Have you been tolerating headache pain for too long?


 In this article:

  • Headache disorders affect more than 50% of the world’s population.

  • There are many different types of headache disorders.

  • Migraines result in missed work, missed school, and missed social engagements.

  • Medications, therapies, and treatments can help prevent debilitating headaches (including migraine) and treat headache episodes and symptoms.

We all experience headaches from time to time. Typically, these headaches aren’t much more than a nuisance. But, for the 50% of the world’s population that have a headache disorder, a seemingly simple headache can (and often does) interfere with their physical, mental, and social health. Severe headaches, especially migraines, can keep people from work, students out of classrooms, and friends from socializing. In fact, migraines alone are the second leading cause of disability worldwide. Collectively, headache disorders are the third leading cause of disability.

Despite this prevalence, headaches are still under-treated and under-recognized.

“There is a lot of noise but not a lot of signals when it comes to migraines and headache disorders,” explains H. Alexander Krob, MD, neurologist and medical director of the Headache Program at Providence Oregon Brain and Spine Institute. “It can be overwhelming for people to cut through all that static noise to find the approach that will truly help them manage their headache.”

“It’s my job – and my goal – to help people living with headaches live better,” he says.

Here, Dr. Krob shares insight on the basics of headache disorders and how knowledge can empower you to find relief. 

Types of headache disorders

A headache disorder refers to recurrent headaches – typically ones severe and frequent enough to interfere with your daily life. The most common primary headache disorders (headaches with no known underlying cause) include migraines, cluster headaches and tension headaches.


Women are most likely to suffer from migraines. One of the most common primary headache disorders, migraines typically begins at puberty. Symptoms of untreated (or unsuccessfully treated) migraine pain typically include:

  • Pain on one or both sides of the head
  • Moderate or severe pressure or pulsating pain
  • May compel people to find rest in a dim, quiet location
  • Lasts more than four hours 

Cluster headaches

Cluster headaches are headaches that occur frequently over days, weeks, or months – called a cluster period. Symptoms of cluster headaches typically include:

  • Pain felt in or around one eye
  • Severe or extremely severe pain
  • A sense of restlessness during the attack
  • Pain that lasts less than three hours with one or more attacks per day (often in clusters at certain times of the year0)

Tension headaches

Tension-type headaches can be episodic (occurring for fewer than 15 days a month) or chronic (occurring more than 15 days a month). Also more common in women, these types of headaches typically start in the teen years. Symptoms of tension-type headaches typically include:

  • Pressure or tightness
  • Pain that feels like a band around the head
  • Pain that sometimes spreads into or from the neck

Other types of headache disorders

Migraine, tension, and cluster headaches are the most common primary headache disorders, but there are many other types. Other headache disorders include:

  • Exertional headaches
  • Sinus headaches
  • Hypertension headaches
  • Medication overuse headache

Headache red flags

Sometimes, a headache can be a symptom of something else. Maybe you’re feeling particularly stressed, or you stared at your computer screen a little too long. While rare, some headache symptoms may be a sign that something more serious is going on. Seek emergency care or contact your doctor immediately if you’re experiencing any of the following red flags with your headache:

  • Signs of illness, such as fever or weight loss.
  • Neurological symptoms, including altered consciousness, inability to move a limb or confusion.
  • Sudden onset of headache pain, also called thunderclap or split-second headache.
  • A different pattern from usual headaches.
  • New or different headache symptoms in individuals with certain pre-existing conditions (autoimmune disorders, pregnancy, history of major cancer).
  • Symptoms triggered by exertion, straining or position-change

Diagnosing headache disorders

There are many types of headache disorders, but according to Dr. Krob, there is a simple approach to diagnosing and treating headaches.

“The first unwritten rule of headache medicine is that any recurrent, disabling headache is a migraine until proven otherwise,” he states. “And you do not need a neurologist to diagnose migraines to start a treatment plan that works for you. After all, migraines affect more than 50 million people in the United States each year. It’s far more likely you’re experiencing migraines rather than a more serious condition causing headaches.”

There is no specific test for diagnosing migraines. Rather, your provider will ask you questions about your symptoms and gather in-depth information about your health and headaches. Tests, such as an MRI, CT or blood tests, don’t diagnose migraine. However, they may be used to rule out other conditions in people experiencing certain red flag headache symptoms.

Together, this information can paint a clearer picture of what may be triggers for your headache and appropriate treatment that will help bring you relief.

“Your primary care provider will work closely with you to create a treatment plan that’s right for you,” Dr. Krob shares. “And, if needed, you and your provider can rely on support from a neurologist or headache medicine provider to further reduce frequency and intensity of headaches.”

Preventing migraines, severe headache

People with migraines should emphasize prevention, especially when they have four or more days of migraine each month, or when migraine sidelines them for two or more days a month.

That’s why Dr. Krob encourages his patients to be proactive, including avoiding known triggers when possible and making healthy choices. Another piece of advice he offers his patients – take preventive medicines.

There are three types of “platform” migraine prevention medicines. These are generic medicines that were made for other diagnoses but have been used to help may people over many decades prevent migraines. These medications are familiar to most primary care providers and easily available at a low cost. They include:

  • Medicines made to prevent high blood pressure (like propranolol)
  • Medicines made to help seizures (like topiramate)
  • Medicines made to help depression and anxiety (like amitriptyline)

“These medicines are taken regularly, even when you don’t have a migraine, to reduce the frequency and severity of your migraine attacks. You and your primary care provider can find the right choice for you considering your needs and possible side effects,” says Dr. Krob.

Treating headache disorders

There may be no cure for migraines or other headache disorders, but there are effective treatment options when a severe headache strikes. Your doctor will work with you to develop a plan that’s right for you. Common treatments include:

  • Prescription medication. Triptans are a class of medication that block pain pathways in the brain. Generally safe and effective, side effects may include nausea, fatigue, or what’s called “triptan sensations” (a warm, tingling feeling in the chest, arms, legs, and face).
  • Over-the-counter medication. Taken alone or along with triptans, over-the-counter medication can help relieve pain and other symptoms associated with migraine. Be sure to talk to your doctor about what you can take along with your prescriptions.

Hope is here

As a migraine sufferer himself, Dr. Krob understands firsthand the frustration severe headaches and migraines can bring.

“It’s an understatement but a headache can make you feel just miserable. It interferes with life, work, and friendship. It keeps you from simple things like working around the house, enjoying a book, or even just watching a television show.

“Often, people who suffer from migraines or severe headaches think there isn’t any relief available. But there is. A headache specialist will help you look at the whole picture. We’ll get familiar with your symptoms and your goals and your daily life. Then, we’ll create a plan that will help you feel better.”


Find a doctor

If you have been tolerating headache pain for too long, a provider from the Providence Oregon Brain and Spine Institute can help. If need to find a doctor, you can use our provider directory. Through Providence Express Care Virtual, you can also access a full range of health care services.

Download the Providence App

We’re with you, wherever you are. Make Providence’s app your personalized connection to your health. Schedule appointments, conduct virtual visits, message your doctor, view your health records, and more. Learn more and download the app.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.