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 Indiana University Health, experienced neurologists provide expert evaluation and individualized treatment of headaches and migraines for adults and children.

Headaches fall into four categories:

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 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 if a band is being tightened around the skull. Pain is usually mild to moderate.

Some people get 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

Migraines are the most common type of disabling headache. Migraine headaches are characterized by severe pain—usually described as throbbing or pounding—felt on one side 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 United States 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
  • Medicines

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

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

Migraines without auras are the most common type of migraines. Headache pain usually comes without warning and is felt on one side of the head. People may also have nausea and increased sensitivity to light and sound.

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.

If you experience any of the following symptoms, 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

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

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.


Pain medicine can reduce the severity and duration of migraines and can be taken as soon as someone starts having migraine symptoms. A number of medicines have been approved for relief of migraine pain. Migraine-relief medicines include:

  • Triptan drugs, such as sumatriptan or rizatriptan, which increase the level of serotonin in the brain. Triptan medicines are available as tablets, nasal spray and injections.
  • Ergot derivative medicines, 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, experienced specialists help people manage medicines to avoid both migraine-related pain and over usage.

Preventive medicines can lessen the frequency of migraines and may be recommended if someone is experiencing migraines weekly. A number of medicines 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:

  • Anticonvulsants, 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, 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 a patient’s dependence on medicine. During treatments, which typically occur once every three months, botulinum toxin is injected into the muscles of the brow, eyes, forehead and the side and back of the head.