I had a patient in the office this week with a severe headache. Headache is a common problem that can be tough to treat. My patient’s experience really made me think it’s time to write about headache treatment.
My family has a strong tendency towards migraine. Both my parents, myself, and both my sons have migraine. My personal experience with migraine has made me learn a lot about headache in general. Also, headache is very common problem we see often in primary care.
In thinking about headaches and headache treatment, there are 3 keys to choosing the right therapy.
What type of headache is it?
Choosing the right headache treatment depends on knowing what kind of headache you have.
Tension headaches are by far the most common type of headache. That’s the headache that’s felt in the temples and in a band around the head. Sometimes it is felt in the back of the head and radiates around the head. This type of headache is thought to be caused by muscle tension in the neck and in the muscles of the head and face.
Migraine is usually felt in one side of the head, often centered near the eye, is severe and pounding or throbbing in character, and has associated nausea and sensitivity to light and sound. Some patients have a vision problem called an aura that comes before the headache starts. We don’t really know what causes migraine. Usually there is a family history.
Sinus headache is just what its name suggests, pain caused by sinus pressure. It is felt in the forehead, cheeks or behind the ears and sometimes radiates to the top of the head. There is usually associated congestion and other sinus symptoms.
The last major and (thankfully) most uncommon type of recurrent headache is cluster headache. These mostly affect men, are brief but sharp, stabbing, severe pains centered in one eye. That eye usually gets red and watery and sometimes the nose runs on that side.
Other, more serious causes of headache are rare but do happen. These include brain tumor, aneurysms and other vascular problems, meningitis, and other causes of increased pressure inside the head.
How often do you have them?
The more often you have headaches, the more difficult they are to treat. If you have headaches more than 8-10 times per month, you should definitely see your doctor. If you have 15 or more headache days per month, that is considered chronic daily headache.
Daily suppressive medication will decrease the frequency and intensity of chronic headaches. Taking abortive treatment alone (medication to make the headache go away once you have it) will NOT work.
Taking over-the-counter medication for chronic daily headache will actually make the headache worse. This is due to something called rebound, where the temporary relief of headache actually makes the headache come back stronger once the medicine wears off.
If your headaches are frequent please see your doctor. The sooner you get started evaluating and treating your headaches the sooner you will feel better.
Are you doing anything that is making your headaches worse?
In addition to taking over-the-counter pain relievers too frequently, there are a number of things people do that can trigger or worsen headaches. Not getting enough sleep, not drinking enough water, and eating too many sweets are examples of common mistakes that can make chronic headaches worse. Chronic headaches are a common symptom of sleep apnea.
Do you have any nutritional deficiencies? More than 50% of Americans don’t get enough magnesium in their diet. Stress makes you need more B vitamins. Magnesium and B vitamin deficiencies can cause headaches, and taking supplements can help keep them away.
Are you eating foods that may trigger headaches? Some common headache triggers are chocolate, red wine, aged cheese and MSG. I have patients who have chronic headaches whose headaches have gone away when they have identified and eliminated foods to which they are sensitive, like wheat gluten and dairy.
There are 3 keys to headache treatment. Your doctor will help figure out what type of headache you have and what treatment is best, and will also explore whether you’re doing anything that is contributing to your headaches. Successful headache treatment depends on it!
QUESTION: Do you suffer with headaches? What do you do about them?