Headaches: What’s Causing Yours?

Is there anything that can get in the way of your day’s activities like a headache? We’ve all been there. But did you know that there are several different types of headaches you may be suffering from – and each has its own causes? It’s true. The good news: There are things you can do to deal with – and sometimes even prevent – the headaches plaguing you. In this episode of Total Health Radio, our guest physician walks us through the different types of headaches, shares how we can identify our own personal triggers, and explores options for how we can best manage headache pain when one strikes.

About the Guest
Jenny Bajaj, MD, is an internal medicine physician with Kaiser Permanente in Colorado.

Episode Host
Joyce Gottesfeld, MD, is an OB/GYN with Kaiser Permanente Colorado, where she’s worked 17 years. She’s a wife, proud mother of three girls, runner and blogger. Read more about Dr. Gottesfeld.

Learn More
Looking for more information about headaches (and how to deal with yours)? Check out these online resources.


DR. GOTTESFELD: Welcome to Total Health Radio. I’m Doctor Joyce Gottesfeld. Nothing gets in the way of a productive day quite like a bad headache, but it turns out that not all headaches are created equal. Doctor Jenny Bajaj is the assistant chief of Population and Prevention Services for Kaiser Permanente, and an internal medicine physician with a busy practice here in Colorado. She’s here to tell us about the different kinds of headaches, how to know which type you have, and how to manage the pain when you have one. Doctor Bajaj, thank you for joining us.

DR. BAJAJ: Thank you for having me, Doctor Gottesfeld.

DR. GOTTESFELD: So, can you tell us what is a headache?

DR. BAJAJ: A headache is a pain sensation in your head that is caused by blood vessels and nerve fibers. We don’t quite understand exactly how they work, but it’s basically pain coming from the area of the inside of the brain. Typically headaches occur either on the whole head, top of the head, sides of the head, back of the head, or they can happen on just one side of the head.

DR. GOTTESFELD: Okay. Anything goes. So can you tell us about what the different kinds of headaches are? Cause I hear about different tension headaches, migraines. Can you kind of go over that with us?

DR. BAJAJ: Sure. So there are actually lots of different types of headaches. The two most common kinds of headaches are what we call primary headaches and secondary headaches. And I’m actually gonna talk about the three most common headaches in each of those categories.

DR. GOTTESFELD: So, can you tell me what primary and secondary means?

DR. BAJAJ: A primary headache is a headache that is not caused by another factor, such as medication withdrawal, alcohol abuse, or some other reason.


DR. BAJAJ: The two most common types of primary headaches are migraines and tension headaches.

DR. GOTTESFELD: Okay, I hear a lot about both of those. So what is a tension headache?

DR. BAJAJ: A tension headache is a headache that basically goes around your head, is on the top of the head, the sides of the head, or in the temples. It’s usually both side of the head and it frequently stems from muscle problems in your neck or in your upper back.

DR. GOTTESFELD: I’m starting to get a headache just hearing you suggest all those things. So what causes tension headaches?

DR. BAJAJ: Tension headaches can be caused by a lot of different things. The most common cause of a tension headache is stress but tension headaches can also be caused by things like changing your caffeine amount; so too much or too little. Very commonly people miss their caffeine dose and come in with a bad headache and, why, it’s just caffeine withdrawal. Actually, secondary exposure to smoke – cigarette smoke.

DR. GOTTESFELD: Hm, interesting.

DR. BAJAJ: Primary, so if you’re a smoker that can actually cause headaches.


DR. BAJAJ: Sleep apnea can cause headaches; thyroid problems; high blood pressure; eyestrain; and some medications can cause headaches.

DR. GOTTESFELD: Wow, so when people get a tension headache, how long does that last?

DR. BAJAJ: Tension headaches usually start around the middle of the day and they can last usually up to 24 hours, sometimes a little bit longer especially if they’re untreated.

DR. GOTTESFELD: So tension headaches are basically caused by tension.

DR. BAJAJ: Basically they’re caused by tension, yes.

DR. GOTTESFELD: So, I’m envisioning someone, it’s a long day – maybe like you said, they didn’t have their cup of coffee, they’ve been staring at their computer screen all day. Maybe they didn’t sleep well the night before, that kind of thing, and then it comes on.

