Headaches Causes & Symptoms

A typical migraine attack produces some or all of these signs and symptoms:
• Moderate to severe pain, which may be confined to one side of the head or may affect both sides
• Head pain with a pulsating or throbbing quality
• Pain that worsens with physical activity
• Pain that interferes with your regular activities
• Nausea with or without vomiting
• Sensitivity to light and sound

When left untreated, a migraine typically lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or just once or twice a year. Not all migraines are the same. Most people experience migraines without auras, which were previously called common migraines. Some, however, have migraines with auras, which were previously called classic migraines. If you're in the second group, you'll likely have an aura about 15 to 30 minutes before your headache begins. Auras may continue after your headache starts or even occur after your headache begins. Whether or not you have auras, you may have one or more sensations of premonition (prodrome) several hours or a day or so before your headache actually strikes, including feelings of elation or intense energy, cravings for sweets, thirst, drowsiness, irritability or depression.
Some researchers think migraines may be caused by functional changes in the trigeminal nerve system, a major pain pathway in your nervous system, and by imbalances in brain chemicals, including serotonin, which plays a regulatory role for pain messages going through this pathway. During a headache, serotonin levels drop. Researchers believe this causes the trigeminal nerve to release substances called neuropeptides, which travel to your brain's outer covering (meninges). There they cause blood vessels to become dilated and inflamed. The result is headache pain.

A cluster headache strikes quickly, usually without warning. Within minutes, excruciating pain develops. The pain typically develops on the same side of your head throughout a cluster period, and often the headaches remain on that side throughout your life. Less frequently, the pain may switch to the opposite side of your head in the next cluster period. Rarely, the pain switches sides from one attack to another. The pain of a cluster headache is often described as sharp, penetrating or burning. People with this condition say that the pain feels like a hot poker being stuck in the eye or that the eye is being pushed out of its socket.
Unlike migraine and tension headache, cluster headache generally isn't associated with triggers such as foods, hormonal changes or stress. But some people with cluster headache are heavy drinkers and cigarette smokers. Once a cluster period begins, consumption of alcohol can trigger a splitting headache within minutes. Other possible triggers include the use of medications such as nitroglycerin, a drug used to treat heart disease. The beginning of a cluster period often follows occasions when normal sleep patterns are disrupted, such as during a vacation or when starting a new job or work shift. Some people with cluster headache also have sleep apnea, a condition in which the walls of a person's throat collapse momentarily, obstructing the sleeper's breathing repeatedly during the night.

A tension headache can last from 30 minutes to an entire week. You may experience these headaches occasionally, or nearly all the time. If your headaches occur 15 or more days a month for several months, they're considered chronic. Unfortunately, chronic tension headaches sometimes persist for years. A tension headache may cause you to experience a dull, achy pain or sensation of tightness in your forehead or at the sides and back of your head. Many people liken the feeling to having a tight band of pressure encircling their heads. In its most extensive form, the pain feels like a hooded cape that drapes down over the shoulders. The headache is usually described as mild to moderately intense. The severity of the pain varies from one person to another, and from one headache to another in the same person. Many people report that the pain starts first thing in the morning or late in the day when work stress or conflict at home is anticipated.
The exact cause or causes of tension headache are unknown. Until a few years ago, many researchers believed that the pain of tension headache stemmed from muscle contraction in the face, neck and scalp, perhaps as a result of heightened emotions, tension or stress. But many researchers have questioned this idea. More recent research discredits this theory. Studies using a test called an electromyogram, which records the electric currents generated by muscle activity, haven't detected increased muscle tension in people diagnosed with tension headache. In addition, people with migraine have as much muscle tension as do people with a tension headache, if not more. As a result, The International Headache Society uses the term "tension-type headache" instead of "tension headache," calling attention to the fact that muscle tension may not be the main cause of this kind of head pain.

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