Headache is defined as pain in the head and upper neck. The head and neck are the more common areas of pain in the entire body. Because so many people suffer from headaches, the treatment of which is often difficult, the Headache Clinic at the University of Utah strives to understand the specific diagnosis more completely, enabling us to provide better and more effective treatment regiments.

Our physicians, physician assistants, and medical staff combine extensive experience, compassion, and the latest technology in addressing your health care problems due to headache. We provide inpatient and outpatient treatments for all headache disorders.

Headache: A Patient’s Guide

For appointments and consultations, contact us.

Phone: (801) 585-7575

Headache Questionnaire for New Patient

For 34 years Lenda has suffered from migraines. Listen to her advice for other migraine sufferers and learn how she has helped manage her own care.

Headache

What is a headache?

A headache is pain or discomfort in the head or face. Headaches vary greatly in terms of the location and intensity of the pain, and how often the headaches occur. The brain tissue doesn’t have pain-sensitive nerve fibers and doesn’t feel pain. But, other parts of the head can be responsible for a headache including:

  • A network of nerves that extends over the scalp
  • Certain nerves in the face, mouth, and throat
  • Muscles of the head, neck, and shoulders
  • Blood vessels found along the surface and at the base of the brain

Different types of headaches include:

Migraine

In this type of headache, symptoms other than pain occur as part of the headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual symptoms typically occur with migraines. Migraines also have distinct phases. Not all people have each phase, however. The phases of a migraine headache may include:

  • Premonition or prodromal phase. A change in mood or behavior may occur hours or days before the headache.
  • Aura phase. A group of visual, sensory, or motor symptoms can precede the headache. Examples include vision changes, hallucinations, numbness, changes in speech, and muscle weakness.
  • Headache phase. Period during the actual headache with throbbing pain on one or both sides of the head. Sensitivity to light and motion are common, as are depression, fatigue, and anxiety.
  • Resolution phase. Pain lessens during this phase, but may be replaced with fatigue, irritability, and trouble concentrating. Some people feel refreshed after an attack, others do not.

Tension headaches

Tension headaches are the most common type of headache. Stress and tight muscles are often factors in tension-type headaches. These are common symptoms of a tension-type headache:

  • Slow onset of the headache
  • Head usually hurts on both sides
  • Pain is dull or feels like a band or vice around the head
  • Pain may involve the back part of the head or neck
  • Pain is mild to moderate, but not severe
  • Tension type headaches typically do not cause nausea, vomiting, or sensitivity to light (photophobia).

Cluster headaches

Cluster headaches usually occur in a series that may last weeks or months.

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These are the most common symptoms of a cluster headache:

  • Severe pain on one side of the head, usually behind one eye
  • The eye that is affected may be red and watery with a droopy lid and small pupil
  • Swelling of the eyelid
  • Runny nose or congestion
  • Swelling of the forehead

What causes a headache?

Headaches are classified as primary or secondary.

  • A primary headache means the headache itself is the main medical problem, although other factors, such as muscle tension or exposure to certain foods, may be identified. Other contributing factors include medicines, dehydration, or hormone changes.
  • A secondary headache is related to an underlying medical condition. An example of this would be a headache due to neck injury, eye problems, jaw, teeth or sinus infection.

What are the symptoms of a headache?

Headache symptoms depend on the type of headache. The frequency of headaches and the intensity of the symptoms may vary, too. Typical headache symptoms include:

  • Slow onset of the headache
  • Head usually hurts on both sides
  • Pain is dull or feels like a band or vice around the head
  • Pain may involve the back part of the head or neck
  • Pain is mild to moderate, but not severe

Tension type headaches typically do not cause nausea, vomiting, or sensitivity to light (photophobia).

The symptoms of a headache may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How is a headache diagnosed?

Your doctor will want to do a comprehensive medical evaluation and diagnostic testing. He or she will also ask about your medical history, and do physical exam and certain tests.

Questions commonly asked during the exam may include:

  • When do headaches occur?
  • What is the location of the headache?
  • What do the headaches feel like?
  • How long do the headaches last?
  • Have there been changes in behavior or personality?
  • Do changes in position or sitting up cause the headache?
  • Do you have trouble sleeping?
  • Do you have a history of stress?
  • Is there a history of head injury?

If your doctor suspects migraine or tension-type headaches and the neurological exam is normal, no further testing may be needed. However, if it is not a primary type headache, then other tests may be done to find the cause.

Tests used to find the cause of a headache may include:

  • Blood tests. Various blood chemistry and other lab tests may be run to check for underlying conditions.
  • Sinus x-rays. An imaging procedure done to evaluate for congestion or other problems that may be corrected.
  • Magnetic resonance imaging (MRI). A test that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Computed tomography scan (also called a CT or CAT scan). An imaging test that uses X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

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How are headaches treated?

Your healthcare provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

The goal of treatment is to stop headaches from occurring. Effective headache management depends on finding what type of headache you have and may include:

  • Avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting
  • Changing eating habits
  • Exercise
  • Resting in a quiet, dark environment
  • Medicines, as recommended by your healthcare provider
  • Stress management

Migraine and cluster headaches may need specific medicine management including:

  • Abortive medicines. Medicines prescribed by your healthcare provider act on specific receptors in nerves and blood vessels in the head to stop a headache in progress.
  • Rescue medicines. Medicines bought over-the-counter, such as pain relievers, to stop the headache.
  • Preventive medicines. Medicines prescribed by your healthcare provider taken daily to reduce the onset of headaches.

Some headaches may need immediate medical attention including hospitalization for observation, diagnostic testing, or even surgery. Treatment is individualized depending on the underlying condition causing the headache. Full recovery depends on the type of headache and other medical problems that may be present.

