Headache Experts Now at Lakewood Hospital

Learn more about headaches and know when to call the doctor...

According to the National Headache Foundation, more than 45 million Americans suffer from chronic, recurring headaches and of these, 28 million suffer from migraines. About 70% of headache sufferers are women. Headaches are the most common cause of absenteeism from work and school. Migraine sufferers lose more than 157 million work and school days annually because of headache pain.

What are the types of headaches?
A comprehensive headache classification guide was established by the International Headache Society and includes more than 150 diagnostic headache categories. Based on research, a practical headache classification includes primary and secondary headaches.

Primary Headaches
Primary headaches: those that are not the result of another medical condition, such as tension, migraine, mixed headache syndrome and cluster headaches.

Tension headaches: the most common type of primary headaches, accounting for about 90% of all headaches diagnosed. Tension headaches are also called chronic daily headaches or chronic non-progressive headaches. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time. Tension headaches are not usually associated with sensitivity to light or noise. Tension headaches can be classified as chronic, occurring more than 15 days per month, or episodic, occurring less than 15 days per month.

Migraines: the second most common type of primary headaches. The exact cause of migraines is unknown, although they are neurovascular in nature and are related to changes in the brain as well as inherited abnormalities in certain areas of the brain. Migraine pain is moderate to severe, often described as pounding, throbbing pain. Migraines can last from 4 hours to 3 days and usually occur 1 to 4 times per month. Migraines are associated with symptoms such as sensitivity to light, noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain.

Mixed headache syndrome: the combination of migraine and tension headaches.

Cluster headaches: the least common, but most severe, type of primary headache. The pain of a cluster headache is intense and may be described as having a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term "cluster headache" refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to recur.

Secondary headaches
Secondary headaches, or those that result from another medical condition, include sinus headaches, hormone headaches, chronic progressive headaches or headaches that occur as a result of a head injury, trauma, or more serious condition such as a tumor.

Sinus headaches: headaches associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

Hormone headaches: headaches in women are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Chemically induced hormone changes, such as with birth control pills, also trigger headaches in some women.

Chronic progressive headaches: headaches that get worse and happen more often over time. Chronic progressive headaches are also called traction or inflammatory headaches. These are the least common type of headache, accounting for less than 5% of all headaches. Chronic progressive headaches may be the result of an illness or disorder of the brain or skull.

What causes headaches?
Headache pain results from signals interacting among the brain, blood vessels and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain. It’s not clear, however, why these signals are activated in the first place.

There is a migraine "pain center" or generator in the mid-brain area. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels, causing constriction, followed by the dilation of these vessels and the release of prostaglandins, serotonin and other inflammatory substances that cause the pulsation to be painful. Serotonin is a naturally occurring chemical essential for certain body processes.

Headaches that occur suddenly (acute onset) are usually caused by an illness, infection, cold or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat), or otitis (ear infection or inflammation).

In some cases, the headaches may be the result of a blow to the head (trauma) or, rarely, a sign of a more serious medical condition.

Common causes of tension headaches or chronic nonprogressive headaches include emotional stress related to family and friends, work or school; alcohol use; skipping meals; changes in sleep patterns; excessive medication use; tension; and depression. Other causes of tension headaches include eye strain and neck or back strain caused by poor posture.

When to call the doctor?
If you have headache symptoms, the first step is to go to your family physician. He or she will perform a complete physical examination and a headache evaluation. During the headache evaluation, your headache history and description of the headaches will be evaluated. You will be asked to describe your headache symptoms and characteristics as completely as possible. A headache evaluation may include a CT scan or MRI if a structural disorder of the central nervous system is suspected.

If symptoms continue to get worse
If your headache symptoms become worse, or become more frequent despite treatment, ask your family physician for a referral to a specialist, such as the Cleveland Clinic headache specialists, who can help ease your pain.

Headache specialists on staff of the Cleveland Clinic Neurological Institute at Lakewood Hospital

Cynthia Bamford, MD

Stephen Samples, MD

Cynthia Bamford, MD, and Stephen Samples, MD, headache specialists at the Cleveland Clinic Neurological Institute at Lakewood Hospital, are accepting new patients who suffer from headache disorders.

To schedule an appointment, please call 216.529.7110.