pounding, or pulsating, it moves the pain out of tension type headache criteria and into migraine headache criteria. Tension headaches do not come with other symptoms, like vomiting or nausea. There may be some mild level of sensitivity to light (photophobia) or sound (phonophobia), but there can not be both together per ICHD3 criteria. If there are both present, it moves the headache into more of a migraine type of headache, which does require these to occur together, rather than restricted to one or the other. Your doctor may refer to these as “tension-type headaches.” They are often referred to as “stress headaches” by people too.

Typically, people don’t see their doctor for tension headaches. These types of headaches may last for a short time (30 minutes) and last for up to two hours, depending on the individual. By International Classification of Headache Disorders criteria (ICHD3), they can last from 30 minutes up to 7 days. Tension headaches are different from other types of headaches because:

• The pain typically is not as severe (as with a migraine)
• The headache might only happen briefly (different from a cluster headache, which comes and goes over different periods of time)
• They typically are not caused by a sinus or ear issue (as with a sinus headache, which could indicate a sinus infection).

What Causes Tension Headaches?

Tension headaches are not caused by a single underlying factor. They are not hereditary. Some medical professionals believe that tension headaches are caused by tension in the neck, scalp, and shoulder muscles. There are some suspected “triggers” for tension headaches, which may include:

• Staring at a television or computer screen for too long
• Sitting for work with an uncomfortable posture
• Jaw issues
• Issues sleeping

Stress may also be a trigger for tension headaches. If you are having family issues, recently lost a job, or you are overcommitted in any aspect of your life, you may experience tension headaches from time to time.

How Do You Prevent Tension Headaches?

Some tension headaches may be prevented by good lifestyle choices. For example, if you work frequently at your computer, take breaks while working. Good posture is also going to reduce strain on your neck and shoulder muscles, helping reduce the likelihood of a tension headache.

Reducing stress is also a good way to reduce the likelihood of a tension headache. Little things, such as organizing your day, taking breaks, and reducing certain stressful obligations may help reduce the onset of tension headaches.

If these conservative treatments are not helpful, sometimes daily preventive medications are used for a few months until the headaches improve in frequency.

When Is a Tension Headache Considered Chronic?

A tension headache is considered chronic when a person suffers from the tension headache 15 or more days per month for three or more months. Chronic tension headaches may be indicative of other health issues.

What Are Some Common Treatments for Tension Headaches?

When a medical professional describes “abortive treatments” for tension headaches, they are referring to medications that you take as needed to relieve the headache. These can include Tylenol, Advil, Excedrin, and other over-the-counter medications.

Some other types of treatments include preventative measures that are employed to reduce the likelihood and intensity of a tension headache. Some types of preventative treatments that are not in the form of medication include massage, relaxation therapies, acupuncture, and other similar treatments. Lifestyle changes may also reduce the likelihood of tension headaches. Reducing caffeine consumption, good diet and nutrition, and healthy sleeping patterns will play an important role in reducing tension headaches.

If you notice the onset of a tension headache, there are some common remedies that also produce good results:

• Use a cold compress and take a break in a cool, dark room
• Relax and reduce stress
• Eliminate the trigger that you think caused your headache (for example, use an ergonomic chair if you are working at a desk)
• Consider reducing lifestyle factors that contribute to stress

Does Diet Play a Role in the Onset of Tension Headaches?

Tension headaches are closely related to diet. If you get tension headaches, you may avoid them in the future by watching consumption of the following foods and beverages:

• Caffeinated beverages and diet soft drinks
• Deli meat, ham, bacon, and other processed meats can contain nitrates, which may lead to tension headaches
• Avoid aged cheese to reduce the likelihood of a tension headache
• Ramen noodles, Doritos, and other similar foods use MSG, which can lead to tension headaches

People who like soda may benefit from soft drinks that do not contain caffeine or artificial sweeteners. Sprite and other citrus soft drinks do not have artificial sweeteners and caffeine that can contribute to headaches.

Weight also is a contributor to tension headaches, as well as other types of headaches. Being overweight can cause tension headaches and people who are overweight might also experience migraines more frequently than people who have a healthy weight level.

