Headaches – Migraines, chronic daily headaches, cluster and tension headaches

shutterstock_142814494We see patients with headaches in the medical clinic almost everyday. Although they are usually not life threatening they can be quite debilitating.

Several different types of headaches have been described in the literature including:

1)   Tension/Muscle contraction type headache

2)   Migraine headache

3)   Chronic daily headache

4)   Cluster headache

Muscle contraction/Tension headache symptoms:  pressure or tightness around both sides of head or neck, mild to moderate pain that is steady and usually does not throb, pain is generally not made worse with activity, pain can increase or decrease in severity, there is often tenderness in the muscles of the head, neck or shoulders.

Migraine headache symptoms:  migraines are a type of headache that seems to get worse with light, noise or motion.  Some people have nausea and vomiting with this type of headache.  Migraines can last for a few hours to up to 3 days.

Migraine triggers:  Some possibilities include:  Stress, anxiety, worry, menstral periods, birth control pills, fatigue, lack of sleep, hunger, certain foods or drinks (wine, any alcohol, aged cheeses, nutrasweet, MSG, nuts), etc.

Cluster headache symptoms:  Cluster headache are more rare.  They begin quickly without any warning and reach their peak within just a few minutes.  The headache is usually deep, excruciating, continuous and feels explosive, although can be pulsatile and throbbing.  The attack may happen up to 8x/day but usually only lasts for a short time (between 15 minutes – 3 hours).  The pain usually is around the eyes or temples and rarely starts in the face, neck, hear or side of the head.  It’s always on one side, and never on both sides of the head.  Most people who get this type of headache are very uncomfortable and can be restless and pace or rock back and forth when the attack occurs.  Cluster headaches can be associated with tear production, eye redness and runny nose, sweating and pale skin.  These types of headaches can begin at any age but have a genetic component.

Chronic daily headache/Medication overuse headache:  Headaches that occur as frequently as every day or present more than 15 days per month or at least three months are considered chronic daily headaches.  Most people with this type of headache have migraine or muscle contracture type headaches as the underlying type.  If you use medications frequently to treat headaches, a vicious cycle can occur where the frequent headache cause the patient to take medication frequently (non-prescription or prescription) and then a rebound headache occurs as the medication wears off.  Some types of medication that can cause these rebound headaches are:

1)   Narcotic medications such as vicodin or Percocet

2)   Butalbital medications such as Fiorinal or Fioricet

3)   NSAIDS such as Advil, Motrin, Aspirin

4)   Triptans (such as Imitrex)

5)   Excedrine (aspirin, caffeine and acetaminophen combo)

Other types of headaches:  Sinus headache or post-trauma headache

Danger signs of headache:  Seek medical attention of you have any of the following:

1)   Headache is the worst headache of your life

2)   Headache comes on suddenly and becomes severe within seconds or minutes

3)   Occurs with a seizure, personality change, confusion or passing out

4)   Beings right after vigorous exercise or a minor injury

5)   New headache and is accompanied by numbness, weakness or vision changes.

Do I have a brain tumor?  Headaches do occur in approximately 50% of people with brain tumors.  However, headaches are common and tumors are rarely found in people who are being evaluated for headaches.  If you are concerned about the possibility of brain tumor, please see a medical provider.

Treatment of headache:  The treatment is tailored to the individual patient.  Treating the underlying cause of the headache is the most efficient way to reduce the pain and frequency of headaches.  Sometimes  a headache diary can be helpful for people who have frequent and severe headache in order to help determine what might be triggering the headache.

For migraines, we break the treatment into two groups: acute management of the headache (medication you can take immediately for relief), and preventive management which include medications you can take on a regular basis to reduce the frequency of headaches that occur in the future.

Some medications which might be used to treat and acute headache are pain relievers such as aspirin, Tylenol, Toradol,  Excedrine, Triptans(such as Imitrex) for migraine, anti-nausea agents such as Reglan or Phenergan, Ergotamines, and sometimes narcotic pain medications.

For migraine prevention, commonly prescribed medications include beta blockers (propranolol is an example), tri-cyclic antidepressant medications such as amitriptyline, anti-seizure medications such as Depakote, Neurontin or Topamax, calcium channel blockers such as Verapamil.

Neurologists are doctors that specialize in the diagnosis and treatment of headaches.  To find a neurologist near you check out the American Academy of Neurology website at:  http://patients.aan.com/findaneurologist/

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com


2 thoughts on “Headaches – Migraines, chronic daily headaches, cluster and tension headaches

  1. C.L

    Hi Dr. Rennie,
    I saw you in urgent care sometime in July for a horrendous migraine. After sharing your personal story, you got me thinking more and more about what could be the trigger. My migraines were getting worse, lasting up to four days per week. My Primary Doctor had me try several different medications including preventive and pain relief. The meds were not working and so I decided that the cause must be environmental. I tried changing my diet and sleep patterns to no avail. The only thing that seemed to increase the intensity would be fluorescent lights. So I decided it was worth a try to eliminate all fluorescent bulbs, including cfls, from my home. For the first time in six months I have not had a migraine in over a week. In addition to the migraines ceasing, the daily nausea has also stopped. The lights were poisoning me! Maybe it should be added as another cause, it seems that many people have the same problem. Thank you for the care you provide and the additional advice!

    1. Dr. Scott Rennie

      I’m so glad to hear that you are doing better. I’ve heard that fluorescent bulbs can trigger migraines in certain people and I’ll have to update my blog post with that info and mention it to patient’s as a possible cause too. Thank you for your suggestion and feel free to comment any time!

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