That stabbing pain near your eye. A throbbing pain on one side of the head. The vise-like pressure around the top third of the head. A dull ache at the base of the skull. All of these pains are referred to as headaches, but where the pain is situated may actually signal different types of headaches — and different types of treatment.
Not all headaches are created equal, and there are more than 150 different kinds of headaches, according to the Headache Society, but most of those are quite rare. The “most common types of headaches in the absence of trauma are tension headaches and migraine headaches,” says Dr. Seogeun Hong, an internal medicine expert with St. Joseph Hospital in Orange, California.
Dr. Kevin Weber, a neurologist at The Ohio State University Wexner Medical Center‘s Neurological Institute who specializes in treating patients with headaches, says that certain headaches tend to occur in certain parts of the head. “There are certain rare headache syndromes that are strictly unilateral (on one side only). Sometimes we also can also use head pain location to identify an irritated nerve contributing to the headaches.”
Where it hurts might help your doctor figure out what type of headache you’re dealing with and what’s causing the pain, but “the location alone may not give us all we need to determine the headache type,” Weber says. “The location is one aspect of history taking we use to determine the type of headache.”
Forehead and Temple Pain and Pressure: Tension Headaches
“Typically, tension headaches are mild headaches on both sides of the head,” Weber says. They often respond well to “over-the-counter medications, time and rest.” Over-the-counter pain relievers, such as ibuprofen and acetaminophen, are usually helpful.
Hong says that tension headaches “mostly give the person a feeling of pressure or tightness and is not associated with other symptoms.” The pain is often centered in the front of the head or in a band across the forehead to the temples. Many people also have pain or stiffness in the neck, shoulders and upper back. Because these headaches are caused by stress or tension, massage, physical therapy, acupuncture or acupressure can sometimes be effective for relieving them.
One-Sided or Global Pain With Other Symptoms: Migraine Headaches
The Migraine Research Foundation reports that migraine is “an extraordinarily prevalent neurological disease, affecting 39 million men, women and children in the U.S. and 1 billion worldwide.” This makes it the third most prevalent illness in the world, and nearly a quarter of all U.S. households include someone who experiences migraines.
Migraines usually occur “on one side of the head and are pounding in nature,” Hong says, but they can occur most anywhere in the head and are not confined to a specific location. Some patient report experiencing pain in the face that may or may not accompany pain in the head. What defines migraines most clearly is the presence of other symptoms including:
— Nausea and/or vomiting.
— Vision changes, often just before the pain starts.
— Sensitivity to light or sound.
Not all symptoms will occur for all patients, and it can be sometimes tricky to diagnose migraines specifically. Dr. Jeffrey Fraser, a neurologist with Santa Clara Valley Medical Center, says “most recurrent headaches are migraine or tension headaches, but even experts can’t always agree on how to distinguish ‘migraine’ from ‘tension’ headaches, when some of the classic symptoms of migraine are not present.”
However, “migraine headaches typically are more severe than tension headaches,” Weber says. Though they can be awful for those who experience them, the good news is there are now many effective medications that can halt or prevent them from occurring.
Hong adds that ” migraine headaches often have triggers, so if a trigger is identified, avoiding that trigger will help with the migraines.” However, some migraines are refractory, meaning they don’t respond to treatments. Migraines can be severe and debilitating. If they don’t respond well to treatments or your medications stop working, “make sure to have close follow-ups with the physician or practitioner who is treating you. Sometimes it will take time to find the right medication that can help you with the migraines. It needs patience and sometimes will require trials of several different migraine medications. Don’t give up,” she says.
Pressure and Pain in the Sinus Region: Sinus Headaches
If you feel pressure and pain in the face, particularly behind the eyes or either side of the nose, that could be a sinus headache. “Sinus-type headaches could be caused by sinus disease,” says Dr. Molly Rossknecht, a neurologist at the Orange County Migraine & Headache Center in Irvine, California, and medical adviser to WeatherX, a company that makes earplugs that help stop and prevent migraines.
