Chronic Headaches: Types, Causes, Symptoms, Treatments (video/podcast)

Migraine headaches are among the most challenging headache types. What’s more, because of the anatomy of a migraine, they are frequently misdiagnosed or underdiagnosed. Patients will often feel these headaches as pain behind their eyes, in their sinuses, or by their teeth.

“When you have migraine, the trigeminal system deep in the brain stem is hyperactive, and this then activates the trigeminal nerves that come out behind the eye to the sinus area and down to the teeth,” explains Dr. Engel. “And that’s why patients are told to go to the eye doctor or the dentist, when it’s none of that. It’s migraine, which is remarkably common.”

Several factors may contribute to migraine headaches. Common migraine triggers include changes in sleep patterns, hunger and stress. For women, hormones play a significant role. Young women may frequently get a migraine headache during their menstrual period, as may perimenopausal women whose hormone levels fluctuate significantly.

What if you have a headache every day? Surprisingly, the most common cause of chronic daily headaches is migraine.

“If patients do not receive proper treatment for their migraines over time, the headaches escalate so that they begin to have more and more headache days,” explains Dr. Engel. “And often they mistakenly take too many pain medications, which actually can cause something called rebound headache. If you find that you’re having to take medications more than twice a week, you should talk to your doctor about better and more effective treatments.”

Treatments for migraine headaches may involve both lifestyle changes as well as migraine medications.

“There are some very effective medications. If patients have frequent headache days we put them on a preventive medication, which is often something that they take every day,” says Dr. Engel. “If they have relatively infrequent headaches, we give them medication to take as needed.”

Cluster headaches are much less common than migraines. They more commonly happen in men, but occasionally affect women too.

“The biggest clinical distinction between cluster and migraine is that when you have a bad migraine you want to lie down in a dark room, and when you have a bad cluster headache, you can’t stay still,” says Dr. Engel. “Patients with cluster headaches are banging their head against the wall.”

One of the most effective treatments for cluster headaches is oxygen — patients put on an oxygen face mask and the headache goes away. If oxygen does not help, medications similar to migraine medications are available.

Tension headaches are milder than migraines or cluster headaches and usually get better with over-the-counter pain relievers. Some physicians believe tension headaches are mild migraines, while others believe they are related to muscle spasms releasing inflammatory chemicals. They also may be a combination of both factors.

In the past, preventive medications for headaches were pills that were taken daily to decrease headache frequency. Now, preventive medications can be taken less often. Botox injections, done every three months, have also proven effective at preventing migraine headaches.

Lifestyle matters also. Dr. Engel says it is important to stay hydrated, avoid skipping meals, maintain an adequate and regular sleep schedule, and do what you can to moderate stress.

“Headaches are not psychological, they are neurological,” she says. “If you feel like you always have a headache and no matter what you do it’s not going away, or if you infrequently have headaches that are disabling, you should see your doctor. Headache, in particular migraine, is a very treatable condition.”

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