By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TENSION, MIGRAINE, CLUSTER -- DIFFERENT NAMES FOR HEAD PAIN

Question: I have severe headaches. Some are migraines, others are muscular related. They are frequent, but not always the same. How can I tell which ones to worry about? Is there medicine to prevent headaches?

Answer: Headaches are very common. When surveyed, almost all adults said they have had at least one headache in the past year. For most sufferers, over-the-counter pain relievers like acetaminophen, ibuprofen and aspirin are sufficient.

Headaches are classified as primary and secondary. Primary headaches -- accounting for 90 percent of the total -- are not caused by any underlying medical condition. These include migraine, tension and cluster headaches. Secondary headaches, on the other hand, are the result of medical conditions like infection, tumor, sinus problems or trauma. Today, I’ll focus chiefly on primary headaches.

Tension headaches are the most common. These headaches -- which can be chronic and occur daily -- are often related to stress. Tension headache pain can range from mild to moderate.

Migraine headaches, though less common, are more likely to afflict women than men. Migraines, which can be dull or severe, typically produce a throbbing, pounding or pulsating type of pain. They are usually worse on one side of the head, and last six to 48 hours. Also, migraines tend to repeat and are often accompanied by symptoms such as nausea, vomiting or sensitivity to light. A minority of migraine sufferers have warning symptoms, called an aura, before the actual headache begins.

Cluster headaches, while more common in men, are still fairly rare. These headaches come in groups called “clusters.” A cluster -- which can last weeks or months -- can be brought on by stress, or when you are relaxing after a stressful time. During a cluster period, drinking alcoholic beverages can bring on a headache. This can happen very quickly, sometimes before you finish the first drink. That’s why it’s important to completely avoid alcohol during a cluster period.  

Many factors can trigger a primary headache, like foods, odors, weather and emotional factors. Knowing what triggers your headaches can help you prevent them.

Treatment depends on the specific type of headache you’ve been experiencing. Common tension headaches respond well to non-medical therapy, such as relaxation and biofeedback. Osteopathic manipulation of the neck and upper back can be used quite effectively to treat and prevent tension headaches. Migraines can be treated in the acute phase with prescription medications, but ultimately you should use the newer medications that can prevent these painful headaches. With cluster headaches, lifestyle changes -- such as avoiding alcohol, dietary modifications and quitting smoking -- can be helpful.

If any of the following “rules of thumb” are true, you may have a secondary headache and need prompt medical attention for the underlying cause.
• You have more than three headaches a week or need pain relievers almost daily.
• Your headache is accompanied by signs of illness, like fever, dizziness, slurred speech, stiff neck or mental confusion.
• You have a persistent headache after a head injury.
• Your headache keeps getting worse and won’t go away.
• You are over 50 and begin to be bothered by more frequent headaches or have your “first and/or worst” headache of your life.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.