Headaches come in all shapes and sizes

Q. I seem to be getting a lot of headaches lately. I’m pretty sure it’s been caused by stress, but I was wondering if I should have it checked by a doctor.

You should definitely see your doctor. Most headaches are harmless, but they can be a symptom of a serious condition. The American Council for Headache Education urges people to see a doctor if there are any of the following symptoms with headache:

Headaches that began after age 50; three or more headaches per week; taking a pain reliever almost daily; taking more than the recommended doses of over-the-counter pain relievers; stiff neck; fever; shortness of breath; unexpected symptoms that affect your eyes, ears, nose, or throat; dizziness; slurred speech; weakness; numbness; a tingling sensation; confusion; drowsiness; headaches that begin and persist after a head injury; a headache triggered by exertion, coughing, bending, or sexual activity; a headache that intensifies and persists; headaches that change character; persistent or severe vomiting; a headache that is your “first or worst.”

More than 45 million Americans suffer from recurring headaches. About 70 percent of headache sufferers are women.

There are primary headaches that are not related to another condition, and secondary headaches, which are.

Primary headaches include tension, migraine, mixed headache syndrome and cluster headaches.

About 90 percent of primary headaches are caused by tension. These muscle-contraction headaches cause mild-to-moderate pain and come and go. Tension headaches are called chronic if you have them more than 15 days per month. They are episodic if you get them less than 15 days per month.

Most tension headaches can be treated with over-the-counter pain relievers, such as acetaminophen, aspirin and ibuprofen.

The precise cause of migraines is unknown. However, research has demonstrated that migraines involve the actions of nerves and blood vessels. The pain from migraines is moderate to severe.

They can last from hours to days and be combined with stomach distress. Prescription medications are often needed to treat migraines.

Another subcategory of primary headache is mixed headache syndrome, which is the combination of migraine and tension headaches.

Cluster headaches, which come in groups, are the worst type of primary headache. The pain hits behind one eye and it’s severe. Cluster headaches occur one to three times per day during a cluster period, which may last two weeks to three months.

Preventive medications are prescribed for cluster headaches. During a cluster headache, injecting medication or inhaling 100 percent oxygen may help. About 85 percent of cluster-headache sufferers are male.

Secondary headaches include chronic progressive, sinus and hormone headaches.

Chronic progressive headaches worsen and become more frequent. These headaches may be caused by a brain or skull illness, such as encephalitis or inflammation of the brain. If diseases are ruled out, doctors will try to focus on preventing the pain from striking. Preventive medication may include antidepressants, muscle relaxants or other drugs.

Sinus headaches cause pain in the head and face and sometimes can fool you into thinking you have a dental problem. These headaches coincide with other sinusitis symptoms, such as nasal discharge. Over-the-counter pain relievers and decongestants work well with this type of headache.

Hormone headaches come with changing hormone levels during menstruation, pregnancy and menopause. These are treated with non-steroidal anti-inflammatory drugs, such as ibuprofen, and other drugs.

Another type of headache is caused by taking too much pain medication. This type is called a rebound headache.