Brain Pain: A Look Inside

6 min read  |  June 18, 2018  | 

Headaches can be, well… a real pain in the neck. Or a pain in the scalp, sinuses, teeth, joints and other muscles above the chin.

“Headaches are one of the most common types of human pain,” says Dr. Teshamae Monteith, a clinical expert in headaches and migraines and a headache researcher at the University of Miami Health System.

But why do you get them? How do you know when it’s a serious medical condition? And can you prevent them?

Headaches come in two main categories: primary and secondary, according to the International Headache Society’s International Classification of Headache Disorders 3rd edition.

Primary headaches are a pain unto themselves — not caused by or a symptom of a different medical condition. Secondary headaches (only 10 percent of headaches) occur as a result of another condition.

“Secondary headaches can be caused by severe high blood pressure, infections of the head and neck (examples are sinusitis, meningitis), trauma to the head, tumors, fever, medication overuse or withdrawal, stroke, nerve disorders, blood vessel hemorrhages and psychiatric illness,” says Dr. Monteith. “New onset headache or headache that has significantly worsened in relation to a presumed disorder are clues.  The pain may be atypical in some way but may also mimic more common forms of headache.”

There are more than 150 types of primary and secondary headaches, according to the International Headache Society. Since trying to understand all of those might give anyone a headache, let’s focus on the main culprits.


The pulsating or throbbing pain, usually on one side of the head or neck, is a clear sign of a migraine. Migraine sufferers can experience sensitivity to light and sounds, nausea and visual disturbances. Migraines are often caused by a genetic predisposition and can be triggered by stress and anxiety, hormonal changes (in women), changes in sleep patterns and/or environmental triggers such as changes in weather, odors and noises.

“Migraine pain can vary widely between individuals,” says Dr. Monteith. “Sometimes people can work through it. Others need to be taken to the emergency room. Migraines are the second leading cause of years lived with a disability worldwide, and the number one reason for adults ages 15 to 49. They affect us during our otherwise most productive years.”

Treatments include prescription drugs, like triptans for acute treatment, and preventive medications (drugs for hypertension, depression, and seizure disorders). New drugs known as monoclonal antibodies have been specifically designed to treat migraine preventively. For chronic migraine treatment, some patients receive FDA-approved Botox treatments from a qualified provider.

If you get migraines and they are impacting your life, Dr. Monteith says, it is important that you seek medical treatment.

Cluster headaches

People often describe cluster headaches as the worst headache of your life – that you get several times a day for months. Cluster headaches start without warning on one side of your head. Remedies are prescribed by a doctor and include inhaling pure oxygen and sumatriptan for acute treatment. A number of other treatments including steroids, the calcium channel blocker verapamil, and nerve blocks may also help.

Recently, the FDA approved a new, non-drug therapy called gammaCore® for cluster headaches and some migraines. Patients use a simple, handheld device to self-administer stimulation to the body’s vagus nerve in the neck. The device offers a non-invasive alternative for patients who do not respond to oxygen therapy or drugs like sumatriptan, says Dr. Monteith, one of the leading experts using the gammaCore® device for patient care.

Tension headaches

The most common type of this ailment, tension headaches are milder than cluster headaches. What causes them? Doctors still do not entirely know.

“The pain is often dull, pressing, mild, yet annoying. The pain often occurs around the scalp, and pericranial tenderness is the most significant finding,”  says Dr. Monteith.

If headaches are associated with significant levels of disability, it is important to be screened for migraine, which can also be bilateral (occurring on both sides of your head).

Dr. Teshamae Monteith

You can feel tension headaches on both sides of your head. Usually, you can treat them using over-the-counter pain relievers, ice, heating pads and tricyclic antidepressants for prevention. Some individuals have found help from complementary medicine approaches like manual therapies, acupuncture and biofeedback-based techniques.

Should you see a doctor?

According to The National Headache Foundation, seek medical attention if:

  • You have more than an occasional headache.
  • Your headaches are severe or come on quickly.
  • The headache is accompanied by any of the following: confusion, dizziness, fever, numbness, persistent vomiting, shortness of breath, slurred speech, stiff neck, unpredicted symptoms affecting your ears, nose, throat or eyes, unrelenting diarrhea, vision loss or general weakness.
  • The pain continues to get worse or won’t stop.
  • Your headaches interfere with your normal activities of daily life.
  • You find yourself taking pain relievers more than two days a week.
  • Over-the-counter medications are not working at the recommended doses.
  • Your headaches are caused by coughing, sneezing, bending over, exercise or sexual activity.
  • Your headaches begin or continue after a head injury, or other trauma.
  • The characteristics or symptoms of your headaches, or the onset of migraines, change.

If you experience sudden neurological changes, symptoms such as confusion and fever, or you cannot stop vomiting, contact your doctor or call 9-1-1 immediately.

Some patients go to the emergency room after an attack has lasted for several days. Seeking assistance from a qualified medical professional will lessen your chances of needing to go to an ER.

Reducing your risks

Many headache triggers are out of your control, but Dr. Monteith says there are several ways to decrease your risks. These include:

  • Decrease daily stress levels
  • Drink alcohol only in moderation
  • Drink enough water each day
  • Get enough sleep
  • Eat at regular intervals (not skipping meals)
  • Quit smoking or don’t start
  • Decrease consumption of foods with too many additives

“When an occasional inconvenience turns into a disruption in our lives and shows some of the warning signs listed here, do not be afraid or embarrassed to seek professional medical attention,” says Dr. Monteith. “It will ensure an accurate diagnosis, decrease any fears, and will get you feeling well again, and back to ordinary activities.”

If you suffer from headaches, call 877-836-3876 or 305-243-3100 to get advice from the experts at UHealth.

John Senall is a contributing writer for the UMiami Health News Blog. He is a former hospital and comprehensive cancer center communications director.

Tags: Dr. Teshamae Monteith, headaches, migraine triggers, migraines

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