Migraine & Headache

A headache is a broad medical term that refers to the sensation of pain in an area of your head. A migraine is a specific type of headache that causes severe, throbbing pain alongside other symptoms such as nausea, vomiting, and extreme sensibility to light and sound.

People Affected

Headaches are a very common occurrence that affects around 45 million Americans every year. Certain types of headaches are more likely to affect female-identifying patients, including migraines and tension headaches. Migraines tend to begin in adolescence, peak during your 30s and decline after that.

Risk Factors

Risk factors, or causes & triggers, can vary depending on the type of headache you have. There are two main categories of headaches: primary headaches and secondary headaches. Primary headaches are not symptoms of an underlying disease, and triggers for them can be:

  • Genetics/family history (some people are genetically more likely to have headaches).

  • Poor posture

  • Alcohol (especially red wine)

  • Certain foods (including processed meats)

  • Sleep deprivation

  • Skipped meals

  • Stress

  • Dehydration

  • Certain medications 

Secondary headaches are a symptom of an underlying disease. These can be caused by many different diseases, including but not limited to:

  • Sinus infections

  • Arterial tears

  • Blood clots

  • Brain aneurysms

  • Brain tumors

  • Concussions

  • COVID-19

  • Dental and jaw problems

  • Ear infections

  • Brain inflammation

  • High blood pressure

  • Flu

  • Meningitis

  • Panic attacks

  • Strokes

There are a few risk factors or “triggers” specific to migraines: 

  • Hormonal changes in women (such as before or during your period, pregnancy, and menopause. Hormone-based medications such as birth control can also contribute)

  • Coffee

  • Bright lights, sun glare, strong smells, and loud sounds

  • Intense physical exertion (such as exercise and sex)

  • Weather changes

  • Certain foods and additives (such as aged cheeses, salty foods, MSG, and the sweetener aspartame)

Signs & Symptoms

While all headaches result in head pain, specific symptoms and locations of pain vary depending on the type of headache. The following are examples of common primary headaches and their symptoms:

  • Cluster headaches: Intense pain usually in or around one eye or on one side of your head. These might wake you up in the middle of the night, and the headache “clusters” (a series of headaches) can last from weeks to months. You might also experience restlessness, eye redness, stuffy or runny nose, facial sweating, pale skin, flushing, swelling around your eye, and/or a drooping eyelid during the headache. 

  • Migraine: Migraines are commonly felt as a severe throbbing or pulsing pain on one side of the head, and sometimes both sides. Some people experience certain symptoms before the migraine starts, including mood changes, constipation, food cravings, neck stiffness, thirst, increased urination, and frequent yawning. Some also experience an aura, which is usually the visual phenomena of seeing bright spots, flashes of lights black spots, or different shapes. During the migraine, you might feel intense pain, sensitivity to light, sound, smell, and touch, and/or nausea and vomiting. 

  • Tension headache: Tension headaches are often a milder, dull throbbing pain that might be described as a “tight band” around your head. It might be accompanied by the sensation of pressure in your head and/or a sensitive scalp, neck, and shoulder muscles.

Some examples of secondary headaches and their symptoms are: 

  • Sinus headaches: These often feel like a sinus infection, accompanied by pressure around your eyes, cheeks, and forehead. Pain often gets worse if you bend forward or lie down, and you might also have a stuffy nose, an ache in your upper teeth, and/or fatigue. 

  • Spinal headaches: Symptoms can include a dull, throbbing pain that can go between mild and intense, pain that gets worse when you sit up or stand, dizziness, ringing in your ears, hearing loss, blurred or double vision, sensitivity to light, nausea, vomiting, neck pain or stiffness, and/or seizures. 

  • Thunderclap headaches: These are often sudden, intense short periods of pain. You might also have symptoms like nausea, vomiting, fever, seizures, and an altered mental state.

    types of migraines

Pharmacist Tip

When treating your headaches, be cautious of “medication-overuse headaches,” also known as “rebound headaches.” This can happen if you take:

  • Aspirin or ibuprofen for more than 15 days a month.

  • A combination painkiller (such as Excedrin Migraine) for more than 10 days a month for 3 months.

  • Sumatriptan (Imitrex, Tosymra) or rizatriptan (Maxalt) for more than 9 days a month. 

If you still get rebound headaches, it is important to discontinue the overused medication. Initially, headaches may get worse, but they will eventually get better. You can also try non-pharmacologic interventions such as a massage or applying cold compresses to the head. Acupuncture can also be helpful for some patients who experience migraines.

Keeping a headache diary can help you identify triggers of your headaches. Record the time of day when a headache occurs, the specific location of the headaches, how long the headaches last, how your headaches feel, and changes in personality or behavior.  

Some headaches/migraines can actually be caused by neck injuries. If you had a prior accident or injury involving your neck, you should make sure that it isn’t the underlying cause of your headaches.

If you are constantly suffering from migraines, undergo a CT scan to rule out other underlying medical conditions.

Medical Experts

  • Primary Care Doctor: Your general doctor can diagnose and treat headaches. However, because headaches can be caused by such a wide variety of factors, they might refer you to a neurologist if they are concerned about an underlying health condition or complications.

  • Neurologists: Neurologists are medical doctors who specialize in conditions that affect the brain, spinal cord, and nerves. They are able to help identify exactly what type of headache you are experiencing and what, if anything, might be the underlying cause.

Diagnosis

Headaches can often be diagnosed depending on your symptoms by a primary care doctor. However, because headaches are a very common symptom that can be caused by such a wide variety of factors, your doctor might also perform additional testing such as a blood test, skull X-rays, sinus X-rays, an MRI, or a CT scan.

Prescription Treatment

Most headaches can be treated with over the counter pain relievers such as: 

  • Aspirin

  • Acetaminophen (Tylenol)

  • Acetaminophen + Caffeine (Excedrin)

  • Ibuprofen (Advil, Motrin)

  • Naproxen (Aleve) 

If you feel no relief, talk to your doctor about prescription options.

Migraines are typically prevented with and treated by the following types of prescription medications:

  • Triptans: sumatriptan (Imitrex, Tosymra) or rizatriptan (Maxalt)

  • Preventative migraine medications: propranolol (Inderal, topiramate (Topamax), or Amitriptyline.

  • Anti-nausea drugs to help with symptoms: chlorpromazine, metoclopramide (Reglan), and prochlorperazine (Compro)

Not all generics are the same. Different people respond better to different versions of the same drug, depending on the manufacturer. You can search our website to find the best fit for you.

Lifestyle Remedies

For headaches and migraines, a healthy lifestyle can help prevent and manage migraines. When a migraine starts, try to close your eyes and lie down in a quiet, dark room with a cool cloth on your forehead. Avoid triggers such as stress, sensory stimuli (like bright lights, loud sounds, and certain scents), and changes in sleep patterns.

Establish a consistent sleep and eating schedule, stay hydrated, reduce stress, and exercise regularly. Overall, maintaining good posture can also help ease headache pain.

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