The Evolution of Headaches

In ancient Greece, headaches were seen as serious ailments. People would pray to Asclepius, the god of medicine, for relief. If the pain persisted, the common remedy was trepanation—drilling a small hole in the skull to drain supposedly infected blood. Unfortunately, this drastic measure often led to more severe problems.

Today, we no longer use such extreme methods to treat headaches, but we still have much to learn about them. Headaches are classified into two main types: primary and secondary. Primary headaches are conditions in themselves, while secondary headaches are symptoms of other underlying issues. Although primary headaches make up 50% of reported cases, we know more about secondary headaches.

Secondary headaches result from various health issues, such as dehydration, caffeine withdrawal, head or neck injuries, and heart disease. There are over 150 recognized types, each with distinct causes, symptoms, and treatments. For example, a sinus infection—a common cause of secondary headaches—involves inflammation of the sinuses behind the forehead, nose, and upper cheeks. This inflammation puts pressure on cranial arteries and veins, leading to throbbing pain as pain receptors, or nociceptors, signal the brain to release neuropeptides. This causes swelling and heat, resulting in a headache.

Not all headaches are caused by swelling. Some are due to tense muscles and sensitive nerves, creating varying levels of discomfort. While secondary headaches have identifiable causes, the origins of primary headaches remain unclear. Primary headaches include migraines, cluster headaches, and tension headaches.

Tension headaches are characterized by a sensation of a tight band around the head, increasing tenderness in the pericranial muscles. Triggers like stress, dehydration, and hormonal changes are reported but don’t fully explain the symptoms. For instance, dehydration headaches cause the frontal lobe to shrink from the skull, leading to swelling in the forehead rather than the location typical of tension headaches. Theories about tension headaches include spasming blood vessels and overly sensitive nociceptors, but no definitive cause has been established.

Migraines are severe, recurring headaches that can last from four hours to three days, creating a vise-like sensation. In 20% of cases, migraines can overload the brain with electrical energy, causing hallucinations known as auras, which may include visual disturbances and tingling sensations.

Cluster headaches, another primary type, are marked by intense, stabbing pain behind one eye, resulting in a red eye, constricted pupil, and drooping eyelid.

Treatment for tension headaches and many secondary headaches often involves over-the-counter pain relievers, such as anti-inflammatory drugs, which reduce cranial swelling. Proactive measures, like avoiding dehydration, eye strain, and stress, can also help. Migraines and cluster headaches are more complex, with no universal treatments yet available. However, researchers and medical professionals continue to work diligently to understand and address these challenging conditions.