Headaches | Comprehensive Pain Management Center


Headaches are differentiated between generalized pain and local pain. The head itself, neck or

back pain, or ophthalmologic, or eye, origins may cause headaches. Many headaches have no

underlying important conditions but it is significant to have a physician confirm that the cause of

the headache is not severe. Headaches are divided into primary and secondary headaches;

primary headaches are then divided into cluster, tension, or migraine headaches. Secondary

headaches usually have pre-existing disorders causing the pain. To evaluate if a headache may

have a serious underlying condition a physician looks for:

  • Systemic symptoms: cancer, weight loss, fever, immunocompromised
  • Neurologic symptoms: confusion or seizures
  • Onset being new/ sudden
  • Other related disorders: head trauma, drug use, toxic exposure
  • Previous history of headache: progression and changes

Types of secondary headache causes

  • Intracranial hemorrhages
  • Meningeal infections
  • Stroke
  • Malignant hypertension
  • Tumor
  • Glaucoma

Types of primary headaches are Cluster, Tension, and Migraine.

Cluster headache pain is believed to be caused by the opening of blood vessels, which irritates

the cranial nerve causing pain.

  • Men are more frequently affected than women
  • Severe, pulsating pain on both sides: may last anywhere from 20 minutes to 3
  • hours
  • Occur in “clusters”, affect the same spot on the head at the same time of day and
  • same time of year.
  • Some people have tearing from the eye on the side of the head with the pain
  • Emotion and food are not triggers

Tension headaches are thought to be caused by a change of neurotransmitters, chemicals of the brain, as a result of stress or other emotional influences.

Another theory behind tension headaches is that constant strains of the muscles in the face, jaw clenching, or back and neck pain cause the irritation that triggers the headache.

  • Most common diagnosed
  • Feels like a tight band being wrapped around the head
  • Slow onset intensified by lights, noise, and stress
  • May have concurring depression, trouble sleeping, or poor concentration
  • Occur towards end of the day
  • Located on the upper neck and back of head

Migraine headaches are believed to also be related to the blood vessels of the brain and with a discrepancy of neurotransmitters, specifically serotonin. There may also be a genetic predisposition for migraine headaches.

  • More common in women
  • Pain described as intense throbbing lasting over an hour but less than 24 hours
  • Felt on one side of the head and both sides of the head
  • May be preceded by an aura (flash of light, smell, small vision loss)
  • Nausea and vomiting are common
  • Triggers may be loud noise, bright light, certain food, certain medications, menstrual cycle related, exertion activity, depression


There are two different treatment paths for headaches, abortive and preventative. Abortive

therapy is used to offer relief but may not always be effective and may not be useful for

everyone. Preventative therapies are used to decrease the occurrence and intensity of headaches.

Preventative therapies are not used to stop and acute episode and so may be used with abortive


Abortive Therapy

  • Ergots
  • Oxygen
  • Triptans
  • NSAIDs
  • Anti-emetics
  • Opiates
  • Butalbital

Preventative Therapy

  • Antiseizure medication
  • Antidepressants
  • Antihistamines
  • Cardiovascular medication (beta blockers)
  • Botox injections

Comprehensive Pain Management Center