What Are Rebound Tension Headaches?

Rebound headaches happen when your headache comes back. If you regularly take medication to deal with a headache, overuse of headache medications may cause your tension headache to rebound. To reduce the likelihood of a rebound headache, try to limit your consumption of medications like ibuprofen, naproxen, and tylenol to no more than two days per week, or 10 days per month overall.

What Is the Outlook for Tension Headaches?

Fortunately, the outlook for tension headaches is very good. While most Americans will suffer a tension headache on occasion, very few people develop chronic tension headaches. Also, a tension headache will generally not last long, maybe an hour or twos. And if you deal with a tension headache right at its outset and practice good lifestyle choices, tension headaches won’t be a common occurrence in your life.

Getting family members, coworkers, and friends on board will also help reduce headaches. When a person is frequently asked about their headache, they are more likely to be focused on it. Directing attention to other aspects of one’s day will not make a tension headache sufferer dwell on their headache.

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING TO ASK QUESTIONS TO A HEADACHE SPECIALIST OR OTHER HEADACHE, MIGRAINE, AND FACIAL PAIN WEBSITE MEMBERS, VISIT OUR FREE DISCUSSION FORUMS HERE.

Last updated on April 5th, 2021 at 12:57 am

HEADACHE CHART AND HEADACHE LOCATIONS FOR DIFFERENT TYPES OF HEADACHES.

@Neuralgroover

I can picture it now. You’re sitting there late at night breaking out into a cold sweat, heart racing, convincing yourself a brain tumor is the cause of your headache as you are Googling a variety of terms such as…

…temple headache, headache behind eye, headache behind eyes, headache on top of head, headache in the temples, headache back of head, headache in front of head, headache on one side, front of head headache, headache on right side, headache on left side, headache in temple, headache forehead, pain behind eye, headache behind the eyes, headache and nausea, pain behind eyes, headache on left side of head, headache on right side of head, headache in back of head, front head headache, headache temple, headache at the front of head, stomach upset, left side headache, right side headache, headache behind right eye, temples headache, headache behind left eye, nausea and headache, pain in head, sharp pain in head, neck pain and headache, constant headache, head pressure, ice-pick headache, headache front, pressure headache, sex headache, exertion headache, cough headache, right temple headache, left temple headache, throbbing headache, headache meaning location, frontal headache, types of headaches diagram, headache types chart, pounding headache, headache locations chart, headaches in eyes, pain top of head, headache above left eye, headache map, headache above right eye, etc., etc., etc…

Ok, I think you get the point. Sound familiar? Now that you’ve earned your honorary Doctor Google degree, let me help provide some direction for you and your headache self-research.

And let me tell you a BIG secret…

Headaches are not diagnosed based only on their location. They are diagnosed by the “company they keep”. In other words, the characteristics, patterns, and associated symptoms that go with the headache are the more important key pieces of information which narrow down the most likely headache types. Headache location by itself without any other information is actually quite useless. The International Classification of Headache Disorders (ICHD3) classifies every headache type according to the headache and all of the associated features. Each headache type must match a specific set of characteristics and associated symptoms set forth in the criteria, and headache location is only one of many features taken into account.

By combining the headache location with associated symptoms, patterns, and characteristics of the headache, it can then be more accurately narrowed down. This in turn makes choosing the correct treatment more accurate and effective. This is absolutely key. The end result is that you are on the more appropriate path to improvement rather than someone throwing “headache” pills randomly at a headache that they haven’t given a specific name to, and the treatment they are using may not be the treatment that your specific type of headache needs (and sometimes it can even make it worse). I see this scenario in my headache clinic every day given the shortage of headache specialists. This is why I created a FREE headache and facial pain symptom checker as discussed further down.

