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The Doctor Is In: Causes and treatments for headaches

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(KPLR) - More than 45 million Americans suffer from chronic headaches. More than half of those people suffer from migraine headaches.

Dr. Sonny Saggar, the Medical Director at St. Louis Urgent Care, stopped by to discuss the different types of headaches and what can be done about them.

Connect with Dr. Saggar, the Medical Director at St. Louis Urgent Cares at:
• Twitter: @DoctorIsInSTL
• Facebook: DoctorIsInSTL
• Blog:

There are several types of headaches; in fact, 150 diagnostic headache categories have been established.

The most common types of headaches include tension headaches, migraines, cluster headaches, sinus headaches, hormone headaches.

Tension headaches
Tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time.

Causes of migraines are unknown. One theory is that various triggers cause abnormal brain activity, which in turn causes changes in the blood vessels in the brain. Some forms of migraines that are associated with inherited abnormalities in certain parts of the brain. Migraine pain is moderate to severe, often described as pounding, throbbing pain. Migraine headaches can last from four hours to three days and usually occur one to four times per month. Migraines are associated with symptoms such as sensitivity to light, noise, or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. When a child is having a migraine, he or she often looks pale, feels dizzy, has blurred vision, fever, stomach upset, along with the symptoms listed above.

Cluster headaches
The least common -- although the most severe -- type of primary headache, the pain is intense: burning, stabbing or piercing that is throbbing or constant. Most people cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term "cluster headache" refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last two weeks to three months. The headaches may disappear completely (go into "remission") for months or years, only to recur.

Sinus headaches
Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

Hormone headaches
Headaches in women are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Chemically induced hormone changes, such as with birth control pills, also trigger headaches in some women.

In addition to the different types of headaches, Dr. Saggar also answered some of the common questions people may have about headaches.

Are Headaches Hereditary?
Yes, headaches, especially migraines, have a tendency to run in families. 90% of people who have migraines have other family members with migraines.

What Causes Headaches?

Headache pain results from signals interacting between the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain. It's not clear why these signals are activated in the first place.

Headaches that occur suddenly (acute-onset) are usually due to an illness, infection, cold, or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation and infection of the throat), or otitis (ear infection and inflammation).

In some cases, the headaches may be the result of a blow to the head (trauma) or rarely, a sign of a more serious medical condition.

Common causes of tension headaches include emotional stress; alcohol use; skipping meals; changes in sleep patterns; and depression. Other causes of tension headaches include eyestrain and neck or back strain due to poor posture.

Headaches can also be triggered by exposure to secondhand tobacco smoke, strong odors from household chemicals or perfumes or eating certain foods. Stress, pollution, noise, lighting, and weather changes can trigger headaches for some people.

How Are Headaches Evaluated and Diagnosed?
The good news for headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started.

If you have headache symptoms, the first step is to go to your doctor or nurse practitioner, and a good person to start with is your primary care provider, or if you don't have one, your urgent care physician.

He or she will perform a complete physical exam and a headache evaluation. During the headache evaluation, your headache history and description of the headaches will be evaluated. You will be asked to describe your headache symptoms and characteristics as completely as possible.

It is important to give a list of things that cause the headache, aggravate the headache, and things that you have done to relieve a headache. Keeping a headache diary can help your doctor or nurse practitioner diagnose your headache type.

For most headache sufferers, special diagnostic tests will not be necessary. However, a headache evaluation may include a CT scan or MRI if a structural disorder of the central nervous system is suspected. Both of these tests produce cross-sectional images of the brain that can reveal abnormal areas or problems.

Skull X-rays are not helpful. An EEG (electroencephalogram) is also unnecessary unless you have experienced a loss of consciousness with a headache.

If your headache symptoms become worse or become more frequent despite treatment, ask for a referral to a specialist.

How Are Headaches Treated?

Your doctor may recommend different types of treatment to try or may recommend further testing, or refer you to a headache specialist.

The proper treatment will depend on several factors, including the type and frequency of the headache and its cause.

Not all headaches require medical attention. Treatment may include education, counseling, stress management, biofeedback, and medications. The treatment prescribed for you will be tailored to meet your specific needs.

What Happens After I Start Treatment?
When your doctor starts a treatment program, keep track of the results and how the treatment program is working. Keep your scheduled follow-up appointments so your doctor can monitor your progress and make changes in the treatment program as needed.

Connect with Dr. Saggar, the Medical Director at St. Louis Urgent Cares at:
• Twitter: @DoctorIsInSTL
• Facebook: DoctorIsInSTL
• Blog:

St. Louis Urgent Cares presently has 4 locations in St. Louis: Downtown Urgent Care, Eureka Urgent Care and Creve Coeur Urgent Care, and North City.