There is probably no malady more common than the headache. According to a national survey, about 20 percent of women and nearly 10 percent of men ages 18 and older report experiencing a headache or migraine in the past three months.
We associate headaches with common lifestyle triggers such as stress at work, changes in diet, excess alcohol drinking, and also with colds and allergies. Usually, swallowing an over-the-counter painkiller takes care of the problem. But severe, recurring headaches can be related to diabetes, neurological disorders, hypertension or arthritis. They require professional care.
The Yale Medicine Headache & Facial Pain Center focuses on better diagnoses and more personalized treatments for people with severe headaches.
What are the most common types of headaches?
“Headache” is a broad term used to describe many different types of pain, but the term “headache disorder” is the formal name for a medical condition in which a person suffers from recurrent head pain, usually associated with other symptoms such as nausea and sensitivity to light or noise. Different types of headache disorders are defined based on specific characteristics and location of the pain.
Migraine, the most common type of headache disorder, is typically an intense pain made worse by light and sound. More than 90 percent of patients who visit a doctor complaining of headaches are in fact suffering from migraine, according to Yale Medicine neurologist Christopher Gottschalk, MD. About one-third of migraine sufferers will have episodes called “aura,” a type of brain dysfunction that can include seeing shimmering zigzag shapes or visual “sparking,” blind spots, numbness on one side of the body, or trouble speaking.
Cluster headache is characterized by short episodes of intense pain on one side of the head, usually several times a day (and often at a predictable time of the day or night). It is often accompanied by intense redness of the eye or tearing or nasal discharge on the same side as the head pain.
Facial neuralgia refers to severe stabbing or shooting pains in the cheek or jaw for a few seconds at a time. Post-traumatic headaches occur after concussion or other brain injury, and are usually very frequent and severe. They are too often written off as part of post-concussion “syndrome” and not treated adequately. Yale Medicine treats all of those disorders and others at its Headache & Facial Pain Center.
How are headaches diagnosed?
Diagnosing headache disorder is usually straightforward and typically involves asking patients about their personal history of headaches in detail. Brain imaging such as magnetic resonance imaging (MRI) or computed tomography (CT) scans can be used, in some cases, to diagnose a specific cause of head pain.
"It’s unwise to let a headache linger without attempting to quell the pain," Dr. Gottschalk says. Those who let their headaches go untreated, or who have ineffective treatment, are eight times more likely to suffer additional headaches later on compared with people who successfully treat their pain right away.
“A headache is like a fire in your head,” Dr. Gottschalk says. “Like any other fire, if it gets big and goes on for a long time, it becomes very hard to get rid of, and smolders for a long time afterward.”
Why do headaches affect some people more than others?
Anyone can suffer from headache disorders, although it is more common in women. Researchers say they believe hormone changes during puberty contribute to headache disorders in women.
For example, migraines are more commonly diagnosed in boys younger than 12, than in girls younger than 12. But after puberty, migraines are more commonly found in women than in men.
How are headaches treated?
Treating headache disorder requires a two-pronged approach: prevention and intervention. First, most patients can significantly reduce their chances of developing a headache by taking a preventative therapy like a daily dose of a prescription drug such as topiramate (Topamax).
Many patients with frequent migraines benefit from injections of botulinum toxin (Botox). But if a headache does strike, the second step is to quell it with additional medication before it gets worse. Far too often, doctors ignore or underemphasize this second step, and patients suffer through their headaches unnecessarily.
Even if a patient is being treated with a preventive drug such as Topamax, every headache experienced increases a person’s chances of developing another. If a headache becomes disabling or prolonged, a patient should go to an emergency room or acute care center to seek stronger treatment.
How are acute headaches treated?
Migraine attacks are treated with drugs called triptans that mimic serotonin, a chemical found in the body that make people feel well and happy. Some headache attacks need additional medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or certain anti-nausea drugs that help stop a migraine.
Swallowing pills is often not effective for a person who has an acute headache, as the stomach is usually not functioning properly at that time, says Dr. Gottschalk. Therefore, acute headache medication typically works best if it is delivered via nasal spray, injection, or intravenously, directly into the bloodstream. We also now have a battery-powered patch that patients can use at home to infuse medication through the skin.
How is Yale Medicine's approach to treating headaches unique?
Our expertise lies in tailoring treatment to the unique needs of each patient. Dr. Gottschalk established the Yale Headache & Facial Pain Center, a specialized unit within the department of neurology, to address the unnecessary suffering caused by headache conditions.
“They are very common,” he says, “and too commonly misdiagnosed.” Yale Medicine’s specialized acute treatment center utilizes a range of aggressive treatment for severe attacks.
Doctors strive to provide the most advanced preventative treatments to chronic sufferers, including Botox injections, nerve blocks, and nerve stimulators. Patients will also have access to clinical trials for new treatments or therapies depending on their specific condition. If you're interested in learning about clinical trials, click here.