Let’s take migraine as just one example. Migraine can vary widely in its location between patients and between attacks within the same patient. Any one of those Googled headache location terms listed at the top could potentially represent migraine. Those locations could also represent many other specific types of headaches as well, and they would require a much different type of treatment or evaluation than migraine would. The headache location doesn’t fully match with migraine until you combine it with the required criteria of associated symptoms that make the migraine diagnosis which may include a combination of symptoms such as nausea, sensitivity to light (photophobia), sensitivity to sound (phonophobia), throbbing or pounding pain, moderate to severe pain intensity, worsening with exercise, one sided predominance, and of course ruling out other more concerning “secondary” causes of the headaches. So clearly, Googling the headache location alone doesn’t help you figure out the cause or type of the headache at all, nor the most effective treatment. The bottom line is that location of pain alone doesn’t narrow down the type of headache or facial pain that you have. The associated symptoms and patterns that go with the headache are the keys to the possible headache types.

Thus, I created a FREE headache and facial pain symptom checker. The purpose is to help you with more personalized self-research with a list of possible headache types to discuss with your local doctor in hopes of helping you and your doctor have a better discussion of possible headache types, as well as better treatment considerations. Remember, any type of headache and facial pain requires an office visit and physical examination with your doctor. This symptom checker tool is purely educational to provoke thinking of a variety of headache possibilities. However, bad causes of headache can present as mild and simple headache disorders such as migraine. So, a visit to your doctor to evaluate your headache is a mandatory step that you must do.

When you are trying to narrow down the type of headache or facial pain you may have, these are the additional characteristics and symptoms that you need to take into consideration, and are the key questions a headache specialist will ask you in the office. Go through the following list of headache features, think about each one, and write down your responses. If you have different types of headaches, it is important to focus on and think about only one type at a time (even though they are typically different manifestations of the same underlying headache disorder).

1) Location of pain. As mentioned above, pain location is only one of many important characteristics of a headache disorder, but without factoring in the associated symptoms, patterns, and characteristics, it is quite useless alone. I have broken down 8 general patterns of headache and facial pain locations to choose from. Go through the following headache location charts and pick the one that is most consistent with your headache or facial pain location. These are screenshots from the first step of the headache and facial pain symptom checker algorithm. There may be some variation to your attacks and the location may vary between different attacks, so pick the one which summarizes the areas involved overall for the particular type of headache you are analyzing.

2) Frequency of the headache or facial pain attacks. How often do the attacks of headache of facial pain occur? Once per day and several days per month, 8 different attacks per day, etc.? Is there a pattern to the attacks, such as a seasonal occurrence?

3) Duration of the headache or facial pain attacks. When you get an attack of headache or facial pain, how long does each individual attack last until it goes away completely if it is untreated or unsuccessfully treated? 30 minutes, greater than 4 hours, 15 minutes, several days, etc.?

4) Description and characterization of the headache or facial pain. How would you describe the pain of the headache or facial pain if you had to put it into words? Throbbing, pounding, pulsating, achy, excruciating, pressure, electrical, shock, burning, sharp, stabbing, ice pick stabbing, etc.?

5) Associated neurological symptoms. Is the headache associated with visual disturbances such as lost vision, flashing lights, shapes, zig-zags, colors, wavy lines, kaleidoscope, jagged edges, etc.? Is there numbness or tingling in an area of the body associated with a headache attack such as on one side of the face and body? Is there weakness on one side of the body with the headache? Are there problems speaking or getting words out with a headache attack?

6) Additional symptoms. Is your stomach upset or do you feel nauseated or sick to your stomach with a headache attack? Do you vomit? Do you feel sensitive to bright light and/or loud sound when the headache is at its worst (where you would prefer to be in a dark quiet area if you had the chance)? Does an eye turn red or tear excessively during a headache attack? Does your nose run or get congested on one side during a headache attack? Does your eyelid droop on one side or does it get puffy around an eye on one side with a headache attack?

When you are done going through and thinking about all of these headache characteristics, patterns, and associated symptoms, take a run through this FREE headache and facial pain symptom checker algorithm questionnaire which I created to help you with more personalized self-research with a list of possible headache types and treatments to discuss with your local doctor.

Good luck, and I hope this tool leads you in a better direction of more educational and useful discussions with your doctor regarding possible headache types and more effective treatment considerations!

