The headache, sometimes handy as an excuse, more often than not, a very real, annoying discomfort. For some, it is a pain that is debilitating and in some rare instances a headache could signal an emergency medical situation.

But what exactly is a headache? Are all headaches caused by the same thing? In a nutshell, headaches (those that are not due to brain stroke) occur when something causes blood vessels in and around the brain to dilate. This in turn causes the release of chemicals that promote inflammation, which in turn causes further blood vessels to dilate causing further inflammation with the end result being pain.

Fortunate is the human being who has never experienced a headache or rarely does. Many people say they suffer from migraines, not headaches, and sometimes the person who thinks he/she has severe headaches could actually be having migraines. Muscle tension headaches can frequently trigger a migraine. For me, as a primary care provider, the distinction is important. A patient’s treatment plan may vary depending on the type of headaches experienced. For example, the triptan group of drugs used to treat migraine (e.g. Imitrex) does nothing for sinus/allergy headaches.

In 1858, Dr. Edward B. Foote wrote in his book, “Plain Home Talk: Medical Common Sense,” that “bilious headaches” occur because the liver extracts from the blood certain properties which, when collected together, constitutes bile, a carbonaceous compound which, poured into the duodenum, becomes one of the agents of digestion. When the liver becomes so diseased as not to do this, the blood becomes loaded with these bilious properties, and the digestion becomes impaired. These irritating matters in the blood visit the head and coming within sensible contact with delicate nerves therein, because irritations which make themselves felt in the form of aches.” His treatment was probably his own patented liver tonic. Needless to say, Foote’s theory and treatment no longer applies.

Medical theory today categorizes headaches as migraine (where the origin of the headache is vascular, having to do mostly with the blood vessels of the brain), acute rhino sinusitis headache (the pain accompanied by severe head colds and/or true sinus infections), episodic muscle tension headache (where the origin of the headache is due to the muscles of the head, scalp and neck become inappropriately tensed) and finally atypical headache. Migraine itself is subdivided into classic migraine and common migraine, which are headaches that are usually not preceded by an aura and account for 80 percent of migraines. Classic migraine is usually preceded by an aura, which is a sensory disturbance such as the experience of flashing lights or zigzagging lines in the visual field, unusual tactile sensations or smells (sensory aura), or disturbances in speech (dysphasic aura). The symptom depends which part of the surface of the brain is affected. Most commonly the visual area is affected. An aura can sometimes occur without headache and the headache can sometimes occur without the preceding aura. In fact any combination is possible: aura followed by headache, headache followed by aura, aura and headache developing simultaneously, aura on its own without headache and lastly the commonest situation — headache on its own without aura. Migraine headaches are also generally accompanied by nausea and vomiting and sensitivity to lights and sounds. Cluster headache refers to the characteristic grouping or clustering of headache attacks. The headache periods can last several weeks or months, and then disappear completely for months or years leaving the sufferer pain-free for long intervals. Cluster is one of the least common types of headache. Most sufferers get one to four headaches per day during a cluster period that occur regularly, at the same time each day. Cluster headaches often awaken the sufferer in the early morning or during the night and have been called “alarm clock headaches.”

Symptoms of all types of headaches can overlap to a degree. But any headache that is significantly different from the sufferer’s own typical headache, or described as the most severe headache ever experienced, or is associate with other neurological symptoms such as loss of vision, or loss of balance, etc., is probably more the atypical type and may constitute an emergency.


• Throbbing, intense pain, generally moderate to severe.

• Usually one-sided, though the pain can move from side to side, and sometimes affects both sides.

• Pain is often near the eye of the affected side.

• Often disabling.

• May last hours, days, or even weeks.

• In some instances, the migraine may continue long enough to require an emergency room visit, or even hospitalization, so that stronger medications can be given to break the cycle (status migrainous).

• Often accompanied by visual disturbances and/or extreme sensitivity to light, sound, and odors.

• “Classic migraine,” experienced by about 20 percent of headache sufferers is preceded by warning signs called an “aura.”

• Migraines without the aura are termed “common migraine.”

Tension headache:

• Constant, dull pain, usually mild to moderate pain.

• Not incapacitating.

• Pain is often accompanied by muscle tightness in the shoulders and neck.

• Often on both sides of the head.

• May last an hour, a week, or anywhere in between.

• The pain is often described as a band of pain around the head or “like a vise.”

Sinus/allergy headache:

• Pain generally mild to moderate.

• Centered around sinuses, above and below eyes.

• Pressure often makes teeth ache as well.

• May be accompanied by feeling of pressure behind the eyes.

• Often relieved by decongestants, antihistamines, or other allergy medications.

• Often seasonal.

• Studies have shown that the majority of self-diagnosed sinus headaches are actually migraine.

Cluster headache:

• Severe, sharp, stabbing pain.

• Usually on one side of the head, centered around the eye.

• Almost always severely incapacitating.

• Occur in clusters of 1-4 headaches a day for several weeks, lasting 10 minutes to two hours each, then stopping for months.

• On the affected side, the eye tears, and the nose is often stuffy or runny.

• Most frequent among men.

• Occur most often in the fall and spring.

Whether it is due to migraine, sinuses, muscle tension, or cluster, try to keep a log of your pain that includes:

• When do the headaches occur?

• What makes the headache worse and what makes the headache better?

• Is there a discernible pattern to the headaches?

• Are the particular triggers to bring on the headaches?

• Is there family history for any type of headache?

All of these questions when discussed together with your health care provider’s additional fact finding questions and physical exam could be of great value in diagnosing correctly and prescribing an appropriate treatment plan and/or medication.

Agnes Oblas is an adult nurse practitioner with a private practice and residence in Ahwatukee Foothills. For questions, or if there is a topic you would like her to address, call (602) 405-6320 or email Her website is

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