About Headaches

Overview

Headache is a very common symptom experienced by 65–80% of women and 57–75% of men, meaning more than half of both women and men experience it. When a headache occurs, people may worry that it could be caused by a brain disease, but in most cases there is no serious illness. Headaches are broadly divided into primary headaches, in which there is no specific disease in the brain, and secondary headaches, which appear due to various diseases. Primary headaches can be classified into tension-type headache, migraine, and cluster headache. Relatively common causes of secondary headaches include inflammation of the temporal artery (temporal arteritis), myofascial pain syndrome that causes pain in the shoulders or neck, and medication-induced headaches. Among secondary headaches, conditions directly related to life-threatening illness include brain tumors, cerebral hemorrhage, increased intracranial pressure, encephalitis, and meningitis. Here, I will mainly explain primary headaches.

Causes

1. Tension-type headache This is the most common type of headache. The characteristic symptom of tension-type headache is a steady feeling of tightness and pressure, as if a band is wrapped tightly around the head. The pain is mild and usually begins in the late afternoon or evening, lasting for several minutes. In some cases, the pain can be very severe and may make it difficult to sleep, but in general it is not severe enough to wake a person up.

The frequency of pain varies from person to person. Most people say they experience it only occasionally, but depending on the person, some complain of headaches every day or more than twice a week. Tension-type headache is common in middle age, and there is no major difference between men and women. It is associated with poor posture, cervical spine disorders, tension in the head and neck muscles, narrowing of blood vessels in the muscles, stress, anxiety, and depression. Tension-type headache can worsen with sleep apnea, in which breathing stops for more than 10 seconds during sleep, as well as medications, excessive drinking, and caffeine intake.

2. Migraine The exact cause of migraine has not yet been identified. There are two theories: one explains that headaches occur when cerebral blood vessels constrict and then dilate, pressing on the surrounding tissues; the other explains that headaches occur due to abnormalities in the metabolism of serotonin, a neurotransmitter in the brain. Migraine is more common in women, and if a person has migraine, there is a higher chance that someone in the family also experiences migraine.

Migraine may occur only a few times in a lifetime, or it may appear several times a week. It usually first appears between puberty and the age of 40, and the intensity and frequency of migraine decrease with age, so it often improves after menopause. Because of these characteristics, it is sometimes assumed that the female hormone estrogen affects migraine.

3. Cluster headache Cluster headache causes a piercing pain in one eye and the area around it, and among primary headaches, its symptoms are among the most severe. Symptoms occur about 1 to 3 times a day for several weeks or several months. The pain feels as if the head and eye are being carved out, but it does not leave any special disability. If there is very severe pain around the eye and vision problems, there is a possibility of glaucoma, so an ophthalmology consultation is necessary. Cluster headache is more common in men, and symptoms usually begin in the teenage years or early 20s.

Smoking and drinking are lifestyle factors that can trigger cluster headache. The exact reason cluster headache occurs is not known, but it is thought to be related to abnormalities in biological rhythms controlled by the brain, disorders of cerebral blood vessels, and brain neurotransmitters such as serotonin and histamine. Cluster headache is more likely to occur in men, people over 30, those who drink excessively, those taking vasodilators (nitroglycerin), and those who have previously injured their head or undergone surgery.

So far, I have explained headaches. In the next part, we will look at the diagnosis and treatment of headaches.

Source: Korea Centers for Disease Control and Prevention National Health Information Portal