Lisa Savage, MD


Article: Headache

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Everyone has had a headache at some time or another. Most headaches are minor and can be treated with over-the-counter pain relievers. However, an estimated 45 million Americans suffer from chronic headaches—headaches serious enough to interfere with daily life.

In this pamphlet you will learn about:

  • * The different types of headache
  • * What symptoms are common with the different types of headache
  • * What causes headaches
  • * Types of treatment used to relieve headaches

Types of Headaches


The most common type of headache is a tension headache. Tension headaches usually create a steady squeezing or pressing pain on both sides of the head. It feels as if a band is being tightened around your head.

Tension headaches can occur occasionally or they can be chronic. They can last from 30 minutes to several days. They often occur upon waking.


Migraine headaches affect 18% of women and 6% of men in the U.S. Although many people believe they suffer from migraine headaches, most headaches that people get are not migraine.

Migraine is a severe throbbing pain on one or both sides of the head. It may occur with other symptoms, such as nausea and sensitivity to light and noise. Migraine attacks occur occasionally—once or twice a week, or sometimes every few years. They do not typically happen every day.

There are two types of migraine headaches— "migraine with aura" and "migraine without aura." An aura is a symptom that usually occurs 10-30 minutes before a migraine attack. During an aura, the person may see lines or flashing lights. They may temporarily lose vision or have speech problems or tingling in the face or hands. People who have migraines without aura may have symptoms that include mood changes, fatigue, diarrhea, increased urination, and nausea.


Cluster headaches affect only a small percentage of people. The cause of cluster headaches is not known. This is the only type of headache that is more common in men than women.

Cluster headaches are described as a very severe, nonthrobbing pain felt behind one eye. They usually occur periodically over several weeks or months. The pain can last up to 3 hours.

Headache Triggers

You may notice that certain factors trigger your headache. Some known headache triggers include:

  • * Diet—Alcoholic beverages, caffeine, and foods that contain certain substances (see box)
  • * Eating and sleeping patterns—Fasting or skipping meals, getting too much or too little sleep, or becoming dehydrated (not drinking enough water)
  • * Emotions—Stress, anxiety, excitement, or anger
  • * Medications—Medications such as those to treat chest pain (angina) and high blood pressure
  • * Environment—Things in your workplace and home, including bright lights; noise; eyestrain; and inhaling fumes from substances, such as gasoline, insecticides, or cleaning agents

For women, one main trigger is a change in the body's level of hormones. Many women notice that headaches occur around their menstrual periods or during pregnancy. Using oral contraceptives (birth control pills)—which alter the level of hormones in the body—can also bring on headaches.

Headaches can also be caused by sinus or dental problems. A sinus headache can arise from an allergy or a cold.

Food Triggers

Some foods contain substances that are known to trigger a headache.

Tyramine, a natural chemical:

  • * Chocolate
  • * Yogurt
  • * Sour cream
  • * Aged cheese
  • * Red wine

Nitrites, a preservative:

  • * Smoked fish
  • * Bologna
  • * Sausage
  • * Hot dogs

Monosodium glutamate (MSG), an additive:

  • * Chinese food
  • * Processed or frozen foods

Controlling the Pain

Keeping track of your headaches in a "headache diary" can help you pinpoint what causes them. For 1 or 2 months, write down the times you have a headache and any events that could have triggered it, such as meals, noise, or your menstrual cycle.

Look for patterns when your headaches occur. Once you know what triggers your headaches, it may be easier to prevent them.

Most headaches can be controlled by making a few lifestyle changes:

  • * Exercise —Exercising releases your body's endorphins, its natural painkilling agent. Regular exercise also relieves stress and helps you sleep better.
  • * Avoid eyestrain —Have your eyesight checked regularly.
  • * Avoid food triggers —Be aware of what foods cause your headaches and remove them from your diet.
  • * Relax —Try relaxation techniques that help reduce stress, such as massage, biofeedback, and meditation.
  • * Keep your routine —Avoid changes in the number of meals you eat or hours you sleep.
  • * Drink plenty of water

When to See a Doctor

Most headaches do not require medical attention. Some headaches, however, can be a sign of a more serious problem, such as high blood pressure. It is rare for a headache to be caused by a brain tumor. Be aware of the symptoms that may signal a problem, and call your doctor if you experience any of them (see box).

If you visit your doctor for treatment of headaches, diagnosing the cause of your headache is the first step. He or she may ask detailed questions about your headaches, such as:

  • * How often do you have headaches?
  • * Where is the pain?
  • * How long do the headaches last?
  • * When did you start having headaches?

Your doctor may also obtain a history of your health, including questions about any past head injuries and about your use of medications. Special tests or a referral to a specialist may be recommended. This information will help your doctor determine what type of treatment is necessary.

Warning Signs

If your pain is more severe than usual and you have any of the following symptoms, see your doctor right away—it could be a signal of a more serious problem:

  • * Stiff neck along with high fever
  • * Confusion, dizziness, weakness
  • * Convulsions


Most tension headaches can be relieved with over-the-counter pain relievers, such as aspirin, acetaminophen, or ibuprofen. However, avoid taking these medications daily or almost every day.

Heavy use of pain relievers may hamper the body's own system for fighting pain. This can lead to a condition known as "rebound headache." When pain relievers are overused, they no longer ease the pain, which leads sufferers to take more medication. Rebound headaches can usually be relieved by stopping the use of the medication all at once—or "cold turkey." Although a withdrawal headache may occur for 2 or 3 days, most people notice fewer headaches within 2 weeks.

Migraine headaches can sometimes be relieved with ice packs or by putting pressure on the temple on the painful side of the head. For mild migraine attacks, aspirin or acetaminophen may give some relief. If the over-the-counter medications do not work, your doctor may prescribe stronger medications. If you have two or three migraine attacks per month, your doctor may suggest medications to help prevent them.


Headaches are a common problem and are usually not a sign of a serious medical condition. Most people get headaches at some point and are able to treat them with over-the-counter medication. Limiting stress, avoiding triggers, and getting regular exercise can help keep headaches under control. If your headaches persist, become severe, or differ from what is normal for you, see a doctor.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © Dr. Lisa Savage, MD. All rights reserved.