Why Does My Head Hurt?

| Posted On Apr 26, 2017 | By:

Almost everyone has experienced a headache at some point in their lives, but did you know that there are over 150 unique types of headaches? Common though they may be, one headache may definitely not be like another. Different types of headaches are defined by a combination of symptoms, duration, frequency, and triggers, and respond to different kinds of treatment.

Below are a few of the more distinct types of headaches, their causes, symptoms, treatments, and for the headache sufferer, preventive measures to hopefully avoid them altogether.

Tension Headaches

These are by far the most prevalent type of headache that affects adults and teenagers— about 80% of the population has had one at one time or another. Tension headaches cause a dull aching pain, tightness, or pressure (like a band) around your forehead or the back of your head and neck. These headaches are also called stress headaches because they are often caused by mental or emotional stress, anxiety, or physical stressors on the body, such as lack of sleep or poor posture.

For most of us, tension headaches occur episodically, but for some people they can be chronic, occurring several times each week or even daily. The good news is that they can be short-lived when treated by over-the-counter pain relievers.


Almost 30 million Americans suffer from migraines, with women affected more than men by a factor of 3. Migraine headaches cause an intense, pounding, throbbing pain, often on just one side of the head. Along with the pain, people can have a multitude of other symptoms: sensitivity to light, noise, or smells; nausea or vomiting; or blurred vision. As a precursor to a migraine headache, some people also experience auras, which present as visual disturbances such as zigzags, shimmery or wavy vision, bright flashes of light, or even blind spots.

Migraines can last from 4-72 hours and can occur as frequently as once a week, or as rarely as once or twice per year. Although the exact cause is not fully understood, we do know that there are many environmental factors that can trigger migraines, ranging from certain foods and drinks to stress, changes in sleeping patterns, intense exercise, and bright lights or loud noises. Hormonal changes in women (pregnancy, menopause, points during the monthly cycle) can also trigger migraines. Knowing your specific migraine triggers is important for preventing them. There are also numerous medications that are used to treat migraines when they occur.

Sinus Headaches

Sinus headaches are caused by sinusitis, an inflammation and swelling in your sinuses, which are the air-filled cavities above and on the sides of your nose. When you have allergies or a respiratory infection like a cold or the flu, your sinuses can fill with mucous and if they don’t drain properly, the pressure builds up, causing a headache. Sinus headaches are therefore accompanied by symptoms such as a runny nose and nasal congestion and can cause pain and pressure in your cheekbones, forehead, or the bridge of your nose. The intensity of pain and pressure may also noticeably change when you move or turn your head, especially when you bend down.

The best way to treat a sinus headache is to treat the underlying sinusitis. For some people, antihistamines or decongestants may not be the best choice – they can sometimes be too drying or they may not be safe to use because they raise your blood pressure. In those cases, a steroid nasal spray or saline irrigation (i.e. pre-packaged sprays which are made with distilled water) may be a better option. You can also use a home-made saline solution as long as you use distilled water or boiled water (at room temperature) to reduce infection risk.

Interestingly, many people with frequent headaches attribute them to sinus problems when they are actually having migraines! This is why we always recommend discussing chronic headaches with your clinician to make sure you are getting the right kind of treatment.

Cluster headaches

Thankfully, cluster headaches are fairly rare, occurring in less than 1 person in 1,000, as this type of headache is the most severe. These cause a burning or piercing pain behind one eye (although the pain can radiate to other parts of the face). The pain is almost always confined to one side of the head, and will either throb or be constant in its intensity. Unlike migraines, where lying down in a dark room may help, most people with cluster headaches cannot sit or lie still due to the pain and will often pace during an attack. Also unlike migraines, they are more common in men than in women.

Cluster headaches tend to happen in groups (hence the name “cluster”), occurring 1-3 times per day over a cluster period lasting 2 weeks to 3 months. The headaches may go away completely for a time only to return. While there is no cure for cluster headaches, there are treatments as well some preventive measures, too. .

Medication Overuse or Rebound headaches

Adding insult to injury for the chronic headache sufferer is the possibility of developing a medication overuse headache (MOH). Also called a rebound headache, this type can occur in people who have frequent migraine, cluster, or tension headaches and use medications 10-15 (or more) times per month. Although all pain relieving medications have the potential to cause medication overuse headaches, higher risk of MOH seems to occur with:

What does a medication overuse headache feel like? It can vary, oftentimes depending on the type of chronic headache you already experience, and can be described as a dull pain like a tension headache or a more severe migraine-like headache, sometimes with the accompanying nausea or light sensitivity. What’s most consistent about MOH, however, is the pattern of the pain: beginning in the morning (or even waking you up), it subsides with use of medication, only to return as the medication wears off.

The treatment for MOH is, simply, to stop taking the current pain medication you use. But don’t try to do this on your own – work with your clinician to map out a treatment plan to help you through this transition. Depending on how long you have been taking a certain pain medication and how much you’ve been taking, the recovery period can vary from a few weeks to a few months. Therefore, work with your clinician to figure out if you should stop taking your medication all at once or gradually, if you should take other medications or try different therapeutic techniques to alleviate short-term symptoms, and what the longer-term plan should be to manage the underlying chronic headaches you experience.

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About Dr. Sarah Post

Dr. Sarah Post is an internist at Harvard Vanguard’s Kenmore practice and is board certified in internal medicine. She received her medical degree from the University of Pennsylvania School of Medicine in Philadelphia. She completed her residency and internship at Brigham and Women’s Hospital in Boston. Dr. Post is currently welcoming new patients. For more information about becoming a patient, please call 1-800-249-1767.

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