Even the toughest athletes can be sidelined by a pounding headache. Understanding the types and causes of the most common types of headaches can help prevent time away from training.
The official classification system for headaches was revised and published by the International Headache Society in 2004. The purpose of the classification is to provide a standardized set of criteria for diagnosing headache pain and to set standards for research.
Primary versus Secondary Headaches
According to the classification system, headaches are classified into two groups. Primary headaches are those headaches in which the pain is a result of the headache diagnosis. Secondary headaches are those in which the headache pain is the result of another disorder (i.e., head injury).
The first goal is to get a good history to discover if the headache pain is a result of a primary or secondary headache. When dealing with athletes, care must be taken to determine if the headache is the result of a head and/or neck injury. If there is a history of head injury, the athlete needs to be held out of all practice/competitions and immediately referred for further medical evaluation.
Primary headaches are divided into four types including migraine, tension, cluster, and exertional. A comprehensive headache history can help determine the type of headache along with the possible triggers that may be causing the headaches.
Headache Triggers
The history should include a description of the type of pain (pounding, tight, pressure), location of pain (back, side, front, unilateral or bilateral), frequency, time of day, length of pain, and possible triggers (Athletic Therapy Today, July, 2009):
- Caffeine
- Alcohol
- Foods
- Sleep deprivation
- Dehydration
- Perfume
- Nicotine
- Missed Meals
A headache log is a good way to document the above information for the purpose of trying to find a pattern. This type of log is also good information to bring when being evaluated by a medical professional.
Migraine Headaches
According to an article posted in Postgraduate Medicine (December, 2002), migraine headaches are the most common type of headache presented to physicians. Symptoms include unilateral (one side of the head) pounding, nausea, photophobia (sensitivity to light), phonophobia (sensitivity to light), frequently preceded by a visual aura (flashes of light, may vary).
Migraines typically last between 4 and 72 hours. Athletes tend to suffer migraines at a lower rate (3%) than the general population (12-18%) (Athletic Therapy Today, July, 2009). Migraines are treated by medication, identification and avoidance of triggers, relaxation techniques, biofeedback, and regular aerobic exercise. Prescription prophylactic medication may also be given to prevent the reoccurrence of migraines.
Tension Headaches
Tension headaches are typically related to stress and are the most common type of headache. According to Adeniji, O., and Mokha, M. in their article "Headache Disorders in Athletes" (Athletic Therapy Today, July, 2009), more women than men are subject to tension headaches.
These headaches tend to be experienced in the front of the head (bilateral) and tend to be mild to moderate in intensity. Tension headaches are commonly treated with over-the-counter NSAID medication.
Cluster Headaches
Cluster headaches can be further defined into several different types depending on location, symptoms, and whether they primarily affect men or women. However, these headaches generally “cluster” in their timing, are brief in duration, and have pain located around the eyes.
Patients suffering cluster headaches can have repeat headaches for several weeks followed by weeks or months of remission periods. Cluster headaches are traditionally treated with prescription Triptan drugs (Athletic Therapy Today, July, 2009).
Exertional Headaches
The last type of headache in the primary category is exertional headaches. As described by the name, exertional headaches are brought on by strenuous activity. Although these types of headaches can mimic migraine headaches, the difference is that a comprehensive medical history will reveal that these headaches are triggered by activity. Exercising during heat or at higher elevations may also trigger this type of headache.
Exertional headaches can be reduced by gradually increasing the intensity of the individual’s workout and ensuring that the athlete is properly hydrated prior to exercising.
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