The Medical Minute: Why does my head hurt? What can I do about it?

Unless you’re reading this Medical Minute in a painless parallel universe, you’ve likely felt the malady known to medical science as a headache.

Maybe you sometimes experience a pounding in your sinuses or a stabbing pain in the back of your head, along with watery eyes and or a feeling of pressure throughout your skull. Maybe it happens regularly, or you only know it as a symptom of a larger problem.

If you’re looking for relief, a good place to seek help is Dr. John Messmer, medical director at Penn State Health Medical Group ― Palmyra. Messmer has been practicing medicine for nearly half a century and has helped treat nearly five decades worth of headaches.

Here Messmer discusses what you can do to feel better and when it’s best to seek help, and helps answer the most worrisome question on many patients’ minds: “Is it a tumor?”

What are some different varieties of headache? And what can you do about them?

Migraine

“Not every bad headache is a migraine,” Messmer said, so don’t just assume that’s what your headache is.

The severe version of a true migraine often happens regularly, maybe several times a month. It can cause the patient to miss work or school. “It can kill a day or two,” Messmer said.

According to the World Health Organization (WHO), a migraine:

• is a headache of moderate or severe intensity
• is one-sided or behind the eye. “It’s almost always unilateral,” Messmer said.
• is pulsating in quality
• is aggravated by routine physical activity
• lasts hours or up to two to three days

What causes them is unknown. Some experts say they come from “the release of pain-producing inflammatory substances around the nerves and blood vessels of the head,” according to WHO. They can be triggered by alcohol and certain foods. Women sometimes get premenstrual migraines, Messmer said.

Complicated migraines carry stroke-like symptoms, where the sufferer develops a numbness on one side of their body. They often occur in people who had migraines when they were younger. “They got all through middle age without a problem,” Messmer said, “and now they’re 60 or 70 years old and they’re having these again.”

Remedies

“If it’s properly diagnosed as a migraine, there are several levels of intervention,” Messmer said.

For a simple, mild migraine, where the pain isn’t too bad, a couple of over-the-counter painkillers like aspirin or ibuprofen and an hour-or-so nap in a dark room can work wonders.

For a true migraine that occurs more frequently ― several times a month ― doctors prescribe different kinds of drugs for their abortive or prophylactic effects. These include a class of drugs known as triptans, which work best if you catch the headache right at its onset. Another drug called a calcitonin gene-related peptide receptor blocker also can halt a migraine.

Tension-type headaches

These used to just be called tension headaches “but they were probably misnamed,” Messmer said. “It’s not necessarily tension in the sense of life tension or tension in the sense of muscular tension.”

Usually a neurovascular issue causes a tension-type headache, Messmer said. Anxiety and anger can be the spark, but so can sitting in the wrong position or drinking too much coffee or alcohol. The pain can materialize in any part of your head.

WHO notes that tension-type headaches often feel like pressure and sometimes spread into the neck. They can be episodic.

“It takes a skilled evaluator to determine whether or not it’s a migraine,” Messmer said.

Remedies

“One of the things a physician should be doing is determining what the problem is and then fixing that problem,” Messmer said. For example, if you’re getting them from not getting enough sleep or having too much coffee, a physician should help you determine that.

If you’re getting the headaches only occasionally, like once a month, your basic headache medicine ― Tylenol or ibuprofen ― should do the trick.

If you get many of these headaches, some patients find benefit in taking a riboflavin supplement, Messmer said. Also, exercise, stretching and relaxation therapy can help.

Cluster headaches

Like migraines, cluster headaches are vascular, but only a very small percentage of people get them. Usually, they occur in men.

These are short, very severe headaches in a cluster. You might experience two or three over a five-day period. They often come with eye difficulties like pupil dilation and tearing. “It’s related to the vascular innervation of the face,” Messmer said.

Remedy

Oxygen sometimes relieves the symptoms of cluster headaches, but very few people can carry oxygen tanks in anticipation of these attacks, Messmer said, so the symptoms are often treated with the same drugs that are used to treat migraines.

At what point should you see a doctor for a headache?

When you can’t control them yourself. “If they are significantly impairing your life, your job, your education, your personal relationships,” Messmer said. “It’s unique to everybody. For some people, one headache a week is OK. For another, one headache a year is too much.”

However, if your head has suddenly started aching regularly and it hasn’t been a problem before, it’s a good idea to see a doctor. Most people start getting migraine headaches in their teens. If all of a sudden you start getting them and you’re much older, ask a doctor about it.

Also, if you develop a headache coupled with blurred vision or you find you can’t use one of your limbs, seek help immediately, Messmer said. “You should go to the Emergency Department,” he said.

So…could it be a tumor?

Usually, to quote Arnold Schwarzenegger, “It’s not a tumor!”

In fact, a headache in and of itself is not a common sign that you have a tumor, because it’s probably not your brain that’s hurting. The brain itself doesn’t feel pain.

A brain tumor can cause a headache if it results in a related condition. For example, the mass could be in a position where it blocks the flow of spinal fluid, and the fluid starts to build.

“I used to tell medical students, ‘Everybody with a brand-new headache has a brain tumor until you prove otherwise,’” Messmer said. “If they’re coming to you with a headache, one of their concerns is a brain tumor.”

Anyone with concerns about their headaches should connect with their medical provider for a full assessment.

Related content:

• The Medical Minute: Sinus headache? Maybe not.
• The Medical Minute: New treatments for migraines show promise

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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