Headache

Tension headache (first onset)

Tension headache is described as feeling like there is a band around the head that gets tighter and tighter. The headaches may occur in episodes – a few times a week – or chronically, where they almost never entirely go away.

This is a common type of headache but the cause remains unclear. It may be a combination of stress and an overactive sensitivity to pain.

Symptoms include dull, aching pain and tightness in the forehead, sides, and back of the head, and sometimes pain in the neck and shoulder muscles. Unlike migraines, there is usually no nausea, vomiting, or sensitivity to light.

Tension headaches are not dangerous in themselves, but can interfere with work and with quality of life.

Diagnosis is made through patient history and sometimes physical examination. CT scan or MRI may be done to rule out a more serious cause of the headaches.

Over-the-counter and other pain relievers are sometimes prescribed. Lifestyle changes to reduce stress, improve diet, and increase exercise are often helpful, as is massage and biofeedback.

Rarity: Common

Top Symptoms: new headache, nausea or vomiting, moderate headache, loss of appetite, mild headache

Symptoms that always occur with tension headache (first onset): new headache

Symptoms that never occur with tension headache (first onset): photo and phonophobia, throbbing headache, headache resulting from a head injury

Urgency: Self-treatment

Sinus headache

Sinus headache, also called sinusitis or rhinosinusitis, is caused by either a bacterial or a viral infection of the sinuses (open spaces) behind the eyes and nose.

Symptoms include fever; thick nasal discharge which may be clear, white, greenish or yellowish; some loss of sense of smell; foul-smelling breath; and pain, congestion, and pressure over the sinus areas of the face, especially if bending forward or lying down.

A self-diagnosed "sinus headache" very often turns out to be a migraine headache with a few sinus symptoms. This requires very different treatment from an actual , and is an important reason to see a medical provider about any sort of ongoing headaches.

Diagnosis is made through patient history, physical examination, and sometimes CT scan or MRI of the head to look for changes in the sinuses.

A true sinus headache, if caused by a bacterial infection, will be treated with antibiotics. If caused by a viral infection, the symptoms can be treated with over-the-counter pain relievers and alternating hot and cold compresses.

Rarity: Common

Top Symptoms: headache, headache that worsens when head moves, facial fullness or pressure, mucous dripping in the back of the throat, sinus pain

Symptoms that always occur with sinus headache: headache

Symptoms that never occur with sinus headache: fever, being severely ill, sore throat, muscle aches, cough, drooping eyelid

Urgency: Self-treatment

New migraine

A migraine is a one-sided headache that causes intense pain and throbbing due to blood vessels dilating in the brain.

The exact reason for new-onset migraine headache is not known, but a number of causes are being studied:

• Pregnancy.
• Soy isoflavone supplements, especially in men.
• Use and overuse of certain medications.
• Traumatic head injury.
• Angioma, which is a cluster of dilated blood vessels in the brain.
• A complication of surgery for some heart conditions.

Anyone with a sudden severe headache should be seen by a medical provider, so that a more serious cause can be ruled out. A transient ischemic attack, also known as TIA or mini-stroke, can have symptoms similar to a migraine but is far more serious.

Diagnosis is made through patient history, physical examination, and imaging such as a CT scan.

Treatment for migraine varies with the individual. Lifestyle changes may be recommended and there are a number of medications that may be tried.

Rarity: Common

Top Symptoms: new headache, fatigue, nausea, mild headache, headache that worsens when head moves

Symptoms that always occur with new migraine: new headache

Symptoms that never occur with new migraine: fever, diarrhea, productive cough, headache resulting from a head injury

Urgency: Self-treatment

Insomnia disorder

Insomnia disorder means being unable to fall asleep, or to stay asleep long enough to get the normal seven to eight hours of sleep per night.

Common causes are pain; sleep apnea; depression; stress and worry over life events; circadian rhythm disorders such as jet lag; aging; and certain medications.

Many medical conditions, such as diabetes and heart disease, cause poor sleep. Women who are pregnant or menopausal may experience insomnia due to hormone shifts.

Symptoms include waking up during the night; feeling tired in the morning; daytime sleepiness and irritability; and increased errors and accidents through inability to concentrate.

Diagnosis is made through physical examination, patient history, and sometimes testing at a sleep study center.

Treatment consists of addressing underlying medical conditions, along with managing stress and checking all medications and supplements.

Improving "sleep hygiene" means establishing a routine of lying down in a dark room at the same time each night, with no television, computer, or phone. Avoiding food and caffeine before bedtime will prevent heartburn and wakefulness while trying to sleep.

Influenza

Influenza, or "flu," is a contagious respiratory illness caused by viruses. It is spread through the air by coughing, sneezing, or even talking.

Anyone can get the flu, but those who are very young, over 65, and/or have pre-existing medical conditions are most at risk for complications.

Symptoms include fever, chills, cough, sore throat, body aches, and extreme fatigue. The symptoms may appear very suddenly.

Flu can bring on secondary bacterial infections in the lungs or ears. Dehydration is a great concern because the patient rarely wants to eat or drink.

Diagnosis is usually made by symptoms. There are tests that use a swab taken from the nose or throat, but they are not always accurate or necessary.

Treatment consists mainly of good supportive care, which means providing the patient with rest, fluids, and pain-relieving medication such as ibuprofen. Do not give aspirin to children.

Antibiotics cannot help with the flu, since antibiotics only work against bacteria. There are anti-viral medications that a doctor may prescribe.

The best prevention is an annual flu shot.

