LEWISBURG – The pulsing, nagging pain in your head may not be a migraine. Headaches come in various forms and not all are treated the same.

Area neurologists gave a breakdown of the differences among headaches, from the simply annoying and uncomfortable to the downright debilitating.

Dr. Jessica Ahlum is a neurologist with Evangelical Community Hospital. Dr.Stuart Olinsky is with UPMC in North Central Pa. Neurology. Dr. Abigail Chua, Headache Specialist with Geisinger is board certified in both neurology and headache medicine fellowship.

“Many things can cause headaches, such as poor sleep, too much caffeine, and dehydration. In addition, some people have neurologic or medical conditions that predispose them to getting headaches,” Chua said.

Many folks often assume a bad headache and a migraine are one and the same. Not so, said Ahlum.

“Migraines are classed into a group of certain symptoms,” she said, including light and sound sensitivity, smell changes, and some neurological symptoms such as numbness and tingling. Patients with migraines also experience an aura at first, or an awareness that the migraine is setting in. An aura may consist of the symptoms mentioned and/or nausea or dizziness an hour or so before the pain of the migraine begins. A migraine is often contained to one side of the head and face. “A general headache is not associated with any of this,” Ahlum said.

“If you experience migraines frequently, it’s important to speak with your physician to rule out underlying issues,” Olinksy said.

Common forms of headaches, other than migraines, include tension headaches, occipital neuralgia, and cluster headaches. Neurologists can determine the type of headache a patient is experiencing based on the symptoms surrounding the pain.

The most common type of headache is a tension headache. The pain wraps itself around the forehead to the back of the head like a tight elastic band.

“When most people think of a headache, that dull pressure and discomfort in the head, they’re describing a tension headache,” Olinksy said, “These headaches are very common and most often do not have additional symptoms. While they can be painful, they are rarely a sign of more serious illness.”

Ahlum said a tension headache is often due to a muscle spasm in the neck or head. The pain is often moderate and can be treated with over-the-counter pain medications.

Cluster headaches are known for their location. The pain triggers autonomic symptoms such as red eye, eye lid swelling, dilated pupils and stuffy nose. These extremely painful headaches come in “clusters” throughout a day and do not last more than an hour.

“A cluster headache commonly awakens you in the middle of the night with intense pain in or around one eye on one side of your head,” Olinsky said, “Bouts of frequent attacks, known as cluster periods, can last from weeks to months, usually followed by remission periods when the headaches stop. During remission, no headaches occur for months and sometimes even years. Cluster headaches are rare and not life-threatening.”

The only known treatment to relieve cluster headaches is inhaling oxygen. “The classic way to know if it’s a cluster headache is to give supplemental oxygen,” Ahlum said, and determine if the headaches stop.

Occipital neuralgia occurs when nerves in the back of the head are irritated, Ahlum said. “This can cause a sharp, shooting pain in the back of the head,” Ahlum said and is often accompanied by pain in the back of the neck and behind the ears. An injury to the neck or head can cause these headaches in which the nerve is pinched.

Arthritis in the upper spine can also cause headaches, Ahlum said. In severe cases, she refers patients with this issue to pain management for further treatment.

Ahlum said when a patient is referred to her with chronic head pain, she meets with them to discuss their symptoms. She is able to group the headache pain into one or two groups: migrainous or non-migrainous.

Ahlum said she likes to rule out serious concerns immediately by getting an MRI of the brain to determine if there has been a stroke or if a tumor is present. She also looks into the back of the eyes to see if there is pressure being placed on the brain by any growths. Another concerning factor is weakness or hyperreflexia (loss of movement).

“There are no guaranteed signs to indicate that a headache is being caused by an underlying condition. However, headaches that are brand new in a person younger than 5 or older than 50 years old should be evaluated by a medical professional to make sure there are no worrisome signs,” Chua said.

It’s common for patients to fear the worst with frequent, intense headaches, Olinksy said. “If headaches are taking a toll on your life day-to-day, it’s time to make an appointment. This could mean that they are happening more often, they have been more severe than usual, or when pain relievers or other over-the-counter medicine doesn’t help,” Olinsky said.

In the case of a stroke there may be sensory changes, numbness or tingling and facial weakness, Ahlum said. “When treating headaches it is very rarely a stroke.”

In most cases, the problem is not life threatening, but it is instead simply life impacting as chronic head pain left untreated can impact one’s day to day activities.

Women may experience headaches more often than men, Olinksy said.

“Migraines and tension headaches are both more common in women than men. When it comes to migraines, many women can be triggered by sleep pattern changes, eating or drinking something in particular, or strong scents or light patterns. Migraines can also be triggered around the time of a woman’s period due to the variation of estrogen levels during a menstrual cycle.”

No matter the cause of your headache, keep in mind how you self-medicate.

“If your headache is not being improved with over-the-counter medications, or you find you are taking a lot of medications,” Ahlum said, then it is time to see a neurologist.

Often patients choose to self medicate and can overmedicate, Ahlum said. Coping incorrectly with head pain by taking too much medication for an extended period of time can actually cause a rebound headache, she said.

“It’s best to see a neurologist for pain management,” Ahlum said, and to limit taking pain medications for headaches to two to three times per week. “Any over-the-counter medication taken more than that is too much.”

Neurologists can help find the best prescription medication for your type of headache. Ahlum said patients often inquire if they should take opioids for their headaches. “We have so many other medications to offer and these (opioids) are often overused,” she said.

Common causes for typical headaches include stress and dehydration, she said. Other causes can include overuse of caffeine and MSG in certain foods. Headaches can also be part of another existing condition.

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