Health & Wellness

Migraine or tension headache? Knowing when to call the doctor could save your life

Headaches aren’t created equal. The pain can be dull and constant, throbbing or searing. They can be annoying, disabling — or, rarely — the sign of a life-threatening medical problem. Knowing which kind of headache you have can help you get treatment and relief.

About 80 percent of adults suffer from headaches at least occasionally , said Dr. Laurie Knepper, an associate professor of neurology at the University Pittsburgh School of Medicine and a physician with the University of Pittsburgh’s Headache Center.

These are common headache symptoms.

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Tension headaches

By far the most common reason for head pain, tension headaches tend to be mild and short-lived.

Symptoms include:

  • Pain involves the whole head, not just one side.
  • Mild pain which is often described an aching pressure.
  • Often triggered by stress.
  • Usually improves with a dose of over-the-counter pain medication.
  • Stress management techniques can help over the long term.
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Where 3 different types of headaches hurt worst: a tension headache is felt all over the head; a migraine often on one side of the face; and a cluster is a "horrible pain" around the eyes.

Migraines

Migraines are "one of the most disabling conditions," said Dr. Yvonne Curran, an assistant professor of vascular neurology at Northwestern University’s Feinberg School of Medicine.

About 18 percent of women and 6 percent of men experience migraines. The current thinking is people who get migraines inherit a brain that is hypersensitive, said Knepper. Once a trigger is encountered, a cascade of events starts, culminating in the stimulation of a brain area that spews out inflammatory chemicals.

“The good thing about migraines is that once they are identified, they usually improve with preventive medications and lifestyle changes,” said Curran.

Most migraines are benign, albeit excruciating. A small subset of those with aura— premonitory symptoms, such as a shimmering or sparkly sensation — do have an increased risk of stroke, Knepper said.

Women with migraines related to menstruation can sometimes be helped by birth control pills that smooth out estrogen levels, although these medications are contraindicated in women with aura because they may hike stroke risk.

Migraine symptoms:

  • Usually affect just one side of the head

  • Pain can be throbbing, drilling or pounding

  • Symptoms worsen with exercise

  • Often brings sensitivity to light, sound and smells

  • Head pain is often accompanied by nausea

  • They can be treated with prescription medications designed to prevent the headaches or drugs that abort the attack once it’s already started.

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Cluster

About 5 to 10 percent of the population suffers from cluster headaches, which occur in a series typically on one side of the head or around the eye. They often start during sleep and are more common in men than women. Cluster headaches are excruciating, a 10 out of 10 on the pain register, according to Knepper.

“You wake up in the middle of the night with horrible pain around the eyes," said Knepper. They occur pretty much as a cluster for four to six weeks and then go away for a year, two or three and then come back in another cluster.”

Symptoms:

  • Eyes may tear up
  • Eyelid may droop
  • They often respond to triptans, medications also used for migraines

Sinus headaches

True sinus headaches are very rare, experts say.

“Probably more than 80 percent of these turn out to be migraines,” Curran said. “On imaging, they don’t have sinusitis. People think it’s a sinus headache because it’s in the front of the face, where the sinuses are.”

Over-the-counter sinus medications can just make the problem worse.

Symptoms:

  • Low-grade fever

  • Elevated white-blood cell count

  • Active sinusitis

Headache associated with aneurysm

Even among people who have migraines, the head pain associated with an aneurysm stands out.

“Generally you think of aneurysm when a patient tells you the headache was sudden onset and is the worst headache they’ve ever experienced,” Knepper said. “It can be fatal if you don’t get treatment. This is the most scary kind of headache."

It’s considered an emergency and you should go straight to the emergency room.

Symptoms:

  • Headache appears suddenly

  • Pupils may dilate

  • Extremely painful

  • Vision may be blurred

  • Numbness or weakness may occur

  • Speaking may become difficult

Exploding Head Syndrome

Not a typical painful headache, but people with this rare condition have the sensation that they’ve just heard a loud explosion, either as they are falling asleep or as they are waking up in the morning.

While the condition isn’t painful, it can be very distressing, Curran said. People may think anything that goes on in their head has "got to be really, really bad."

In fact, the condition isn’t dangerous and it can be treated with anxiety-reducing medications.

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