Rarity: Common

Top Symptoms: fatigue, headache, loss of appetite, cough, muscle aches

Symptoms that never occur with influenza: headache resulting from a head injury

Urgency: Phone call or in-person visit

Concussion not needing imaging

A concussion is also known as traumatic brain injury or TBI.

Concussion is the result of being struck in the head. In some cases, especially with infants, being violently shaken so that the head whips back and forth can also cause a concussion.

Most susceptible are those playing contact sports. However, concussion is often the result of an automobile accident or simple fall and can happen to anyone.

Symptoms include headache; loss of balance and coordination; difficulty with memory and concentration; and sometimes, but not always, loss of consciousness.

If symptoms do not clear within a few hours, or seem to get worse, take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history and physical examination. A mild concussion does not show up on imaging because there is no bleeding or swelling in the brain. Mild concussion is entirely a disruption in brain function, with nothing to see on an image.

A concussion does not usually need treatment, but head injuries can result in more serious complications, like bleeding in the brain, you should be seen for an evaluation today, just to be sure. The health care provider will determine if imaging of your head, like a CT scan, is necessary. If your symptoms change or worsen, go to the ER immediately.

Rarity: Common

Top Symptoms: dizziness, irritability, depressed mood, difficulty concentrating, trouble sleeping

Symptoms that always occur with concussion not needing imaging: head or face injury

Symptoms that never occur with concussion not needing imaging: recent fall from 6 feet or higher, severe vomiting, posttraumatic amnesia over 30 minutes, slurred speech, fainting, moderate vomiting

Urgency: Primary care doctor

Common cold

The common cold is a contagious viral infection that can cause cough, congestion, runny nose, and sore throat. Most adults catch two to three colds per year, and kids can get more than eight colds each year.

Rest and drink plenty of fluids. Colds are contagious and can easily spread to other people, so if possible, avoid close contact with others, such as hugging, kissing, or shaking hands. Colds typically resolve within 7 to 10 days.

Cluster headache

A "new onset" cluster headache means that the person has never experienced a before. These headaches most commonly start after age 20.

A cluster headache is characterized by intense pain on one side of the forehead, especially over one eye. It often strikes in "clusters," meaning the headache comes and goes frequently. It may occur at about the same time of day for several days or weeks in a row.

The specific cause for cluster headache is not known. Drinking alcohol, breathing strong fumes, exercising to the point of becoming overheated, and heavy smoking are all possible triggers.

Diagnosis is made through patient history, since there is no specific test for cluster headache. Blood tests, neurologic tests, and imaging such as a CT scan or MRI may be done to rule out any other cause for the new onset of head pain.

Referral will be made to a headache specialist, who can offer new treatments to help the patient manage the symptoms and improve quality of life.

Rarity: Uncommon

Top Symptoms: severe headache, nausea, throbbing headache, history of headaches, sensitivity to light

Symptoms that always occur with cluster headache: severe headache

Urgency: Hospital emergency room

Brain tumor or mass

In medical terms, "mass" and "tumor" mean the same thing: the unexplained, out-of-place growth of tissue anywhere in the body, including the brain.

The cause of any sort of brain tumor is unknown. Some originate in the brain, while others spread from cancers growing in other parts of the body.

Symptoms may include increasing headaches; nausea and vomiting; blurred or double vision; loss of sensation in an arm or leg; loss of balance; confusion; speech difficulties; or seizures.

If symptoms persist, it is important to see a medical provider so that any treatment can begin as soon as possible.

Diagnosis is made through neurological examination, CT scan, and/or MRI.

If the mass or tumor is found to be benign, that means it is not cancer and not harmful. It may or may not be treated.

If it is malignant, that means it is cancer and must be treated. This will involve some combination of surgery, radiation therapy, and chemotherapy, followed by specialized therapy to help with recovery.

Rarity: Rare

Top Symptoms: fatigue, headache, nausea, loss of appetite, irritability

Symptoms that always occur with brain tumor or mass: focal neurological symptoms

Urgency: In-person visit

Acute bacterial sinusitis

Acute bacterial sinusitis, also called bacterial rhinosinusitis or "sinus infection," has symptoms much like viral rhinosinusitis but a different treatment.

Any sinusitis usually begins with common cold viruses. Sometimes a secondary bacterial infection takes hold. Like cold viruses, these bacteria can be inhaled after an infected person coughs or sneezes.

Anyone with viral sinusitis, upper-respiratory allergy, nasal passage abnormality, lung illness, or a weakened immune system is more prone to bacterial sinusitis.

Symptoms include thick yellowish or greenish nasal discharge; one-sided pain in the upper jaw or teeth; one-sided sinus pain and pressure; fatigue; fever; and symptoms that get worse after first improving.

See a doctor right away for severe headache, high fever, stiff neck, or vision changes. These can indicate a medical emergency.

Diagnosis is made with a simple examination in the doctor's office.

Bacterial sinusitis can be treated with antibiotics, but this is not always necessary.

Often rest, fluids, and over-the-counter pain relievers and decongestants are enough.

Prevention is done through good lifestyle and hygiene to keep the immune system strong.

Rarity: Common

Top Symptoms: fatigue, headache, cough, sinusitis symptoms, muscle aches

Symptoms that always occur with acute bacterial sinusitis: sinusitis symptoms

Symptoms that never occur with acute bacterial sinusitis: clear runny nose, being severely ill

Urgency: Primary care doctor

Questions your doctor may ask about headache

• Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
• Any fever today or during the last week?
• Have you experienced any nausea?
• Have you lost your appetite recently?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.