The difference between migraines, cluster, and tension headaches—plus when to see a doctor


So, your head hurts. What do you do?

When it comes to headache treatment, it all depends on what type of headache you have to begin with. Although some headache types are vastly different-migraine is the only type of headache accompanied by the sensory symptoms known as aura, for example-others share common symptoms and triggers and are frequently misdiagnosed.

At least at home. Often, a patient comes in claiming sinus headache, without any of the congestion, fever or other symptoms of a true infection, says Robert Cowan, M.D., professor of neurology and director of the headache program at Stanford University. Most likely, it's actually a migraine, he says, and "all the antibiotics in the world aren't going to help it."

The most common type of headache is tension-type, says Cowan, which can be brought on by stress, anxiety, alcohol, or eye strain as well as other triggers. Cluster headaches and medication overuse headaches (formerly known as rebound headaches) are also relatively common. Sinus headaches are much rarer, he says, but not as rare as more troubling syndromes Cowan has treated, including SUNCT headaches, in which patients experience brief stabbing pains as many as hundreds of times a day that require IV medication to treat.

Of course, your head might hurt because of direct trauma, such as a car accident or sports injury, says Dawn C. Buse, Ph.D., associate professor of neurology at the Albert Einstein College of Medicine of Yeshiva University and the director of behavioral medicine at Montefiore Headache Center. Others experience what are known as exertion headaches, she says, which can occur after coughing, exercise, or even sex.

While a headache specialist may be your best bet at an accurate diagnosis, knowing the answers to a few key questions can help you and your doctor arrive at the right treatment plan.

"It's really helpful to have your headache history organized," says Cowan. Knowing how long your headaches last, how severe they are, how frequent they are, and what triggers them can paint a picture for your doctor when you're not currently experiencing pain. "You have to pay attention to your life," he says, just like a person with asthma has to pay attention to the weather when exercising outside.

Below are some of the crucial questions you should keep track of when it comes to your headaches-and a basic picture of what the answers might mean.

Sources: Johns Hopkins Medical Center, National Institutes of Health, WebMD, ProMyHealth, Stanford Medicine, Montefiore Headache Center

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