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The most common pain experienced in the US is headache pain. Most headaches are
benign tension type headaches, but there are many other types described below.

Tension Type Headaches Each year, 74% of the population develops these headaches.
These headaches are a pressure or tightness in quality, are not worsened with activity,
and occur on both sides. There is usually no nausea or vomiting, or light sensitivity.
Female:male 1.4:1

Migraine Headaches These are usually one sided headaches that may have an aura
(wavy lines in vision, etc). They are pulsating headaches, moderate to severe, lasting
4-72 hours, aggrevated by walking stairs, accompanied by light sensitivity, nausea, and
sometimes vomiting. Each year, 10% of the population experiences these headaches.
Women:men ratio is 3:1 and there is a great increase in migraines 2 days before and 5
days after the beginning of the menstrual period.
Medication Withdrawal or Rebound Headaches If headaches are treated frequently with
medications, the lack of these same medications will trigger the headache. Daily
acetaminophen (Tylenol) will trigger headaches if drug is stopped. Similarly, potent
narcotics may trigger migraines and other types of headaches if taken more often than
three times a week. Frequent use of Immitrex or other drugs in the same class will
trigger migraines if taken too frequently. Many patients do not realize they are
perpetuating their own headaches by taking medications for most headache occurrences.
Occasional medication use works best for headache treatment.

Cluster Headaches Occurring in a 4:1 male:female ratio, these headaches are present in
0.07% of the population each year. They are one sided, severe intense one sided
headaches, often over or behind one eye, last 15-180 minutes, and are characterized as
so intense the patient paces incessantly or bangs his head against the wall. Other
characteristics include a red eye (conjunctiva), small pupil, excessive tearing from the
affected side, facial sweating, droopy lower eyelid, and nasal stuffiness. Most of these
patients are smokers, many of the attacks occur at night, and there may be several
attacks per day. Alcohol triggers these headaches.

Post Traumatic Headaches These are common after automobile accidents, may be acute
or chronic, are not related to brain injury, and may actually be continuation or worsening
of other types of headaches already present.

Cervicogenic Headaches One sided head pain, usually beginning in the back of the head
and radiating forward, produced by abnormal positions of the neck or by pressure at
specific points on the neck are the characteristics of cervicogenic headache pain. Often
this pain begins with whiplash trauma or other trauma to the facet joints of the cervical
spine.

Occipital neuralgia These headaches are often in the posterior (back) of the head and
radiate up and over the top of the head. They are often due to a fall or other trauma to
the back of the head and represent the nerve response to such trauma with entrapment
of the greater or lesser occipital nerves. Other causes of occipital neuralgia include a
blood vessel in the brain compressing part of the nerve and this vessel possible to be
moved during neurosurgery.

Brain Tumors Approximately half the patients with brain tumors will have headaches, but
percentage wise, these are a very very tiny fraction of all types of headaches. Three
quarters will have both sided front headaches while one quarter will have one sided
headaches. Almost always, these headaches represent either a new onset of headaches
never before seen in the patient or a significant perceptible change in the type or intensity
of headaches. Seven out of eight with brain tumors will have papilledema (swelling of the
optic nerve in the eye), one sided paralysis, or seizures.

Sinus Headaches These are much less common than generally thought. A true sinus
headache is in the front of the face or above the eyes (deep sinuses may refer pain to the
head), worsened by bending over forward and by coughing, is associated with a fever,
cough, drainage, sore throat. Many patients assume that because they have had sinus
problems in the past, tension type headaches are mistaken for sinus headaches.
Treatment of these headaches with antihistamines and nasal sprays cause rebound pain
from swelling of the nasal mucosa.

Sexual Induced Headaches Masturbation or intercourse may induce a mild headache that
disappears usually within one hour afterwards. However, there is an explosive type of
sexually induced headache that is severe, located in the back of the head, and persists
from hours to several days. Exertion or repeated sexual intercourse within a few day
period can trigger the headache once again.

Post Dural Puncture Headaches Following a spinal block or spinal tap or epidural catheter
placement with aberrant needle or catheter placement a positional post dural puncture
headache results. This headache almost goes completely away upon lying down flat while
standing brings on the headache immediately. This is due to continued leakage of spinal
fluid.

Other There are many other sources of chronic headaches such as difficulty focusing the
eyes, intracranial masses (<0.02% of headaches), hydrocephalus, systemic infections,
meningitis, hyperthyroidism, hypertension, electrolyte imbalance, etc.