Do me a HUGE favor and if you have found this headache symptom checker tool helpful and it led to a more successful outcome of narrowing down your headache types and treatments when you saw your local doctor, PLEASE let me know and drop me a message here or on Twitter!!

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING TO ASK QUESTIONS TO A HEADACHE SPECIALIST OR OTHER HEADACHE, MIGRAINE, AND FACIAL PAIN WEBSITE MEMBERS, VISIT OUR FREE DISCUSSION FORUMS HERE.

Last updated on April 10th, 2021 at 05:26 am

WAKING UP WITH HEADACHES: 6 TYPES OF WAKE UP HEADACHES.

@Neuralgroover

WAKE UP HEADACHE

Do you frequently wake up with a headache? This is a common feature with several types of headache disorders, but they are all distinct headache types with completely different treatments. Let’s discuss the 6 most common types of wake up headaches and the reasons why you may be waking up with headaches.

1) MIGRAINE

Migraine commonly causes wake up headaches for many patients, and is by far THE most common cause of wake up headaches. Sleep stage transitions can be a trigger for migraine attacks in many patients. Migraine is also susceptible to changes in sleep patterns. So for many, sleeping in (such as on the weekends or on vacation) can be a common (and cruel) migraine trigger leading to waking up with headaches. Thus, trying to maintain a similar sleep schedule on the weekends and weekdays can help with this type of trigger.

Other causes of wakeup headache commonly occur in patients that are stuck in chronic migraine (15-30 days per month with at least 8 headache days with migraine features), particularly if they are in rebound headache (medication overuse headache) from excess pain or “as-needed” medications. This occurs when a person with migraine is using triptans, OTCs (over-the-counter pain meds), or NSAIDs (non-steroidal anti-inflammatory drugs) more than 10 days per month, opiates or opioids more than 8 days per month, or butalbital medications such as fioricet or fiorinal more than 5 days per month, on average. Rebound headache occurs because as the patient is sleeping, the overused medication is being metabolized and eliminated from the body and the headache (typically migraine) is triggered as a result of withdrawal from the medication and the need to take more. Patients in this cycle will often notice that after they take their overused medication, the headache calms back down again. It starts to worsen again as they are due for another dose and it is wearing off. This pattern is characteristic for rebound headache. Caffeine withdrawal headache can also be a cause of wake up headaches, for similar reasons as described for rebound headache.

Treatments for migraine are discussed here. The key for abortive (as-needed) migraine treatment for waking migraines is that is must be something fast acting to have a chance to catch the migraine. The difficulty with waking migraines is that you are already “behind the ball” by the time you wake with the migraine because you’ve missed the early treatment window where most medications such as the triptans would normally be most effective. So for waking migraines, injectable Sumatriptan (Imitrex), nasal Zolmitriptan (Zomig) or Sumatriptan (Imitrex), are typically going to be the most effective triptans. With that said, sometimes patients can get away with a fast-acting oral triptan such as Rizatriptan (Maxalt) as well. Other options for waking migraines would be DHE (Migranal nasal spray or injection), or one of the new gepants (Nurtec ODT, Ubrelvy) since they can still be effective if taken up to 4 hours past the migraine onset, which is really great and expands the migraine onset treatment window. A neuromodulatory device could also be considered.

If you are averaging more than 4 migraines per month, a daily preventive treatment is generally recommended. There are many options for this including a daily pill, natural supplements, a once monthly or quarterly CGRP monoclonal antibody (Aimovig, Ajovy, Emgality, Vyepti), Botox, or a neuromodulatory device.

2) CLUSTER HEADACHE

Cluster headache is another classic cause of wake up headaches. It is a very distinct form of headache that is easy to pick out with its characteristics. Cluster headache is classified as a trigeminal autonomic cephalalgia (TAC). There are 4 types of TAC syndromes, and cluster headache is the most common of them. The other 3 TAC syndromes are hemicrania continua, paroxysmal hemicrania, and SUNCT/SUNA, none of which are waking headache types. There are some overlapping characteristics between all 4 of these TAC headache types, but cluster headache is the only one that often wakes the patient from sleep.