If you have a runny or congested nose, watery eyes and a headache, it may well be that you might need an over-the-counter decongestant or allergy medicine to relieve the underlying sinus pressure. If a sinus infection is the cause of the pain and pressure, you may need an antibiotic.
Stabbing Pain Around One Eye: Cluster Headaches
A less common type of headache, called cluster headaches, usually occur around the eye “and can cause severe pain very quickly and can be associated with redness of the eye and/or a stuffy nose,” Hong says. Cluster headaches are very painful and severe — they’re sometimes called ice-pick headaches because some patients describe the pain as feeling like someone is stabbing them with an ice pick. They come on suddenly.
People who get them will often experience several episodes of them over the course of a few days or weeks, and then they’ll disappear for a while, only to return again. Thankfully, this type of headache isn’t very common. They are the only type of headache that is more common in men than women. No one knows for sure why men get them more often. The cause of cluster headaches isn’t fully understood, but the Mayo Clinic reports that these intense headaches might be related to abnormalities in the body’s biological clock.
Pain at the Base of the Skull: Occipital Neuralgia
Occipital neuralgia occurs when the nerves that run from the upper back and neck into the scalp become inflamed or irritated. It can cause pain at the base of the skull at the nape of the neck, also called the occipital region. Rossknecht says this condition can cause pain to radiate up toward the eye, usually involving the “cheek and forehead,” she says. The pain may be “sharp, electric or burning,” and tends to come in short bursts of up to a few minutes. Though it’s sometimes mistaken as a migraine, it’s actually “very different from migraine pain,” she says.
Massage, muscle relaxants and anti-inflammatories may help relieve this type of pain.
Pain in the Neck and Head: Cervicogenic Headaches
Cervicogenic headaches are “triggered by issues in the neck and the cervical spine,” Rossknecht says. These triggers may include:
— Spinal stenosis, a condition that causes a compression of the spinal canal.
— A herniated disc, also called a bulged, ruptured or slipped disc, occurs when some of the cushioning between vertebra comes out of alignment.
— Concussions, a form of traumatic brain injury that occurs after an impact to the head.
— Other trauma, such as whiplash.
— Arthritis in the cervical spine, another term for the bones that make up the neck.
The pain begins on one side of the neck and radiates up and toward the front of the head. They’re often confused with either tension or migraine headaches. Other symptoms may include:
— Reduced range of motion in the neck.
— Pain in the neck, shoulder or down the arm of the affected side that may be triggered or exacerbated by movement on that side.
— Pain around the eye.
— Sensitivity to light and sound.
Treating the underlying cause can stop these types of headaches from occurring.
When to Visit a Doctor
Fraser says that patients should see their primary care provider when “they have frequent episodic headaches that frequently interfere with work or other daily activities or they have a new type of headache that is still persistent and progressive.”
“There are many red flags in headaches that can point to a more serious problem,” Weber says. So while most headaches are not a major concern, if you experience a sudden and severe headache or a change to how an otherwise typical headache experience, it might be time to visit with your primary care provider.
“Certainly, if you get any neurologic deficits with your headache, such as weakness, trouble with speech or seizures, you need to seek medical care immediately,” Weber says.
In addition, the following factors should send you to the emergency room:
— If you suddenly have the worst headache of your life.
— If you’re over the age of 50.
— If you have a compromised immune system (those with HIV or on chemotherapy, for example).
— If you experience double vision, vomiting or mood changes.
— If your headaches coincide with a change in gait or other problems moving normally.
Any of those situations should be cause for concern and a reason to seek care. Rossknecht adds that if you’ve fallen and hit your head or sustained some other kind of head trauma, you should seek emergency care right away. Similarly, if your headache occurs alongside an inability to move your limbs, that could signal a stroke and warrants emergency care.
No matter where it hurts, Weber says it’s important for people coping with frequent headaches to know you aren’t alone. “Many people get headaches, and you don’t have to suffer. There are a lot of new, exciting treatments out there, some of which were tailored specifically for headaches and not other types of pain. If you have recurrent headaches, please see your primary care provider, who can provide a referral to a neurologist if necessary.”
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