Can headaches be prevented?

When headache triggers are known, avoiding the triggers can prevent a headache. Reducing stress can minimize or prevent headaches caused by stress. Migraine and cluster headaches may be prevented by taking a daily preventive medicines.

When should I call my healthcare provider?

Most headaches can be managed with over-the-counter pain relievers. However, call your healthcare provider right away if a severe headache is accompanied by:

  • Stiff neck
  • Fever
  • Nausea
  • Vomiting
  • Convulsion
  • Shortness of breath
  • Confusion
  • Muscular weakness
  • Double vision
  • Change in level of consciousness.

Symptoms that may suggest a more serious headache include:

  • Worst headache ever, or new type of headache
  • Recurring headaches in children
  • Headaches that start early in the morning
  • Headache that follows a head injury
  • Pain that is worsened by strain, such as a cough or a sneeze
  • Vomiting without nausea
  • Sudden onset of pain
  • Headache that is becoming more severe or continuous
  • Personality changes
  • Seizures

Key points about headaches

  • A headache is pain or discomfort in the head or face area.
  • Types of headaches include migraine, tension, and cluster.
  • Headaches can be primary or secondary. If it is secondary, it is caused by another condition.
  • Avoiding headache triggers is the best prevention.
  • Mild to moderate headaches can be managed with over-the-counter medicines, but tell your healthcare provider if your headache is severe and you have other symptoms.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would  happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

How a Migraine Happens

Theories about migraine pain

Older theories about migraines suggested that symptoms were possibly due to fluctuations in blood flow to the brain. Now many headache researchers realize that changes in blood flow and blood vessels do not initiate the pain, but may contribute to it.

Current thinking regarding migraine pain has moved more toward the source of the problem, as improved technology and research have paved the way for a better understanding. Today, it is widely understood that chemical compounds and hormones, such as serotonin and estrogen, often play a role in pain sensitivity for migraine sufferers.

One aspect of migraine pain theory explains that migraine pain happens due to waves of activity by groups of excitable brain cells. These trigger chemicals, such as serotonin, to narrow blood vessels. Serotonin is a chemical necessary for communication between nerve cells. It can cause narrowing of blood vessels throughout the body.

When serotonin or estrogen levels change, the result for some is a migraine. Serotonin levels may affect both sexes, while fluctuating estrogen levels affect women only.

For women, estrogen levels naturally vary over the life cycle, with increases during fertile years and decreases afterwards. Women of childbearing age also experience monthly changes in estrogen levels. Migraines in women are often associated with these fluctuating hormone levels and may explain why women are more likely to have migraines than men.

Some research suggests that when estrogen levels rise and then fall, contractions in blood vessels may be set off. This leads to throbbing pain. Other data suggest that lower levels of estrogen make facial and scalp nerves more sensitive to pain.

What commonly triggers a migraine?

People who get migraines may be able to identify triggers that seem to kick off the symptoms. Some possible triggers include the following:

  • Stress and other emotions

  • Biological and environmental conditions, such as hormonal shifts or exposure to light or smells.

  • Fatigue and changes in one's sleep pattern 

  • Glaring or flickering lights

  • Weather changes

  • Certain foods and drinks

The American Headache Society suggests documenting triggers in a headache diary. Taking this information with you when you visit your healthcare provider helps him or her to identify headache management strategies. 

Specialties:

Headache, Neuro-Ophthalmology

Locations:

Imaging & Neurosciences Center (801) 585-7575

Susan K. Baggaley, M.S.N., FNP-C, NP-C

Patient Rating:

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Susan Baggaley, MSN, FNP-C is a certified nurse practitioner, seeing patients with complex headache disorders including migraine, cluster, and chronic daily headaches. Susan has over 16 years of specialty headache experience and has been involved in numerous research and clinical drug trials. She also directs all neurology outpatient clinics at th... Read More

K.C. Brennan, M.D.

Patient Rating:

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K.C. Brennan, MD, is a clinician scientist who specializes in the treatment of headache. disorders. His lab studies the basic mechanisms of migraine and post-traumatic headache.... Read More

Kathleen B. Digre, M.D.

Patient Rating:

4.8

4.8 out of 5

Kathleen B. Digre, MD, specializes in neuro-ophthalmology and headache and practices at the John A. Moran Eye Center, University of Utah, Salt Lake City. She evaluates and treats complex visual complaints which can be due to optic nerve or brain disease. Dr. Digre sees patients with complex neuro-ophthalmic disorders such as papilledema, photophobi... Read More

Rebecca Wilson, D.O.

Rebecca Wilson, D.O., is a clinical instructor in the Division of Physical Medicine and Rehabilitation whose interests include osteopathic manipulative medicine, preventative medicine and wellness, integrative health, cancer rehabilitation, and neuromusculoskeletal medicine. She is passionate about supporting the unique healing process of every ind... Read More

Specialties:

Back, Cancer Rehabilitation, Headache, Myofascial Pain, Neck, Non-operative Musculoskeletal Disorders, Osteopathic Care, Osteopathic Manipulative Medicine, Physical Medicine & Rehabilitation, Preventive Medicine

Locations:

Huntsman Cancer Institute
Linda B. and Robert B. Wiggins Wellness Center
(801) 587-4585
School of Medicine
Physical Medicine & Rehabilitation
(801) 581-2267

University Campus/Research Park

Imaging & Neurosciences Center 729 Arapeen Drive
Salt Lake City, UT 84108
Map
(801) 585-7575
John A. Moran Eye Center 65 Mario Capecchi Drive
Salt Lake City, UT 84132
Map
(801) 581-2352