Is It Just a Headache – Or Something More? Understanding When to Seek Medical Care

Everyone encounters a headache at some time—whether it's a subtle ache after a long day or an intense pain caused by stress or insufficient sleep. However, headaches vary. Some may be mild and brief, while others can indicate something more serious.

In recognition of Headache and Migraine Awareness Month in June, Saddleback Medical Center wants to bring awareness to the different types of headaches, how to recognize the signs that warrant medical attention, and explore ways to effectively manage this common yet often misunderstood condition.

Most Common Headache Types

Headaches can vary greatly in intensity, duration, and cause. The most frequently diagnosed primary headache types include tension headaches, migraines, and cluster headaches.

Tension Headaches

• What they feel like: Tension headaches are the most common type. They often feel constant, dull pressure or tightness—sometimes described as a "band" around the head. You may also feel tenderness in your scalp, neck, or shoulders.
• Triggers: Stress, poor posture, dehydration, fatigue, and eye strain are common culprits. These headaches tend to build gradually and aren’t usually accompanied by nausea or visual disturbances.
• Treatment: Over-the-counter pain relievers like acetaminophen or ibuprofen can help. So can relaxation techniques such as deep breathing, gentle neck stretches, adequate hydration, avoiding excessive caffeine use, and sleep. Chronic tension headaches—those that occur 15 or more days per month—may require further evaluation and long-term management strategies.

Migraines

• What they feel like: Migraines are more than just “bad headaches.” They’re a neurological condition that can cause throbbing or pulsing pain, usually on one side of the head. They’re often accompanied by nausea, vomiting, and extreme sensitivity to light, sound, and smells. Some people experience aura—visual disturbances like flashing lights or zigzag lines—before the headache begins.
• Triggers: Hormonal changes, specific foods (like aged cheese or processed meats), caffeine overuse or withdrawal, alcohol, stress, lack of sleep, and environmental changes are just a few common triggers.
• Treatment: Migraine treatment is multifaceted. Acute migraine attacks can sometimes be relieved with medications like triptans, gepants or NSAIDs. Preventative treatment, including prescription medications, Botox injections, Calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies, or even neuromodulation devices — may be recommended for people who experience frequent migraines. Lifestyle modifications and identifying personal triggers are key parts of managing migraines effectively.

Cluster Headaches

• What they feel like: Cluster headaches are extremely painful and come in cyclical patterns or “clusters.” They often occur suddenly and typically affect one side of the head, usually around or behind one eye. The pain is severe and can be accompanied by tearing, nasal congestion, eyelid drooping on the affected side, and is more commonly found in males.
• Triggers: Alcohol, strong smells, high altitudes, and certain medications can sometimes trigger attacks. However, cluster headaches often occur without a clear trigger.
• Treatment: These headaches are rare but extremely intense. They may require fast-acting treatments like oxygen therapy or injectable medications. Preventive treatments, such as verapamil or corticosteroids, can help reduce the frequency of clusters.

When to Worry: Headaches That Need Medical Evaluation

While most headaches are generally harmless, certain symptoms might indicate serious conditions such as a tumor, aneurysm, stroke, or infection. It is important to seek medical attention if you experience:

• A sudden, severe headache (this can sometimes indicate possible brain bleeding)
• Headaches following a head injury
• New headaches if you are over 50 years old
• Headaches that disrupt sleep
• Worsening progressive headaches
• Headaches coupled with confusion, vision changes, difficulty speaking, weakness, or numbness
• Headaches accompanied by persistent nausea or vomiting
• Headaches associated with fever, stiff neck, altered mental state, or rash (possible meningitis)
• Significant changes in your usual headache pattern or severity

If headaches are frequent, debilitating, or interfere with daily activities, it is important to consult a medical professional.

Diagnosing Headaches: What to Expect

A comprehensive history and physical examination are typically the initial steps when visiting a doctor for headaches. The doctor will inquire about the frequency, duration, location, and characteristics of the headaches, as well as any associated symptoms or triggers. It is also important to get an eye exam from an optometrist or an ophthalmologist.

In certain cases, additional tests such as MRI or CT scans may be recommended to rule out serious causes, particularly if there are warning signs present.

