Headaches afflict millions of Americans each day — but they are often misdiagnosed and treated improperly by the patient.

One headache's symptom can often be confused with the symptom of another headache, doctors say.

"The most common type of headache that affects people in this country is tension headaches," said Dr. Brian Grosberg, director of the Inpatient Headache Program at Montefiore Headache Center in Bronx, N.Y. "Many people see a neurologist because they think they have a migraine, but really there has been no diagnosis."

The following guide is a starter-kit to diagnosing your headaches.


Migraines affect approximately 28 million Americans, and women experience them three times more often than men. (Incidentally, studies have shown that women in their last two trimesters of pregnancy report improvement in their migraines.)

Diagnosis: Typically, the throbbing pain is on one side of the head, but up to 40 percent of patients have pain on both sides.

Migraines, if left untreated, can last up to 72 hours. Accompanying features include sensitivity to light and sound, nausea and/or vomiting.

Triggers: Caffeine, monosodium glutamate (MSG), aspartame (a sugar substitute), nitrates (in processed foods such as hot dogs and deli meats), red wine, changes in barometric pressure, high humidity, menstrual periods, birth control pills, skipping meals, sleeping too much, not sleeping enough.

Risk factors: Obesity, head trauma, stress, snoring, excessive caffeine use.

What to watch out for:

— Allodynia, which means things that are normally comfortable suddenly become intolerable during the migraine, Grosberg said. Examples include not being able to pull your hair back into a ponytail, not being able to wear a necklace, being unable to lie your head down on a pillow.

— Rebound headaches, which occur if you overuse chronic pain medication two or more days a week.

How to treat them:

— Triptans: Acute treatments that, when taken at the headache’s onset, will relieve pain within minutes.

— Beta blockers or calcium channel blockers: Initially designed to lower blood pressure, research has found these drugs are useful in preventing migraines.

— Biofeedback.

— Botox.

— Anti-epileptic drugs.

— Tricyclic antidepressants.


Cluster headaches are the least common form of headaches. Ninety percent of sufferers are male. The headache can last for weeks or months and is generally followed by a remission period, which can last for several months, or even years.

Diagnosis: Cluster headaches are always one one side of the head, and they never switch sides.

Cluster headaches are divided into two forms: episodic and chronic pattern.

Chronic headaches, which are more common, can occur every day, up to eight times a day.

Episodic headaches are random and are usually triggered by a stressful event.

“It’s been nicknamed the ‘suicide headache,’" Grosberg said. “One female patient likened it to giving birth to 100 babies without an epidural. It’s really bad.”

While migraine suffers tend to retire to a dark room when faced with their pain, cluster sufferers are often agitated and restless, Grosberg said.

Triggers: Smoking is a major factor, as is drinking alcohol.

What to watch out for: Tearing of the eye on the side of the head with pain, eye redness, nasal congestion, runny nose, drooping eyelid, a decreasing pupil.

How to treat them:

— Calcium channel blockers, as a preventative.

— Sumatriptans, which are available as an injectable, nasal spray and tablet form, as an acute treatment.

— Oxygen therapy can be given via a non-rebreather mask at 100 percent oxygen at 10 to 12 per liters for 15 to 20 minutes.

— Steroids can be used for transitional treatment.


The basic form of this headache may be related to the tightening of muscles in the back of the neck and/or scalp.

Diagnosis: Characterized as mild to moderate in nature, tension headaches affect both sides of the head and are the most common type of headaches for American adults.

Patients will often complain of feeling like they have a tight band wrapped around their head, Grosberg said.

Unlike migraines, these headaches are not accompanied by sensitivity to light and sound.

Triggers: Stress, anxiety, fatigue and/or anger.

What to watch out for: If you are having these headaches on a frequent basis, it is important to visit a physician to determine if there is an underlying cause, Grosberg said.

Doctors use the letters S-N-O-O-P to determine what may be the cause of tension headaches:

S – “Systematic symptoms” – Is the headache accompanied by fever, weight loss, seizures or secondary risk factors such as an immune deficiency?

N – “Neurological disorders” – Has the patient had an altered level of consciousness, weakness or confusion?

O – “Onset” – Is this a sudden onset, or a "thunderclap" of a headache?

O – “Older” – How old is the patient? Is he or she older than 50?

P – “Progression of headache” – What is the change of frequency, intensity or severity of the headache? Does the headache change if the patient is lying down, sitting up or standing?

How to treat them: Episodic tension headaches can be treated with over-the-counter pain relievers like ibuprofen (Advil, Nuprin, Motrin) or naproxen sodium (Aleve), according to the National Headache Foundation.

Chronic tension headaches may see some relief from an anti-depressant, according to the Foundation. Biofeedback techniques can also be helpful.


Diagnosis: Sinus headaches are accompanied by facial pain, specifically pain above the cheeks under the eyelids, said Dr. Clifford W. Bassett, assistant clinical professor of medicine at the Long Island College Hospital.

Children with sinus headaches may complain of tooth pain, Bassett added.

Triggers: Chronic sinus headaches can be associated with allergies, so if patients are having them frequently, they may benefit from allergy testing or allergy shots, Bassett said.

What to watch out for: If the sinus headache is accompanied by a fever, and/or green or yellowish nasal discharge, it is usually indicative of an infection.

Treatment: If the sinus headache is an infection, antibiotics will be needed, as well as a nasal steroid and nasal saline spray.

If the headache is mild and short-term, the patient may be able to take an over-the-counter analgesic such as acetaminophen (Tylenol) to relieve the pain.