Headaches & Migraines

Everyone has a headache from time to time, but chronic headaches and migraines can be severe and debilitating. Not all headaches require medical attention; but sometimes, a headache can be a warning sign of a serious underlying condition. At IU Health Neuroscience, experienced neurologists provide expert evaluation and individualized treatment of headaches and migraines for adults and children, so people can put pain behind them and live life to the fullest.

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1. Types Of Headaches 3. Diagnosis
2. Symptoms 4. Treatment Options

Types Of Headaches

Headaches fall into four main categories:

  • Tension
  • Migraine
  • Inflammatory
  • Cluster

Tension Headaches

Tension headaches are the most common type of headache. As the name implies, they are usually caused by stress. Tension headaches are sometimes called muscle-contraction headaches because they can occur when the muscles in the neck, face, scalp and jaw are tightened for an extended period. Tension headaches usually cause pain on both sides of the head and can feel as though a band is being tightened around the skull. Pain is usually mild to moderate.

Some people experience tension headaches as a result of skipped meals, fatigue, depression or overexertion. Tension headaches can last for a short time or several days. They usually disappear once the stressful situation is resolved. But some people experience chronic tension headaches for weeks at a time.

Migraine Headaches

Migraine is the most common type of disabling headache. Migraines are characterized by severe pain—usually described as throbbing or pounding—that is felt on one or both sides of the head. Some people also experience nausea and extreme sensitivity to light and noise. Symptoms can last a few hours or more than a day.

Women are three times more likely to have a migraine.  About 12 percent of the U.S. population suffers from them regularly. Migraines can run in families, and people with depression, anxiety, bipolar disorder, sleep disorders and epilepsy may be more prone to migraine headaches.

Although the cause of migraines is not fully understood, many people can trace their migraines to certain triggers, including:

  • Hormonal changes
  • Stress
  • Food
  • Irregular sleep patterns
  • Sudden weather changes
  • Physical exertion
  • Medication

Inflammatory Headaches

Inflammatory headaches are usually a symptom of another condition, such as a sinus or tooth infection. Bacterial meningitis—an infection of the protective membranes covering the brain and spinal cord—can cause an inflammatory headache.

Cluster Headaches

Cluster headaches affect more men than women and usually cause pain on one side of the head. Cluster headaches often occur at the same time of day, or night for several consecutive days.

Symptoms

There are two major types of migraine—migraine with aura and migraine without aura—and symptoms vary depending on the type.

In migraine with aura, people have difficulty seeing and may temporarily lose part or all of their vision. Some people experience flashing lights, stomach pain, or tingling or numbness in the hands or face. This so-called aura usually appears before the headache and acts as a warning sign of the coming migraine. Some people experience aura with no headache pain. Research shows people who experience migraine with aura are at higher risk for stroke.

Migraine without aura is the most common type of migraine. Headache pain usually comes on without warning and is felt on one side of the head. People may also experience nausea, and increased sensitivity to light and sound.

If you experience any of the following, you should call 911, as it could be a sign of a medical emergency.

  • Sudden onset of very severe headache
  • Headache following a head injury
  • Headache with confusion, weakness, double vision or loss of consciousness

Diagnosis

At IU Health Neuroscience, our experienced neurologists diagnose headaches and migraines through patient history and a thorough neurological exam. In some cases, doctors may also conduct MRI, CT or laboratory studies to rule out any other underlying conditions.

Treatment Options

Treatment is usually recommended if a person suffers four or more severe headaches a month. Treatment for migraines focuses primarily on prevention and management of triggers.

Medication

Pain medication can reduce severity and duration of migraines, and can be taken as soon as someone starts experiencing migraine symptoms. A number of medications have been approved for relief of migraine pain. Migraine-relief medications include:

  • Triptan drugs, such as sumatriptan or rizatriptan, which increase the level of serotonin in the brain. Triptan drugs are available as tablets, nasal spray and injections.
  • Ergot derivative drugs, which bind to serotonin receptors in the brain. They are most effective if taken during the early stages of migraine and come in nasal spray or injection.
  • Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, can reduce pain.
  • Narcotics are used for temporary pain relief.

Some people develop headaches as a result of overuse of migraine medication. At IU Health Neuroscience, experienced specialists can help people manage medication to avoid both migraine-related pain and over-usage.

Preventive medication can lessen the frequency of migraines and may be recommended if someone is experiencing migraines weekly. A number of drugs that are primarily used to treat other conditions have been found to be helpful at preventing migraines. Medicines that may be prescribed for migraine prevention include:

  • Anti-convulsants, which are primarily used to treat epilepsy, but are also effective at preventing migraines.
  • Beta-blockers and calcium channel blockers, which are used to treat high blood pressure, but also are effective at preventing migraines.
  • Antidepressants, as they increase the production of serotonin.

Botulinum Injections

At IU Health Neuroscience, physicians also offer botulinum toxin A injections as a preventive treatment for some forms of migraines. This FDA-approved treatment has been proven to reduce migraine frequency in patients with chronic migraine headaches and can reduce people’s dependence on medication. During treatments which occur typically once every three months, botulinum toxin is injected into the muscles of the brow, eyes, forehead, and the side and back of the head. Injections are given every 12 weeks.

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