Just the thought of headaches is enough to give many of us . . . well, a headache. Headaches are among the most common complaints in doctor’s offices. They range from mild, which many people work through, to extremely severe and debilitating, which can result in loss of productivity at home and work, disturbance in interpersonal relationships and great distress.
The good news is that a vast majority of headaches are not serious or indicative of underlying disease. Most can be well-controlled with attention to a few basic principles.
The most common type of headache is the tension headache. However, most patients experiencing tension headaches do not come to see their doctor primarily for this complaint. Rather, they will often mention it in the course of a visit for a different reason.
This is because a tension headache is often a mild, persistent, squeezing-type discomfort that occasionally radiates down to the neck area and is not debilitating. Patients can continue to function without medication or with a mild over-the-counter (OTC) pain reliever, such as ibuprofen or acetaminophen.
Migraines and mixed-type headaches
The headaches seen most often in a clinical setting are migraines or mixed-type headaches — a combination of tension and migraine headaches. Migraine headaches usually have their onset in childhood, adolescence or young adulthood, and often have a strong family history.
Migraine headaches are characterized by symptoms that can range from mild to severe in intensity, and may include many of the following symptoms:
- A throbbing or pulsing headache, usually on one side of the head (occasionally on both sides)
- Sensitivity to light and sound
- Nausea and vomiting
- An aura, which can be visual (flashes of light, blind spots or patterns), auditory (sounds) or even olfactory (smells)
- Increased sensitivity of the scalp or hair on the side of the impending headache
There are a variety of common triggers for migraines. These may include stress; a change in the weather; erratic sleep schedules or mealtimes; consumption of certain foods, alcohol or caffeine; and strong sensory stimuli, such as bright lights or loud noises. Intense physical activity — including sexual activity — along with medications and hormonal changes can also bring about migraines.
How to treat headaches
Many patients ask what they can do at home to prevent and treat their headaches. I recommend that they keep a regular routine, including exercise, mealtimes, sleep habits, healthy relaxation techniques and recreational activities. They should also identify triggers and control them.
Keep a “headache diary” to take note of the frequency, severity, duration and disability caused by the headache, and to identify any triggers. Also note any medication that was taken for the headache and the dose, frequency and effectiveness.
In regard to treatment for mild to moderate headaches — which are non-disabling — simple OTC medications, such as ibuprofen or acetaminophen, may help. For more severe headaches, prescription medication may be needed.
It’s important to remember that the earlier the medication is taken at the onset of the headache, the more effective it will be. However, when taken too frequently, abortive medications — which work to stop the development of a migraine and the related symptoms — can cause what we call “rebound headaches” if discontinued abruptly. A sudden, significant reduction or cessation of caffeine intake can also cause rebound headaches.
Reducing sensory stimulation is also recommended. A dark, quiet room will be more comfortable when experiencing a migraine, and sleep can often offer relief.
When to seek care
There are two types of medical care headache sufferers should consider. Routine care can help establish a diagnosis depending on the frequency, duration and severity of headaches. Together, you and your doctor can determine the need for prescription medication — abortive or preventive — for treatment of your headaches.
Emergency care should be sought if you experience any of the following.
- Abrupt, severe headache — what is often likened to a thunderclap — or a sudden, severe change in the pattern of the headache
- Headache with fever, chills, seizure, weakness, paralysis, change in mental status, trouble speaking or double vision
- Headache after an injury, especially if worsening or accompanied by vomiting, loss of consciousness or a change in mental status
- New onset of headaches if you are over 50
- Headaches after exertion, straining or coughing
There are other causes of headaches or head pain to be aware of. These include issues related to your teeth, jaw or sinuses, as well as trauma, uncontrolled blood pressure and hangovers. Rare causes of headaches may be related to nerve disorders in the head or other conditions, such as bleeding, aneurysms, tumors or infections. Talk to your doctor about your concerns related to headaches and seek emergency care when appropriate.
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