From the Guidelines
Headaches can be caused by various factors, including tension, migraines, sinus problems, dehydration, eye strain, and certain medical conditions, as noted in a recent study published in Nature Reviews Neurology 1. The causes of headaches can be diverse and complex, involving a range of physiological and environmental factors.
- Tension headaches often result from stress, poor posture, or muscle tightness in the neck and shoulders.
- Migraines may be triggered by hormonal changes, certain foods like aged cheese or processed meats, alcohol, bright lights, strong smells, lack of sleep, or weather changes, as discussed in a study on the diagnosis and management of migraine in ten steps 1.
- Sinus headaches occur when sinuses become inflamed due to allergies or infections.
- Dehydration headaches develop when the body lacks sufficient fluids, while eye strain headaches can result from prolonged screen time or vision problems.
- Some headaches are symptoms of underlying medical conditions such as high blood pressure, concussion, or medication overuse, highlighting the importance of differential diagnoses as outlined in a study on the differential diagnoses for migraine 1. For occasional headaches, over-the-counter medications like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours can provide relief, as suggested by guidelines on the pharmacologic management of acute attacks of migraine and prevention of migraine headache 1. Staying hydrated, managing stress, maintaining regular sleep patterns, and taking breaks from screens can help prevent many types of headaches. If headaches are severe, persistent, or accompanied by other symptoms like fever, confusion, or neck stiffness, medical attention should be sought promptly, considering the potential for secondary headaches with underlying pathologic causes, as noted in a guideline on the diagnosis and management of headache in children 1.
From the Research
Causes of Headaches
The causes of headaches can be categorized into primary and secondary headaches.
- Primary headaches are defined as headaches that are unrelated to an underlying medical condition and are categorized into 4 groups: migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary headache disorders 2.
- Secondary headaches are defined as headaches due to an underlying medical condition and are classified according to whether they are due to vascular, neoplastic, infectious, or intracranial pressure/volume causes 2.
Primary Headache Disorders
Primary headache disorders are the most common type of headache and include:
- Migraine: a debilitating headache disorder that can be treated acutely with analgesics, nonsteroidal anti-inflammatory drugs, triptans, gepants, and lasmiditan 2, 3.
- Tension-type headache: a common primary headache disorder that can be treated with over-the-counter pain medications and lifestyle changes 2, 3.
- Trigeminal autonomic cephalalgias: a group of primary headache disorders characterized by autonomic symptoms such as lacrimation and nasal congestion 3.
Secondary Headache Disorders
Secondary headache disorders are headaches that are caused by an underlying medical condition.
- These can include headaches caused by:
- Infection: such as meningitis or encephalitis 4, 5.
- Vascular disease: such as stroke or intracranial hemorrhage 4, 2.
- Neoplastic disease: such as brain tumors 2.
- Intracranial pressure/volume causes: such as idiopathic intracranial hypertension 2.
- Trauma: such as post-traumatic headache 4, 5.
- Substance use/withdrawal: such as caffeine withdrawal or medication overuse headache 5.
- Psychiatric conditions: such as depression or anxiety disorders 6, 5.
Red Flag Signs and Symptoms
Certain signs and symptoms can indicate a serious underlying condition and require further evaluation.