Defining the Headache


Headaches can vary from being a minor nuisance to a debilitating condition. Understanding the type of headache you have and its potential triggers can lead to more pain-free days as well as help you recognize when head pain could be something more serious.

Dr. Yoon-Hee Cha, a neurologist with Warren Clinic in Tulsa and an assistant professor for the University of Tulsa, serves as the principal investigator for the Laureate Institute for Brain Research.

“The most common headaches are tension type headaches that are mild to moderate in severity, bilateral, and of a pressing or pressure quality,” Cha says. “Even though they are not usually severe, they can last enough to impair concentration. If they occur more than 15 days of the month, they are considered to be chronic.”

Migraines are moderate to severe in intensity, typically one-sided with a throbbing or pulsating quality, and associated with either nausea or light and sound sensitivity.

“This type can last from four to 72 hours in adults and as short as two hours in children,” Cha says. “They may be associated with visual auras, which are defined as periods of five minutes to an hour of visual phenomena such as flashing lights, pulsating shapes or colors, zig-zagging lines, holes in vision or even loss of vision.”

She adds that a less common kind of headache is a cluster headache. These headaches are strictly one-sided and usually focused around the eye with autonomic symptoms such as tearing, eye redness, eyelid drooping or nasal congestion. Cluster headaches can last from 15 minutes to three hours and exhibit strong circadian or seasonal cycling.

“Each of these headache types is treated differently so it is important to diagnose them correctly the first time,” Cha says. “One important reason for early diagnosis is to avoid the development of medication overuse headache [MOH]. Chronic uses of over-the-counter medications such as acetaminophen, ibuprofen or combination pills that contain caffeine are frequent causes of MOH. If headaches require more than one treatment per week, it is time to consider preventative treatment, of which there are many options.”

Dr. Ashish Masih, a vascular neurologist with Integris in Oklahoma City, says migraines are commonly underdiagnosed and patients should seek medical attention if headaches interfere with enjoying activities.

“If someone is having more than three headaches per week, they should be evaluated,” says Masih, adding that it’s important to discover what causes headaches and suggesting that patients keep a headache diary to identify triggers.

Cha says stress, the “let-down” period from stress, certain foods and changes in weather are common associated factors in people getting headaches.

“Caffeine can both be a treatment and a trigger for headaches, though the more frequent problem tends to be overuse of caffeine, which then triggers caffeine-withdrawal headaches,” she says.

There are several options for helping with common headaches.

“The most effective over-the-counter treatments for headaches are non-steroidal anti-inflammatory medications like ibuprofen or naproxen,” Cha says. “Staying well hydrated, getting enough sleep and avoiding overstimulating environments where there is too much light or sound can be helpful.”

Her tips for preventing headaches are similar: get regular sleep, stay hydrated, eat foods low in preservatives and do aerobic exercise several times a week.

When to See a Doctor

Some headaches could be a sign of worse health issues. If you have any of the following symptoms, seek medical attention immediately:

• Positional headaches that are worse lying flat and improved when you sit up

• Headaches that wake you up from sleep

• Headaches with neurological symptoms such as numbness, weakness or tingling