DR. BAJAJ: Exactly.

DR. GOTTESFELD: What do you do?

DR. BAJAJ: So if you have a tension headache the first thing you want to do is see if you can relax. Meditate, relax, stretch, use a hot towel on your forehead. Try to get rid of the headache in a natural way before you try medications.

DR. GOTTESFELD: And what medications can you try?

DR. BAJAJ: Over the counter medications like Tylenol, Ibuprofen, Aleve can all be really helpful for run-of-the-mill tension headaches.

DR. GOTTESFELD: And then some over-the-counter pain relievers have caffeine in them, isn’t that right?

DR. BAJAJ: Correct. So Excedrin would be the most commonly used headache medication that has caffeine in it.

DR. GOTTESFELD: Interesting. Okay, and then how often do people get tension headaches?

DR. BAJAJ: People can get tension headaches up to about 15 times per month if they’re really bad. Most people don’t have headaches at all. In fact, there are people who have never experienced a headache. Which is really hard for people who get headaches all the time to believe.

DR. GOTTESFELD: Wow, so someone might get a headache up to half the days of the month.

DR. BAJAJ: Correct. It can be very debilitating. The problem with that is frequently they’ll then take medications half the days per month and then they’ll develop a secondary headache called a rebound headache.

DR. GOTTESFELD: Wow, okay – well then what do you do?

DR. BAJAJ: Rebound headaches are caused by taking pain medication – even over-the-counter pain medication. So the only way to get rid of rebound headaches is actually to take absolutely no pain medication. Keep your caffeine intake steady, drink plenty of water, get plenty of sleep. Don’t mess around with your schedule too much. And they usually take one to two months to go away once you have rebound headaches. It can be quite debilitating to get rid of them.

DR. GOTTESFELD: Wow, so are there things people can do to prevent the onset of a tension headache?

DR. BAJAJ: Absolutely. So, stress relief, mindfulness base living, meditation, massage if you have really tight muscles in your back can be helpful, stretching, yoga; all of those things. The other thing that can be really helpful is actually acupuncture.

DR. GOTTESFELD: Oh, I have seen some studies about acupuncture decreasing headache frequency.


DR. GOTTESFELD: Okay, well those are some good suggestions. Now let’s talk about migraines, what’s a migraine headache?

DR. BAJAJ: Migraine headaches are actually hereditary. So if you have both parents have migraines, your chance of having migraines is 50 percent. Migraines are more common amongst women. Often in women they’re related to their menstrual cycle.

DR. GOTTESFELD: Okay, I meant to ask you about that before – can women get tension headaches related to their menstrual cycle or just migraines?

DR. BAJAJ: They can get tension headaches, those are not usually due to stress, they’re usually due to the hormonal fluctuations in the body.

DR. GOTTESFELD: And so you can see that with tension headaches or migraine headaches. So how does it feel different? Does a migraine feel different than a tension headache?

DR. BAJAJ: Yes. A migraine feels different. Migraines are typically felt on one side of the head or the other. It’s a throbbing constant pain sometimes a poker-like pain. Often times there will be throbbing behind the eye. Migraines are almost always associated with nausea, sometimes vomiting, and light sensitivity and sound sensitivity. You don’t have to have all of them but usually you would have all of them. The other thing frequently associated with migraines is an aura. An aura is telling you you’re about to get the headache. It may be some blurred vision, it may be a certain smell, but it’s not associated with any pain. A lot of patients who have migraines will have an aura that tells them the headache is coming on.

DR. GOTTESFELD: Like a warning sign?

DR. BAJAJ: It’s like a warning sign, exactly.

DR. GOTTESFELD: And how far does that precede the headache? How much time does someone have when they get an aura or a sign, you know, to do something to try and prevent a migraine?

DR. BAJAJ: You know it’s really variable. It can be minutes, it can be more than minutes. So it depends on the person. The other thing to know is patients who have migraines with aura are at higher risk for having a stroke later in life.

DR. GOTTESFELD: Wow I didn’t know that.


DR. GOTTESFELD: So what are the treatments for migraine headaches?