Cluster headaches can occur anytime during the day, but classically occur at the same time every night, often waking the patient up from sleep, many times shortly after falling asleep within an hour or two. Men tend to be affected 3 times more than women, but it is seen in both men and women. It is a severely painful headache, and has been termed “suicide headache” at times because of the pain severity.

Cluster headache is characterized by attacks of severe unilateral (one-sided) orbital (around the eye), supraorbital (above the eye), and/or temporal pain lasting 15 to 180 minutes if untreated. There is either agitation/restlessness with the headache attack and/or at least 1 autonomic sign or symptom on the side of the headache [lacrimation (runniness/tearing of the eye), conjunctival injection (redness of the eye), facial sweating or flushing (skin turning blushed), nasal congestion, rhinorrhea (runniness of nose), sense of ear fullness, eyelid edema (swelling), or partial Horner’s syndrome (miosis (pupil becomes small)) and/or ptosis (droopiness of the eye)]. Headache attacks typically occur from 1 every other day to 8 per day for more than half the time during a cluster cycle. Chronic cluster headache is defined by attacks that occur for more than 1 year without remission, or with remission periods lasting less than 1 month.

Cluster headache attacks occur in “clusters”, or cycles, of frequent headache attacks. These cycles of cluster attacks may last for weeks or months before they go away completely. Remission periods can last months to years. Cluster cycles often occur at a predictable time of year, such as season changes (Fall and Spring are most common).

Treatments for cluster headache are discussed here. In general, at the onset of a cluster cycle, a course of high dosed Prednisone is often started over 1-2 weeks to try to break up or shorten the cycle. An abortive option is also mandatory, and the most effective options are oxygen by a face mask, injectable Sumatriptan (Imitrex), nasal Zolmitriptan (Zomig) or Sumatriptan (Imitrex), or DHE (Migranal nasal spray or injection). A preventive daily treatment is also typically started at the onset of a cluster cycle and there are a variety of options for this.

3) HYPNIC HEADACHE

Hypnic headache has also been called “alarm clock” headache because it often wakes the person up at almost exactly the same time every night. These recurrent attacks occur only during sleep, causing wakening. They typically occur on 10 or more days per month for more than 3 months. The headache lasts 15 minutes and up to 4 hours after waking. This headache usually begins after age 50, but can occur in younger ages too.

The pain is typically mild to moderate, but can be severe occasionally. The pain usually occurs on both sides of the head (as opposed to cluster headache which is 1 sided). There is no restlessness during the headache (as opposed to cluster headache). Hypnic headache is NOT associated with autonomic symptoms [lacrimation (runniness/tearing of the eye), conjunctival injection (redness of the eye), facial sweating or flushing (skin turning blushed), nasal congestion, rhinorrhea (runniness of nose), sense of ear fullness, eyelid edema (swelling), or partial Horner’s syndrome (miosis (pupil becomes small)) and/or ptosis (droopiness of the eye)] (as opposed to cluster headache which requires these autonomic symptoms for diagnostic criteria).

Treatments for cluster headache are discussed here. The most common treatments are some caffeine before bed (in those who can tolerate it and not cause insomnia), or upon waking. Indomethacin taken before bed is also a common treatment.

4) OCCIPITAL NEURALGIA

Occipital neuralgia is a miserable nagging soreness, pain, and headache in the back of the head. I tell patients to think of occipital neuralgia as “sciatica of the head”. It is sometimes associated with cervicogenic headache (headache originating from the cervical spine with associated prominent neck pain), but more commonly occurs by itself. It is typically felt in the suboccipital region (where the base of the skull meets the top of the neck) and radiates variably into the back and top of the head and behind the ears. It can less commonly even radiate to the frontal areas (by the trigeminocervical circuitry in the upper cervical spinal cord and brainstem). It can be one sided or both sides. The pain is often described as an intense stabbing, sharp, shooting, shocking, or burning pain. It often occurs in attacks of pain which may last seconds to minutes, but can also be a continuous unrelenting pain. Sometimes it may not be as intense and may be a lower-level pain such as pressure, aching, soreness or throbbiness. Some patients may have a sensation of numbness or tingling in the back of the head. Associated neck pain is typically in the mix too. The back of the head in the area where the skull meets the neck often feels very sore or tender along the ridge of the skull bone. The pain and tenderness often increase by pushing on the back of the head and along the skull base, or lying on the back of the head. Thus, for some patients, when they lie on the back of the head during sleep, it puts pressure on the occipital nerves and they continue to get more irritated and painful until they may wake the person up from sleep due to the pain.

