Headache is defined as pain in the head and upper neck. The head and neck are the more common areas of pain in the entire body. Because so many people suffer from headaches, the treatment of which is often difficult, the Headache Clinic at the University of Utah strives to understand the specific diagnosis more completely, enabling us to provide better and more effective treatment regiments.

Our physicians, physician assistants, and medical staff combine extensive experience, compassion, and the latest technology in addressing your health care problems due to headache. We provide inpatient and outpatient treatments for all headache disorders.

Headache: A Patient’s Guide

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Phone: (801) 585-7575

Headache Questionnaire for New Patient

Headache

What is a headache?

A headache is pain or discomfort in the head or face area. Headaches vary greatly in terms of pain location, pain intensity, and how frequently they occur. As a result of this variation, several categories of headache have been created by the International Headache Society to more precisely define specific types of headaches.

What aches when you have a headache?

There are several areas in the head that can hurt when you have a headache, including the following:

  • A network of nerves that extends over the scalp

  • Certain nerves in the face, mouth, and throat

  • Muscles of the head, neck, and shoulders

  • Blood vessels found along the surface and at the base of the brain (these contain delicate nerve fibers)

The tissues of the brain itself do not hurt because they do not have pain-sensitive nerve fibers.

What causes a headache?

Headaches may be caused by a number of conditions, such as disorders of the neck, eyes, brain, jaw, or teeth. Headaches with an underlying medical condition are classified as secondary headaches because they are related to the condition. An example of this would be a headache due to neck injury or sinus infection.

Other headaches are classified as primary because the headache itself is the main medical problem, although associated factors, such as muscle tension or exposure to certain foods, may be identified. Other contributing factors may include medications, dehydration, or changing levels of hormones. These factors that influence headaches are sometimes called headache triggers.

What are some of the different types of primary headaches?

  • Migraines. This type of headache is distinguished by the fact that symptoms other than pain occur as part of the headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual symptoms typically occur.

    Migraines are also unique in that they have distinct phases. Not all individuals experience each phase, however. The phases of a migraine headache may include:

    • Premonition phase. A  change in mood or behavior that may occur hours or days before the headache.

    • Aura phase. A group of visual, sensory, or motor symptoms that immediately precede the headache. Examples include hallucinations, numbness, changes in speech, and muscle weakness.

    • Headache phase. Period during the actual headache with throbbing pain on one or both sides of the head. Sensitivity to light and motion are common, as are depression, fatigue, and anxiety.

    • Headache resolution phase. Pain lessens during this phase, but may be replaced with fatigue, irritability, and difficulty concentrating. Some individuals feel refreshed after an attack, while others do not.

  • Tension headaches. Tension headaches are the most common type of headache. Stress and muscle tension are often factors in tension-type headaches. While symptoms may differ, the following are common symptoms of a tension-type headache:

    • Slow onset of the headache

    • Head usually hurts on both sides

    • Pain is dull or feels like a band or vice around the head

    • Pain may involve the back (posterior) part of the head or neck

    • Pain is mild to moderate, but not severe

    Tension type headaches typically do not cause nausea, vomiting, or sensitivity to light (photophobia).

  • Cluster headaches. Cluster headaches usually occur in a series that may last weeks or months, and the headache series may return every year or two. While people often experience symptoms differently, the following are the most common symptoms of a cluster headache:

    • Severe pain on one side of the head, usually behind one eye

    • The eye that is affected may be red and watery with a droopy lid and small pupil

    • Swelling of the eyelid

    • Runny nose or congestion

    • Swelling of the forehead

What are the most serious symptoms of a headache?

Headache symptoms depend on the type of headache. The frequency of headaches and the intensity of the symptoms may vary as well. Symptoms that may suggest a more serious headache include any of the following:

  • Headaches that start early in the morning

  • Pain that is worsened by strain, such as a cough or a sneeze

  • Vomiting without nausea

  • Sudden onset of pain and the "worst headache" ever

  • Headache that is becoming more severe or continuous

  • Personality changes

  • Changes in vision

  • Weakness in the arms or legs

  • Seizures

The symptoms of a headache may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How are headaches diagnosed?

The full extent of the problem may not be understood immediately, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a headache is made with a careful history, physical examination and diagnostic tests.

Questions commonly asked during the exam may include, but are not limited to, the following:

  • When do headaches occur?

  • What is the location of the headache?

  • What do the headaches feel like?

  • How long do the headaches last?

  • Have there been changes in behavior or personality?

  • Do changes in position or sitting up cause the headache?

  • Do you have trouble sleeping?

  • Do you have a history of stress?

  • Is there a history of head injury?

If the history is consistent with migraine or tension-type headaches and the neurological exam is normal, no further diagnostic testing may be necessary. However, if it is not a primary type headache, then other tests may be needed to determine the cause.

Tests used to determine the cause of a headache may include:

  • Blood tests. Various blood chemistry and other laboratory tests may be run to check for underlying conditions.