Maintaining a headache diary can also be very useful. Record the occurrence of headaches, their intensity, what was consumed or done beforehand, their duration, and what provided relief. This can help identify patterns leading to more effective treatment plans.

Treatment Options: Medications and Beyond

Treatment options vary depending on the headache type, frequency, and underlying cause. If you have chronic headaches, it’s important to speak to your primary care physician. If you don’t have one, I encourage everyone to have one, they will help you get in front of any long term or chronic disease with screenings and early interventions. At that time, your doctors may refer you to a neurologist to seek more specialized care. There we’ll evaluate you to determine if you need a common or complex treatment options, from medication to procedures.

Acute Relief Medications

• Over-the-counter pain relievers (acetaminophen, ibuprofen): These are commonly used medications that can reduce pain and inflammation caused by headaches.
• Triptans (for migraines): A class of drugs designed specifically for migraines. These a neurologist or a primary care physician will need to prescribe to you. They work by narrowing blood vessels and reducing inflammation in the brain.
• Gepants (for migraines): These are a newer class of migraine medication that are used when triptans are not tolerated.
• Ergotamines: Medications that help constrict blood vessels and reduce headache pain, often used for severe migraines.
• Anti-nausea medications: These can help alleviate nausea and vomiting that often accompany severe headaches and migraines.

Sometimes headaches are so severe they can’t be controlled by medication. In that case, depending on insurance, family history and evaluation, I work with my patients to treat them in my office or if needed through the MemorialCare Neurosciences Institute at Saddleback Medical Center.

Procedures and Advanced Therapies

• Botox injections: FDA-approved for chronic migraines. Botox injections involve injecting small amounts of botulinum toxin into specific areas around the head and neck. This can help prevent migraine headaches by relaxing muscles and blocking pain signals.
• Calcitonin gene related peptide (CGRP) monoclonal antibodies: FDA-approved treatments for both episodic and chronic migraines. These medications are administered as single injections either monthly or quarterly. They work by blocking CGRP, a neurotransmitter that contributes to migraines through nerve inflammation.
• Nerve blocks: Used for specific types of persistent headache pain. Nerve blocks involve injecting an anesthetic or anti-inflammatory medication near specific nerves to block pain transmission. They can provide relief for various types of headaches, including cluster headaches and occipital neuralgia.
• Neuromodulation devices: Noninvasive treatment option. These devices work by delivering electrical or magnetic pulses to the nerves involved in headache pathways, which can help reduce the frequency and intensity of headaches. Examples include transcutaneous electrical nerve stimulation (TENS) and transcranial magnetic stimulation (TMS).
• Physical therapy or chiropractic care: Potentially beneficial for cervicogenic (neck-related) headaches. These therapies involve manual manipulation and exercises to improve neck alignment, flexibility, and strength, which can alleviate headache symptoms caused by neck problems.

Lifestyle Changes to Reduce Headache Frequency

In addition to medical treatments, lifestyle habits play a significant role in headache management. Here are a few evidence-based strategies:

• Stay hydrated: Dehydration is a common headache trigger.
• Get regular sleep: Aim for consistent sleep and wake times—even on weekends.
• Manage stress: Mindfulness meditation, yoga, and counseling can reduce tension-related headaches.
• Limit caffeine and alcohol: Both can trigger migraines and rebound headaches if overused.
• Exercise regularly: Aerobic exercise boosts endorphins and reduces stress.
• Eat regular, balanced meals: Skipping meals or eating certain trigger foods can lead to headaches.

Don’t Suffer in Silence

Living with chronic or severe headaches can greatly impact your quality of life—but you don’t have to face them alone. At MemorialCare Saddleback Medical Center, our neurology team works with patients to identify the type, and cause, of their headaches and build a personalized treatment plan to reduce pain and restore function.

If you or a loved one is struggling with persistent headaches, I encourage you to seek professional care. With the right diagnosis and treatment, relief is possible—and life can be enjoyed with a clear head.

Learn more about the care offered at Saddleback Medical Center or contact the Saddleback Medical Center neuro nurse navigator. For a headache or migraine consultation with me, call (949) 305-7122.