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

For appointments and consultations, contact us.

Phone: (801) 585-7575

Headache Questionnaire for New Patient


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. This results in several categories of headaches. While the actual brain tissue doesn’t have pain-sensitive nerve fibers and doesn’t feel pain, other parts of the head can be responsible for a headache including:

  • 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)

Different types of headaches include:


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 with migraine. Migraines are also unique in that they have distinct phases. Not all people have 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 vision changes, 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 causes a headache?

Headaches are classified as primary or secondary.

  • A primary headache means the headache itself is the main medical problem, although other factors, such as muscle tension or exposure to certain foods, may be identified. Other contributing factors include medications, dehydration, or hormone changes.
  • A secondary headache is related to an underlying medical condition. An example of this would be a headache due to neck injury, eye problems, jaw, teeth or sinus infection.

What are the 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. Typical headache symptoms include:

  • 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).

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

How is a headache 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 lab 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 health care provider 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 health care provider
  • Stress management

Migraine headaches may require specific medication management including:

  • Abortive medications. Medications, prescribed by your health care provider, 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 health care provider, 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.

Can headaches be prevented?

When headache triggers are known, avoiding the triggers can prevent a headache. Reducing stress can minimize or prevent headaches caused by stress. Migraine headaches may be prevented by taking a daily preventive medication.

When should I call my health care provider?

Most headaches can be managed with over-the-counter pain relievers. However, you should call your health care provider right away if a severe headache is accompanied by:

  • Stiff neck
  • Fever
  • Nausea
  • Vomiting
  • Convulsion
  • Shortness of breath
  • Confusion
  • Muscular weakness
  • Double vision
  • Change in level of consciousness.

Symptoms that may suggest a more serious headache include any of the following:

  • Worst headache ever, or new type of headache
  • Recurring headaches in children
  • Headaches that start early in the morning
  • Headache that follows a head injury
  • 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
  • Seizures

Key points

  • A headache is pain or discomfort in the head or face area.
  • Types of headaches include migraine, tension, and cluster.
  • Headaches can be primary or secondary. If it is secondary, it is caused by another condition.
  • Avoiding headache triggers is the best prevention.
  • Mild to moderate headaches can be managed with over-the-counter medications but notify your health care provider if your headache is severe and accompanied by other symptoms.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

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 happens due to waves of activity by groups of excitable brain cells. These trigger chemicals, such as serotonin, to narrow blood vessels. Serotonin is a chemical necessary for communication between nerve cells. It can cause 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, contractions in blood vessels may be set off. This leads 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 kick off the symptoms. Some possible triggers include the following:

  • Stress and other emotions

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

  • Fatigue and changes in one's sleep pattern 

  • Glaring or flickering lights

  • Weather changes

  • Certain foods and drinks

The American Headache Society suggests documenting triggers in a headache diary. Taking this information with you when you visit your healthcare provider helps him or her to identify headache management strategies. 


Headache, Neuro-Ophthalmology


Imaging & Neurosciences Center (801) 585-7575

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 all neurology outpatient clinics at th... Read More

K.C. Brennan, M.D.

K.C. Brennan, MD, is a clinician scientist who specializes in the treatment of headache. disorders. His lab studies the basic mechanisms of migraine and post-traumatic headache.... Read More

Kathleen B. Digre, M.D.

Kathleen B. Digre, MD, specializes in neuro-ophthalmology and headache and practices at the John A. Moran Eye Center, University of Utah, Salt Lake City. She evaluates and treats complex visual complaints which can be due to optic nerve or brain disease. Dr. Digre sees patients with complex neuro-ophthalmic disorders such as papilledema, photophobi... Read More

Rebecca Wilson, D.O.

Rebecca Wilson, D.O., is a clinical instructor in the Division of Physical Medicine and Rehabilitation whose interests include osteopathic manipulative medicine, preventative medicine and wellness, integrative health, cancer rehabilitation, and neuromusculoskeletal medicine. She is passionate about supporting the unique healing process of every ind... Read More


Back, Cancer Rehabilitation, Concussion, Electrodiagnosis, Headache, Myofascial Pain, Neck, Non-operative Musculoskeletal Disorders, Osteopathic Care, Physical Medicine & Rehabilitation, Preventive Medicine


Huntsman Cancer Institute
Linda B. and Robert B. Wiggins Wellness Center
(801) 587-4585
School of Medicine
Physical Medicine & Rehabilitation
(801) 581-2267

University Campus/Research Park

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