Headaches and Migraines

People suffering from migraines usually feel an intense throbbing pain on one side of their head.  Migraines are often associated with sensitivity to light, sound, and smell and can include nausea and vomiting.  About one third of migraine sufferers experience an aura shortly before a migraine.  An aura is a visual or sensory disturbance that last between 5-10 minutes and can include: seeing zip-zagging lines, flickering lights or spots, partial vision loss, numbness, muscle weakness or difficulty speaking. 

Migraines can last up to three days.  They can occur in children and adults and are far more common in females than males.  The causes of migraines are not fully understood, but they do seem to run in families.   

Triggers can include stress and anxiety, sleep disruption, hormonal changes, skipped meals, dehydration, certain foods and medications, and bright lights and loud noise. 

Tension headaches are usually experienced as a dull, constant pain on both sides of the head.  Sometimes they include tenderness of the face, head, neck and shoulders, pressure behind the eyes, and sensitivity to light and sound.  Most people will experience tension headaches occasionally and they normally last from 30 minutes to several hours.   

Common triggers of tension headache include stress, anxiety, and depression.  Other triggers include dehydration, loud noise, lack of exercise, poor sleep, poor posture, skipped meals and eye strain. 

Cluster headaches are severe and recurring and they are much more likely to occur in men than women.  People who suffer from cluster headache report an intense burning or piercing pain behind or around one eye.  Other symptoms include watering eye, swollen eyelid, a blocked or runny nose, sensitivity to light and sound, and restlessness. 

If you get frequent headaches or your headaches are disrupting your work and life, talk with your primary care doctor first. Many primary care doctors can successfully treat frequent headaches. But if that treatment isn’t working, your primary care doctor may refer you to a headache specialist. Headache specialists should be board-certified in headache medicine and are up to date on all the latest treatments and can diagnose rare headache disorders.

CT scans and MRIs are imaging tests that allow doctors to see images of your brain.  However, according to the American College of Radiology and the Choosing Wisely campaign, such imaging tests can rarely show why a headache occurs and they do not relieve the pain from a headache.  Doctors can diagnose most headaches during an office visit by asking questions about your health and your symptoms.  The doctor may also do a neurological exam which means testing your reflexes.   

Many headache specialists will ask you keep track of your headaches in a diary or journal to help you and your doctor identify what triggers your headaches and their frequency.  Such a diary can help your doctor identify the type of headaches you get and help you to manage them.  Not good with pen and paper, check out one of the many headache tracker apps available on your smart phone.  

Acetaminophen or ibuprofen are over-the-counter medications that are useful in the treatment of occasional headaches, but for those of you that suffer from headaches frequently or if your headaches are disrupting your activities or work, talk with your doctor.  There are a variety of drugs that can stop headaches once they start.  These medications are called “rescue” or “abortive” medications, but you should follow your doctor’s instructions carefully to ensure they are effective.  You may have to try different medications to see which one works for you.  There are also preventive medications that if taken as prescribed, may reduce the number and intensity of your headaches.

Not according to the American Board of Internal Medicine and the American Academy of Neurologists.  According to the ChoosingWisely campaign, opioids, such as hydrocodone or oxycodone or barbiturates should not be used to treat headaches in most cases.  While these are pain medications, they can make headaches worse and there are better drugs for the treatment of headaches.  In addition, these drugs often make users sleepy or dizzy and can be addictive.

People taking medication more than 15 days in a month should talk with their doctor.  They may be suffering from medication overuse headaches (MOH), sometimes known as rebound headaches.  These types of headaches occur frequent or daily and have symptoms similar to tension headaches or migraines.  These types of headaches are caused by overusing certain types of medicine, even if you are taking them as directed.  The only treatment for rebound headaches is to stop taking your medicine. But don’t stop taking your medicine without talking to your doctor first.  They can help you create a strategy to gradually decrease the dosage of medication, or they may be able to prescribe other medications that can ease the withdrawal process.

Some headache sufferers benefit by activities that reduce stress and from avoiding headache triggers. Others can find relief by: 

• Resting in a quiet dark room 

• Applying hot or cold compresses to your head or neck 

• Massage 

• Small amounts of caffeine 

Talk with your doctor about other treatment options that may provide some relief from headaches.