University at Buffalo

Behavioral Medicine Clinic


What are Headaches?


There are four types of headaches: vascular, muscle contraction (tension type), traction, and inflammatory.

The most common type of vascular headache is a migraine. Migraine headaches are usually characterized by severe pain on one or both sides of the head, an upset stomach, and, at times, disturbed vision. Women are more likely than men to have migraine headaches. Some individuals can predict the onset of a migraine because it is preceded by an "aura," visual disturbances that appear as flashing lights, zigzag lines, or a temporary loss of vision. People with migraine tend to have recurring attacks triggered by a lack of food or sleep, exposure to light, or hormonal irregularities (only in women).

The second most common type of vascular headache is the toxic headache produced by fever. Other kinds of vascular headaches include "cluster" headaches, which cause repeated episodes of intense pain, and headaches resulting from high blood pressure.

Muscle contraction headaches appear to involve the tightening or tensing of facial and neck muscles.

Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection.

Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by inflammation, including those related to meningitis, as well as those resulting from diseases of the sinuses, spine, neck, ears, and teeth.


When headaches occur three or more times a month, preventive treatment is usually recommended. There are two ways to approach the treatment of migraine headache with drugs: prevent the attacks or relieve the symptoms during the attacks. Many people with migraine use both approaches by taking medications originally developed for epilepsy and depression to prevent future attacks, and treating attacks when they happen with drugs called triptans that relieve pain and restore function.

Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle. Drug therapy, stress reduction, and elimination of certain food triggers are the most common methods of preventing and controlling migraine and other vascular headaches. Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches.

Managing Your Headache Pain

Behavioral headache treatments have been featured in well over 300 clinical trials. These trials feature a combination of non–drug interventions that modify or eliminate behaviors and thinking patterns that intensify headaches, particularly of the migraine and tension type. On average, behavioral interventions yield 35–55 percent improvement in headache activity as measured by a scale that captures the intensity, frequency, and duration of headaches.

In one study that compared the benefit of medications to behavioral headache treatment, patients who completed behavioral treatment had more headache–free days and fewer headache–related symptoms than patients treated with a proven headache drug. Furthermore, the benefits of behavioral treatments appear to endure, with patients maintaining treatment gains up to seven years after treatment ends. Research that has compared behavioral treatments and drugs has found that behavioral therapies achieve a level of improvements comparable to medications.

If you or someone you know is suffering from pain that medications or other therapies are not effectively controlling, the Behavioral Medicine Clinic may be able to help. Contact us online or call us at 716-898-5671 to get the help you need.


Holroyd, K. A., O'Donnell, F. J., Stensland, M., Lipchik, G. L., Cordingley, G. E., & Carlson, B. W. (2001). Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination. Journal of the American Medical Association, 285, (17), 2208–2215.

Holroyd, K. A., Nash, J. M. et al. (1991). A comparison of pharmacological (amitriptyline HCL) and nonpharmacological (cognitive-behavioral) therapies for chronic tension headaches. Journal of Consulting & Clinical Psychology 59(3), 387–393.

Did you know ... ?
Having a headache is just one symptom of migraine headaches.

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