  • Sinus X-rays. A diagnostic imaging procedure to evaluate for congestion or other problems that may be corrected.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

How are headaches treated?

Specific treatment for headaches will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Type of headaches

  • Severity and frequency of the headaches

  • Your tolerance for specific medications, procedures, or therapies

  • Your opinion or preference

The ultimate goal of treatment is to stop headaches from occurring. Adequate headache management depends on the accurate identification of the type of headache and may include:

  • Avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting

  • Changing eating habits

  • Exercise

  • Resting in a quiet, dark environment

  • Medications, as recommended by your doctor

  • Stress management

Migraine headaches may require specific medication management including:

  • Abortive medications. Medications, prescribed by your doctor, that act on specific receptors in nerves and blood vessels in the head to stop a headache in progress.

  • Rescue medications. Medications purchased over-the-counter, such as analgesics (pain relievers), to stop the headache.

  • Preventive medications. Medications, prescribed by your doctor, that are taken daily to reduce the onset of severe migraine headaches.

Some headaches may require immediate medical attention including hospitalization for observation, diagnostic testing, or even surgery. Treatment is individualized depending on the underlying condition causing the headache. Full recovery depends on the type of headache and other medical problems that may be present.

How a Migraine Happens

Theories about migraine pain

Older theories about migraines suggested that symptoms were possibly due to fluctuations in blood flow to the brain. Now many headache researchers realize that changes in blood flow and blood vessels do not initiate the pain, but may contribute to it.

Current thinking regarding migraine pain has moved more toward the source of the problem, as improved technology and research have paved the way for a better understanding. Today, it is widely understood that chemical compounds and hormones, such as serotonin and estrogen, often play a role in pain sensitivity for migraine sufferers.

One aspect of migraine pain theory explains that migraine pain occurs due to waves of activity by groups of excitable brain cells, which trigger chemicals, such as serotonin to constrict blood vessels. Serotonin is a chemical necessary for communication between nerve cells. It can cause constriction or narrowing of blood vessels throughout the body.

When serotonin or estrogen levels change, the result for some is a migraine. Serotonin levels may affect both sexes, while fluctuating estrogen levels affect women only.

For women, estrogen levels naturally vary over the life cycle, with increases during fertile years and decreases afterwards. Women of childbearing age also experience monthly changes in estrogen levels. Migraines in women are often associated with these fluctuating hormone levels and may explain why women are more likely to have migraines than men.

Some research suggests that when estrogen levels rise and then fall, this may trigger contractions in blood vessels, leading to throbbing pain. Other data suggest that lower levels of estrogen make facial and scalp nerves more sensitive to pain.

What commonly triggers a migraine?

People who get migraines may be able to identify triggers that seem to start the onset of symptoms. Some possible triggers include the following:

  • Stress and other emotions

  • Biological and environmental conditions, such as hormonal shifts or exposure to light

  • Fatigue

  • Glaring or flickering lights

  • Weather changes

  • Certain foods

The American Headache Society suggests documenting triggers in a headache diary. Taking this information with you when you visit your doctor enables your health care provider to identify headache management strategies. 

Susan K. Baggaley, M.S.N., FNP-C, NP-C

Susan Baggaley, MSN, FNP-C is a certified nurse practitioner, seeing patients with complex headache disorders including migraine, cluster, and chronic daily headaches. Susan has over 16 years of specialty headache experience and has been involved in numerous research and clinical drug trials. She also directs a... Read More

Specialties:

Cluster, Family Nurse Practitioner, Headache, Migraine, Neurology

Locations:

Imaging and Neurosciences Center (801) 585-7575

K.C. Brennan, M.D.

K.C. Brennan, MD, recently joined the Department of Neurology as Assistant Professor, treating patients primarily in the Headache Clinic. In addition to his clinical responsibilities, Dr. Brennan is extensively involved in research examining the basic mechanisms of migraine.... Read More

Specialties:

Cluster, General Neurology, Headache, Migraine, Neurology, Traumatic Brain Injury

Locations:

Imaging and Neurosciences Center (801) 585-7575

Kathleen B. Digre, M.D.

Kathleen B. Digre specializes in neuro-ophthalmology and headache. She evaluates and treats complex visual complaints which can be due to optic nerve or brain disease. Her interests include gender differences in neuro-ophthalmic disorders, pseudotumor cerebri, ischemic optic neuropathy, temporal arteritis, papil... Read More

Specialties:

Cluster, Headache, Migraine, Neuro-Ophthalmology, Neurology, Ophthalmology

Locations:

John A. Moran Eye Center (801) 581-2352

University Campus/Research Park

Imaging & Neurosciences Center 729 Arapeen Drive
Salt Lake City, UT 84108
Map
(801) 585-7575
John A. Moran Eye Center 65 Mario Capecchi Drive
Salt Lake City, UT 84132
Map
(801) 581-2352