DR. BAJAJ: We like to start simple, so Tylenol or Ibuprofen, anything in that sort of class is good to start with. Excedrin migraine relief tends to work really well. Some people move beyond where those medicines no longer work for them and then we prescribe medications for them.

DR. GOTTESFELD: And there are medications you can take that are meant to be preventative, is that correct?

DR. BAJAJ: Correct. So I always recommend lifestyle first. If you can get, you know, good lifestyle factors that help you prevent your migraines, that’s the very best thing. So I have my patients keep a headache diary. So what is associated with your headache, is it, “I didn’t get enough sleep last night,” is it a change in the weather or a metric change outside? Some people it’s food or some sort of environmental exposure. So really understanding those triggers first making sure you get plenty of exercise, making sure that you get plenty of stretching. If that’s not working then we could prescribe a preventative medicine, which is a medication that you take every single day and it helps to reduce the frequency of migraines that you would have per month.

DR. GOTTESFELD: That’s great. Now let me ask you one other thing about migraines. How often do people get migraines and how long do they last?

DR. BAJAJ: Again, that’s really variable in terms of how often. Some people will get one or two in their whole life, other people have several per week. Typically the people who are having several per week are in that class that I was talking about earlier of rebound headaches. So they’re taking pain medication frequently and so then their body gets sort of dependent, if you will, on the pain medication.

DR. GOTTESFELD: So how long does a migraine usually last?

DR. BAJAJ: A typical migraine will last 24 to 72 hours, usually more on the 24-hour side. For most people, after a good night sleep they’ll wake up and the migraine will be gone.

DR. GOTTESFELD: So let’s talk a little bit about secondary headaches. What are some of the things that can cause headaches? If someone comes to you with headaches, what are some of the things that you’re looking for?

DR. BAJAJ: So, secondary headaches you are looking for an underlying cause. The most common underlying causes are the rebound headaches that we already talked about, and other medications. So some people are on anti-depressants. If they forget to take a dose they might get a headache, and then there are really rare causes like brain tumors and bleeds in the brain, stroke, things like that, which are rare, but you need to know what to watch out for.

DR. GOTTESFELD: So let’s talk about that for a second. What would be the kind of headache you might have if you had one of those more serious conditions? Would it be different, or feel different, or what are some of the signs that it’s really something more serious going on?

DR. BAJAJ: Absolutely. One of the things that we always look for is double vision or severe vision changes. Now, people who have migraines often will have vision changes, so they’re used to what that’s like. But if you have new onset vision changes with a new onset type of headache, that would be something you would definitely want to be seen for. If you had weakness on one side of the body or face, if you are unable to find words or your speech were garbled. And then there’s the classic, what we call, thunderclap headache, which is where it’s a sudden onset worst headache of your life, that is something you would want to see a physician for right away.

DR. GOTTESFELD: And what does that mean? What’s going on with that?

DR. BAJAJ: Often that means there’s a bleed inside of the head that is causing irritation to the nerves, which is giving you the headache. Those need to be seen and taken care of, obviously, immediately.

DR. GOTTESFELD: And is that from, like, somebody fell and hit their head kind of thing or?

DR. BAJAJ: It can happen with trauma. Most commonly it’s an aneurism that has exploded.

DR. GOTTESFELD: Okay so let’s wrap it up here. If you were to look at the whole spectrum of headaches and it sounds like there’s some overlap in causes and treatments and preventions and things like that. So what would be your three pieces of advice for people to, about headaches, maybe prevention, chiefly, or maybe even treatments?

DR. BAJAJ: Prevention of headaches is best done through lifestyle. So making sure that you’re leading a healthy lifestyle, that you’re eating healthy foods, you’re getting plenty of exercise and rest. So those are really the more important things to prevent headaches. If you have headaches, making sure that you’re not over-treating yourself. And if things are escalating or you have any warning signs, seeking a physician.

DR. GOTTESFELD: Well thanks for coming on the show today Doctor Bajaj and I hope you have a lovely day.

DR. BAJAJ: Thanks for having me.


This show is for educational purposes only. If you have specific health concerns, you are encouraged to address those with your personal doctor. And as always, if you’re having a health emergency, please call 9-1-1 or go to the nearest emergency department.