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In order to talk about headaches, we have to classify what different types of headaches there are. Generally speaking, there are four different categories of headaches: vascular or neurologic, tension or cervicogenic, metabolic or toxic, and miscellaneous. The miscellaneous category houses all the various types of headaches that arise from various areas. This means headaches caused by excessive eyestrain, sinus pressure, a loss of cerebrospinal fluid, bacterial infections, or general pressure changes. (Such as headaches caused by traveling through mountainous terrain or flying an airplane)

Types of Headaches

Vascular and Neurogenic Headaches

The first category vascular and neurogenic has a large variety of causes. Headaches related to vascular (blood pressure and flow) sources typically follow very telltale signs and symptoms. Changes in weather, diet, stress, hydration, exercise can potentially cause or relieve vascular headaches. Neurogenic headaches also have very telltale sources. Neurogenic headaches typically follow very common patterns related to the nerves that are causing the headache. Once the specific nerve that identified, that nerve can be traced back to its point of inflammation.

Tension and Cervicogenic Headaches

Tension or cervicogenic headaches are caused by direct mechanical irritation to nerves or tissues. This is typically seen after injuries to the cervical spine, where the muscles of the neck have a direct impact on nerves to the head. These types of headaches may be caused by sprain/strain injuries and can be related to nerve injuries such as radiculopathy.

Metabolic and Toxic Headaches

Metabolic or toxic headaches are experienced when chemicals of the body are dramatically out of proportion. This is seen in cases of thyroid disorder (too high or too low), cases of uncontrolled diabetes, excessive drug use (narcotic and over-the-counter) and due to unknown metabolic disorders. There are many varying kinds of metabolic disorders, some of which are very minor to start, and can increase and get dramatically worse with time. Some of the first symptoms of these types of disorders may be sporadic, severe headaches.  These types of headaches are probably the most infrequently reported, and most common. “Toxic” headaches can be attributed to the headaches most people wake up with every morning and solve with a caffeinated beverage. Typically upon waking, most people are mildly dehydrated from not being hydrated enough prior to sleeping, then sleeping for 8 hours without more hydration causes a mild headache in the morning.

Other Headaches

The last category is miscellaneous which houses all the various other causes of headaches. The most common in this category are due to sinus congestion and eyestrain. Sinus congestion is most commonly attributed to routine sickness, such as the common cold, and sinus infection. Eyestrain and headaches related to it, is most commonly caused by improper eyewear prescription, or excessive use of computer monitors. Other causes of miscellaneous headaches such as changes in cerebrospinal fluid pressure are extremely serious conditions that need to be addressed with emergency medicine. As with bacterial infections of the cerebrospinal fluid, these conditions can be life-threatening. Typically these types of headaches are incredibly painful, “the worst ever experienced”, and accompanying a high sudden fever (at or above 104°F).

Important Note: Beyond these four categories there are other situations that may cause pain in the head, such as head trauma. It should go without saying that if you hit your head hard enough, it may cause a headache.  In this case please seek emergency evaluation.

The most troubling part of headaches is knowing when they are serious. The vast majority of headaches are temporary, self-limiting, and are nothing to worry about. However, some headaches occur frequently, possibly routinely, and do require treatment. If suddenly, you get the worst headache you’ve ever experienced, without any known cause or reason, seek emergency help. Just because most headaches can pass on their own does not mean all headaches are minor. There are some cases where people have had a symptom of a headache and it is actually been an early sign of a stroke, or bleeding within the brain. If a headache is severe, it is best to get checked by a medical professional.

Is There Reason To Worry About My Headache?

It is estimated that tension headaches are the most common in adults with cervicogenic headaches coming in second. In most cases, headaches are very inconvenient, but not a potential threat to a person’s life but in case they could be all headaches should be evaluated as such.

Headaches may last between several hours to several weeks. The area of pain, how they feel, and how they change over time are critically important to the professional doing the evaluation.

Treatment of Headaches

The most common headaches, tension and cervicogenic, both respond excellent to chiropractic care and myofascial treatments. These types of headaches have been detailed previously, here (link to myodural bridge) and typically resolve after 3 to 6 visits, if acute. If the case has been long-standing (going on for weeks) the number of visits may increase, depending on how the patient responds.

In my office, it is common for a patient to require less visits if they stick to the specific treatment plan. This treatment plan may include supplementation and at home exercises.  Nearly all patients that I have experienced with chronic headaches achieve complete discharge with zero symptoms.

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