Treatment for occipital neuralgia is discussed in much greater deal here and here. In general, first line options are neck physical therapy to this area, as well as an anti-neuritic pain medication such a tricyclic antidepressant (TCA) of Amitriptyline (Elavil) or Nortriptyline (Pamelor), an anticonvulsant such as Gabapentin (Neurontin), or an SSRI such as Duloxetine (Cymbalta) or Venlafaxine XR (Effexor XR).

5) SLEEP APNEA HEADACHE:

Sleep apnea is a common cause of a headache present upon waking in the morning. However, in comparison to the headache types listed above, this headache does not “wake you up”, but rather, you “wake up with it”. It generally fades away as the morning goes on and most often has tension type headache characteristics. So if you snore, often feel unrefreshed when you wake up in the morning, and this is associated with a headache, wake with a sore throat or dry mouth, a conversation with your doctor about possible obstructive sleep apnea evaluation should be pursued. If your bed partner witnesses times where you seem to stop breathing during sleep, then this is very likely. Sleep apnea is associated with elevated high blood pressure and increased risk of stroke and heart attack, so it is important to not let it go untreated. During the deep stages of sleep, your brain is replenishing its neurotransmitters. So, if you are not getting into those deep stages because the sleep apnea is disrupting progression through normal sleep stages, fatigue, memory and cognitive complaints are common.

Treatment varies depending on the severity of the sleep apnea. This is determined by an overnight sleep study called a polysomnogram. These have historically been done in a controlled setting such as a hotel room, but they are now commonly done remotely in your own bed from home too.

6) HEADACHE ATTRIBUTED TO INTRACRANIAL NEOPLASM (BRAIN TUMOR)

Lastly, brain tumor is always in the differential (and at the very top of everyone’s mind when they come in the office), depending on age, prior headache history, and other clinical symptoms. These headaches are typically associated with some other neurological complaints or findings on neurological exam such as vision deficit, imbalance, speech dysfunction, memory or cognitive impairment, or one-sided numbness or weakness. However, this isn’t an absolute, and headaches can certainly present by just themselves as well. With all of that said, this is an uncommon reason for wake up headache or headache in general, surprisingly. Thus, why I have listed it last. However, it is still a reason that you should always be evaluated by your doctor for not only wake up headaches, but for any headache, especially if you don’t have a prior history of headaches, it is a different type of headache from your prior headaches, or you have any associated neurological symptoms.

These are certainly not the only causes of nocturnal headaches, but they are typically the top 6 that are evaluated for first. Disorders such as nocturnal bruxism (teeth grinding and jaw clenching) and TMJ dysfunction, or headache attributed to temporomandibular disorder can also be a contributor to headaches. However, these types of disorders don’t typically cause the patient to wake up with the pain. In addition, the pain is primarily in the temples, in the areas in front of the ear, into the face, and in the master muscles in the jaw. The headaches related to this are more often a tension type headache in description and not severe, and an ache and soreness in the jaw muscles and around the TMJ regions. A dentist should be able to easily diagnose if there is significant nocturnal bruxism happening by evaluating the teeth. Bed partners are also good historians on observations of teeth grinding during sleep.

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING TO ASK QUESTIONS TO A HEADACHE SPECIALIST OR OTHER HEADACHE, MIGRAINE, AND FACIAL PAIN WEBSITE MEMBERS, VISIT OUR FREE DISCUSSION FORUMS HERE.