It's just a headache — until it isn't
If you've lived with headaches long enough to be told they're "just stress" or "just migraines," you know how easy it is for chronic head pain to get waved off — even when it's reshaping your days. Headaches vary widely in frequency, intensity, and cause, and figuring out which kind you're actually dealing with is the first step toward real relief.
What is a headache?
A headache is pain or pressure anywhere in the face, head, or neck. It can be occasional or chronic, mild or severe — and left untreated, it tends to escalate rather than resolve on its own. Most headaches fall into one of three primary types, each with a distinct pain pattern and set of triggers.
Tension, Migraine & Cluster Headaches
| Tension Headache | Migraine | Cluster Headache | |
|---|---|---|---|
| Pain quality | Dull, aching, or a band of pressure/tightness | Throbbing or pulsating, often one-sided | Stabbing or burning, usually around one eye |
| Related symptoms | Muscle tension in shoulders, neck, and scalp; mild light sensitivity | Neck tension, fatigue, light/sound sensitivity, nausea or vomiting | Restlessness, red or teary eye, runny nose, drooping eyelid, sweating |
| Pattern | Most common type; not typically associated with neurological symptoms | Recurrent episodes, can be intense and debilitating | Rare but severe; occurs in cyclical "clusters" followed by remission |
Cluster headache is the most recognized type of a broader category called trigeminal autonomic cephalalgias (TACs) — a group that also includes paroxysmal hemicrania, SUNCT/SUNA, and hemicrania continua. These conditions share core features (severe, one-sided pain with autonomic symptoms like eye tearing, nasal congestion, or eyelid drooping) but differ in duration and frequency. Dr. Kruman evaluates and treats the full spectrum of TACs, not just classic cluster headache.
What causes them?
The exact cause of most headaches isn't fully understood, but each type has recognizable triggers — and identifying yours is often the key to managing frequency and severity.
Tension headaches are driven largely by muscle tension in the head, neck, and shoulders. There's a well-established connection between tension headaches and TMJ disorder — jaw muscle strain can radiate directly into head and neck tension. Common triggers include stress, poor posture, eye strain, lack of sleep, dehydration, caffeine, bruxism (teeth grinding/clenching), and medication overuse.
Migraines are a neurological condition involving a combination of genetic, environmental, and neurochemical factors. Common triggers include hormonal changes, stress, sleep disturbances, dehydration, certain foods, weather changes, sensory stimuli, and hormonal birth control.
Cluster headaches aren't fully understood either, but recognized triggers include disrupted circadian rhythms, alcohol, smoking, certain foods, heat or high altitude, bright light, and changes in sleep patterns.
Triggers are highly individual, and many people have more than one. Tracking your headaches — timing, intensity, and what preceded them — is one of the most useful tools for identifying your specific pattern.
Why headaches need a specialist evaluation
Tension, migraine, and cluster headaches can look alike on the surface but require very different treatment approaches — and a meaningful number of chronic headaches have a jaw-related component that's never been identified. An orofacial pain specialist evaluates the full picture, including whether TMJ dysfunction is playing a role, rather than treating head pain in isolation.
How we treat it
As a board-certified orofacial pain specialist (DABOP), Dr. Kruman evaluates the full range of contributing factors — muscular, jaw-related, and neurological — to build a treatment plan suited to your specific headache pattern, not a generic protocol.