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Headaches are extremely common: most people have a headache at some time in their life. Most headaches disappear on their own (with a little time) or with the help of mild painkillers. Although most headaches are mild and temporary annoyances, some people have headaches that are so severe they need to consult a doctor for pain relief.

Children can also have headaches, some well before they reach the age of 10. Research shows that before puberty, headaches are more common in boys, but that trend is reversed after puberty. Adult women experience more headaches than adult men. They're often linked to the menstrual cycle. With advancing age, both women and men tend to have fewer, less severe headaches.

Headaches come in various forms: tension, migraine, sinus, and cluster headaches. In a small number of cases, a headache may signal a more serious condition that requires immediate medical attention.

Headaches can be triggered by a variety of factors. The most common cause of headaches is prolonged tension or stress. These are called tension headaches or muscle-contraction headaches. Virtually everyone suffers from this at some time. Muscles in your scalp, neck, and face tighten and contract, causing spasms and pain. Psychological factors such as anxiety, fatigue (e.g., eyestrain), and stress (e.g., long periods of concentration) and mechanical neck strain (e.g., working at computer terminal for prolonged periods) are often the culprits behind a typical tension headache.

Migraines are generally more severe and can be debilitating. The cause of migraine is not known but many trigger factors are recognized. These include: hormonal changes (during a woman's menstrual cycle), certain foods (e.g., chocolate, aged cheeses), beverages (e.g., red wine), strong odours, lack of sleep and even stress. It is not uncommon to suffer from mixed tension-migraine headaches.

Sinus headaches are less common than people think. They can occur after upper respiratory infections such as a cold. Along with the headache, people often have a runny or stuffy nose. Sinus headaches are caused when bacteria invade and infect the nasal sinuses.

Cluster headaches are a relatively uncommon type of headache. They tend to occur in clusters over a few days, weeks or months with long headache-free periods lasting from months to years. In some cases, they are triggered by alcohol. The cause is not known.

So-called "ice pick" headaches are severe headaches that occur suddenly, causing a few seconds of intense pain at a small, localized spot. The exact cause of these headaches is unknown, but they are usually not due to a serious problem.

Tension headaches generally cause a constant pressure or a "dull ache" that affects the entire head. In most cases it begins slowly, with the ache usually focused above the eyes. There's a feeling of tightness across the forehead or at the back of the neck. The ache can last for hours or days at a time, with mild to moderate pain that typically worsens by the end of the day.

Cluster headaches occur in "clusters" or groups, with pain lasting about 20 to 90 minutes at a time. They typically start during sleep. The ache and pain is limited to one side of the head and can be extremely severe. They are often accompanied by other symptoms on the side of the headache such as redness and tearing of the eye, drooping eyelid and nasal stuffiness and dripping.

Migraines range from mild to severe. They often occur as one-sided head pain but can sometimes affect both sides. The location, duration, and intensity of pain vary widely from person to person as well as from one episode to another. Migraine is usually a pulsating pain, often with other symptoms such as nausea, vomiting, visual disturbances and hypersensitivity to light, noise and smells. A migraine attack can last from hours to days - averaging 12 to 18 hours. They're often so severe and incapacitating that many migraine sufferers are unable to carry out normal daily activities.

Migraine headaches are divided into two categories: migraine with aura and migraine without aura. Some people experience a pre-headache stage known as an aura, which can last about 10 to 30 minutes. A typical aura includes visual disturbances such as blind spots, zigzag flashes, and light sparks. The aura normally clears as the headache starts, but there can be some overlap. Sometimes the aura will occur without a headache but more often no aura occurs before the headache.

Although headaches can be painful and debilitating, they are usually not due to dangerous conditions. However, occasionally headaches can be a sign of something more serious. Very severe high blood pressure (above 180/110 mm Hg), stroke, or a brain tumour may cause headaches. Meningitis (an infection of the brain's lining) may also cause a headache. Warning signs are a sudden onset of headache accompanied by fever, stiff neck, and visual problems (double vision).

It's critical that you seek emergency medical care if you experience a headache that:

• gets worse over days or weeks
• is accompanied by impaired neurological function (e.g., loss of balance, weakness, numbness or speech disturbance) and double vision (could signal a stroke)
• is accompanied by persistent nausea and vomiting
• is accompanied by seizures, mental disturbances, and loss of consciousness
• is associated with a fever and/or stiff neck (could signal meningitis)
• is different than the usual pattern of headaches you have experienced
• strikes suddenly with great intensity
• wakes you from sleep or is worse when you lie down

If you tend to have headaches that are frequent and severe, your doctor will examine you for any serious, life-threatening conditions (e.g., stroke, meningitis) and start emergency care if needed. As well, if you regularly have headaches and experience a change in the pattern of your usual headaches, you should see your doctor. Typically, a thorough medical history and physical examination is enough for a good diagnosis. Since tension headaches are very common, your doctor will take a history by asking questions about your current stress level and other personal factors (e.g., work) that may be triggering your headaches. Depending on the location, duration, and any accompanying symptoms, the type of headache can be determined. In some cases, a brain scan called a CAT (computer assisted tomography) scan or MRI (magnetic resonance imaging) may be used to check for serious causes of headache.

Since tension headaches are caused by factors such as neck strain, stress and anxiety, treatment involves eliminating the stressful situation, if possible. Taking an over-the-counter painkiller such as acetaminophen or ibuprofen, relaxing, resting, correcting poor posture and exercising can all help to relieve and prevent headache pain.

Cluster headaches respond poorly to over-the-counter medications. Oxygen therapy and prescription medications such as lithium,* calcium channel blockers (used to treat high blood pressure), steroids, non-steroidal anti-inflammatory drugs, and some anti-migraine drugs, as well as others, can help in many cases. If you suspect that you have cluster headaches, you should check with your doctor.

Sinus headaches usually require antibiotics or other treatments to clear up the infection. Once the infection is gone, the headache will go away, too. Until the infection gets better, taking an over-the-counter painkiller can help ease the pain.

Migraines can be treated with over-the-counter painkillers such as acetylsalicylic acid (ASA), acetaminophen or ibuprofen if the headaches are mild.

Stronger medications may need to be prescribed if the headaches are more severe. These can be divided into two groups:

1) Acute treatments:

• pain relievers containing codeine or meperidine
• NSAIDs (nonsteroidal anti-inflammatory drugs)

2) Preventive treatments:

• antimigraine drugs like sumatriptan, zolmitriptan, naratriptan, rizatriptan, and almotriptan
• beta-blockers and calcium channel blockers
• low-dose antidepressants such as amitriptyline
• anti-seizure drugs like valproate, gabapentin, and topiramate
• anti-migraine drugs like methysergide or pizotifen

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.