By Dr. Salma Haque
Physician
Have you had a headache recently? Headaches are especially common among women and an acute attack can range from annoying to completely debilitating.
While some headaches are caused by the daily stresses of life, some are more serious and require your attention. The following is a quick guide to help you tell the difference.
1. Differentiate between tension headaches and migraines.
Tension headaches: These usually develop after a long stressful day. They are characterized by a dull steady pain. The feeling is often described as a tight band around the head, usually affecting both sides, occasionally spreading to the neck or shoulders. These headaches are usually non-throbbing.
Migraines: If you have ever had a migraine, you know it. Migraines are characterized by throbbing on one side of the head and are commonly associated with sensitivity to noise and light. You may also experience nausea or vomiting, visual symptoms, or tingling in the extremities prior to onset. Migraine sufferers often have a family history of similar episodes. Many people suffer from both migraines and tension headaches, and it is possible to experience a combination of the two
2. Understand the three tiers of treatment for migraines.
Preventive lifestyle changes. While there are common triggers, I recommend that my patients keep a diary of their own possible triggers whenever they develop a migraine. This helps them eliminate their personal triggers without becoming overly dependent on medication. These include caffeine, alcohol, tyramine and nitrates contained in food, monosodium glutamate, too much or too little sleep, menstruation, missed meals, weather changes, high altitudes, flickering or glaring lights, and fatigue.
Acute abortive therapy. First-line therapy is to abort an attack with over-the-counter anti-inflammatory drugs like ibuprofen, naproxen, aspirin, or a combination drug with acetaminophen, aspirin, and caffeine. When these options are insufficient, I will prescribe a serotonin agonist (more commonly known as triptans), dihydrooergotamines, or a butalbital-containing agent. These drugs have been shown to be effective, but are associated with more side effects and are not tolerated by all patients. Anti-nausea medication often helps in patients with complicated migraines.
Preventative medication. If patients are getting migraines more than once a month, and they last for three days or more per month or are complicated, I recommend preventative therapy. The most studied of these are beta-blockers (commonly known to treat high blood pressure), amytriptyline (an antidepressant), and some anti-seizure drugs (although side effects are more common). The best option is individualized to the patient. Keep in mind that preventative medication may take two to three months before a clinical effect can be appreciated.
3. Know when to be concerned.
If your headache develops after prolonged reading, computer/television use, or driving: A vision check and new glasses may be in order.
If you develop a fever, stiff neck, have a sudden onset of a severe headache, or a headache that is uncharacteristic of headaches you have had in the past.
If you have jaw and temple tenderness, confusion, weakness, vision changes, or other sensory deficits.
If you develop a new onset of headaches during pregnancy, or after the age of 50.
If your headache seems atypical to you, do not hesitate to immediately seek medical attention.
4. Get familiar with how to avoid headaches.
It can be tough to keep headaches away, especially if you have a tendency to get them, so be careful of the medications you take.
In fact, when pain relievers are being used more than twice a week, headaches can actually increase in frequency and lead to a cycle of daily headaches. If this is a concern, preventive therapy should be considered.
Unfortunately, a lot of patients are unaware of the rebound affect associated with frequent use of many of the migraine medications. Drugs that can cause rebound headaches with withdrawal include ergotamines, triptans, and butalbital, as well as medications that contain caffeine.
Getting inside your headache
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Common headaches:
The most common culprits are tension headaches, migraines, medication over-use, and rebound headaches. -
Secondary headaches:
These are more rare, and associated with an underlying cause such as sinusitis, masses, infection, or intracranial bleeds. Pay attention to these, for they need appropriate, and often emergent workups. -
Cluster headaches:
Also rare, and actually more common in men, these headaches are characterized by a short, sharp pain. They are usually limited to one side of the head, and frequently are associated with tears or a runny nose that is limited to the affected side. These headaches occur in clusters during certain periods of the year, with clusters lasting anywhere from a week to several months. While some benefit from oxygen therapy, treatment is similar to that for a migraine.