headache

The Science of the Headache

Even the fittest aren’t immune to the occasional, sometimes throbbing, pain in the head.

Any athlete who has ever been dehydrated, had a bad night’s sleep, or was feeling stressed has likely suffered a headache. So, yes, everyone. And while your workout won't cause a headache, it can help alleviate or exacerbate them in certain cases. Here, two experts give a rundown on the three most common types of headaches and how to treat them.

Tension-Type Headache (TTH)

This is the most common of all headaches with around 80 percent of people experiencing one at some point in their life. 

What it feels like: Mild to moderate pressure in your head or neck, often akin to a tight band around your forehead, that usually lasts from 30 minutes to 72 hours, explains Susan Broner, M.D., medical director of Weill Cornell Medicine Headache Program in New York. (The exception: There is a chronic form of TTH where folks feel the pain more days than not.) Unlike migraines, tension-type headaches (TTH) don’t get worse with movement and usually aren’t debilitating enough to interfere with your daily life, Broner adds. In fact, it typically isn’t severe enough to warrant a visit to the doctor, points out Nada Hindiyeh, M.D., clinical assistant professor of neurology at Stanford University.

Why you get them: While the exact mechanism that causes tension headaches is still unknown, stress can bring them on. Also, there is likely a link to trigger points in your muscles. “As muscle tenderness increases, so does tension-type headache frequency,” Hindiyeh explains. This isn't to be confused with muscle soreness (such as after a hard workout), but rather a specific type of myofascial pain, a syndrome called myofascial nociception. Over time, the triggering of myofascial pain induces changes centrally in the brain, like increased excitability and decreased central pain inhibition, resulting in more chronic pain, more often. 

How to treat it: Massage, deep relaxation, meditation, and biofeedback can all help alleviate the pain, Broner says. Chronic TTHs might require something like an antidepressant to help reduce the frequency of headaches, but for most people, a simple over-the-counter painkiller will do the trick, she adds.

Migraine Headaches

Though probably the most well-known headache, migraines aren’t actually the most common. “Twelve percent of the population have migraines and they affect women more than men at a ratio of three to one,” Broner says. And the aches aren’t something to be taken lightly: Migraines are the sixth most disabling condition globally, according to the World Health Organization, and it often goes under-diagnosed and under-treated, Broner adds.

What it feels like: A throbbing or pulsating intense pain, sometimes just on one side of the head, that typically lasts four to 72 hours. Often during a migraine people are extra sensitive to light and sound and feel nauseous (sometimes resulting in vomiting), Hindiyeh adds. The pain is usually exacerbated by any physical activity including something as light as taking a walk.

Why you get them: It could be in your DNA; migraines are an inherited disorder. The debilitating pain can be triggered by everything from weather changes, stress, not enough sleep, too much sleep, certain foods, alcohol, even hormones. “A lot of women get a subtype of migraine that we call a ‘menstrual migraine’ since it clusters around the menstrual cycle,” Hindiyeh adds.

How to treat it:  Ice packs or heat, rest, and hydration can be helpful. For many people, NSAIDs like ibuprofen or naproxen can be effective in alleviating the pain. If they’re not, or if you’re taking these pills more than two days a week (which can actually make migraines worse), talk to your doctor about something stronger like triptans, Broner says.

Luckily, you can do a lot to prevent migraines, too. Staying on a routine schedule (eating meals, going to bed and getting up at the same time each day) as well as exercising regularly can help, says Hindiyeh. “Supplements such as magnesium, vitamin B2, coenzyme Q10, biofeedback, acupuncture, deep relaxation techniques, and yoga also can be helpful and make the attack more responsive to acute treatments,” Broner adds.

Cluster Headaches

“This is the most painful of all headache disorders,” Broner says. Luckily, they're rather uncommon, affecting less than one in 1,000 people worldwide, typically before the age of 30, according to the Cleveland Clinic.

What it feels like: “The attacks feel like a hot poker or knife behind the eye, and the pain is severe,” Broner says. Unlike the others, Hindiyeh points out that cluster headaches are strictly one-sided (typically behind the eye) and the excruciating pain is generally much shorter, lasting 15 to 180 minutes but occurring in clusters for a few weeks maybe once or twice a year. 

Why you get them: Researchers aren’t entirely sure what triggers cluster headaches or what’s happening in your brain to bring one on, though Hindiyeh says most believe the hypothalamus (a central brain structure that helps regulate circadian rhythm) plays a role.

How to treat it:  “There are many options in managing cluster headaches, including medications to take when you get an attack as well as daily to help prevent them,” Hindiyeh says. If you suffer this piercing pain, talk to a headache specialist about your options.