What is a headache?

Headache is our most common form of pain and a major reason cited for days missed at work or school as well as visits to the doctor.

The International Classification of Headache Disorders, published by the International Headache Society, is used to classify more than 150 types of primary and secondary headache disorders.

Primary headaches occur independently and are not caused by another medical condition. Migraine, cluster, and tension-type headache are the more familiar types of primary headache.

Secondary headaches are symptoms of another health disorder that causes pain-sensitive nerve endings to be pressed on or pulled or pushed out of place. They may result from underlying conditions including fever, infection, medication overuse, stress or emotional conflict, high blood pressure, psychiatric disorders, head injury or trauma, stroke, tumors, and nerve disorders (particularly trigeminal neuralgia, a chronic pain condition that typically affects a major nerve on one side of the jaw or cheek).

Headaches can range in frequency and severity of pain. Some individuals may experience headaches once or twice a year, while others may experience headaches more than 15 days a month. Pain can range from mild to disabling and may be accompanied by symptoms such as nausea or increased sensitivity to noise or light, depending on the type of headache.

Is there any treatment?

When headaches occur three or more times a month, preventive treatment is usually recommended. Migraine treatment is aimed at relieving symptoms and preventing additional attacks.

Drug therapy, biofeedback training, stress reduction, and elimination of certain foods from the diet are the most common methods of preventing and controlling migraine and other vascular headaches.

Drug therapy for migraine is often combined with biofeedback and relaxation training. One of the most commonly used drugs for the relief of migraine symptoms is sumatriptan.

The first step in caring for a tension-type headache involves treating any specific disorder or disease that may be causing it. A physician may suggest using analgesics, nonsteroidal anti-inflammatory drugs, or antidepressants to treat a tension-type headache that is not associated with a disease.

The Food and Drug Administration has approved galcanezumab-gnlm (Emgality) injections to reduce the frequency of episodic headache attacks. The drug was previously approved by the FDA to prevent migraine in adults.

Other treatment for cluster headache includes triptan drugs, non-invasive vagus nerve stimulation (which uses a hand-held device to transmit a mild electrical stimulation to the vagus nere throgh the skin), and oxygen therapy (in which pure oxygen is breathed through a mask to reduce blood flow to the brain).

Certain antipsychotic drugs, calcium-channel blockers, and anticonvulsants can reduce pain severity and frequency of cluster headache attacks.

The FDA also has approved lasmiditan (Reyvow) and ubrogepant (Ubrelvy) tablets for acute treatment of migraine with or without aura.

What is the prognosis?

Not all headaches require medical attention. But some types of headache are signals of more serious disorders and call for prompt medical care.

These include: sudden, severe headache or sudden headache associated with a stiff neck; headaches associated with fever, convulsions, or accompanied by confusion or loss of consciousness; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person who was previously headache free; and recurring headache in children.

Migraine headaches may last a day or more and can strike as often as several times a week or as rarely as once every few years.

What research is being done?

Research conducted and supported by NINDS, part of NIH, is revealing much about the headache process and may lead to new treatments or perhaps ways to block debilitating headache pain. Other NIH Institutes and Centers also support studies on headache and pain.

Current research efforts include: studies to learn more about headache mechanisms, underlying causes, and genetics; studies aimed at developing new drugs and other treatment options; studies on headache in children and adolescents; studies using diagnostic imaging to provide valuable insight into the pathophysiology of headache disorders; studies to explore the roles behavior and sleep play in headache disorders.