Albany Internal Medicine
Headaches are very common and are responsible for millions of doctor visits each year. More than 9 in 10 adults will experience a headache sometime in their life. Nearly 2 out of 3 children will experience headache in childhood by age 15.
Headaches can range in frequency and severity of pain. Some individuals may experience headaches once or twice a year, while others may experience headaches more than 15 days a month. Some headaches may recur or last for weeks at a time.
The level of pain caused by a headache can range from mild to disabling. Moderate to severe headaches may also be accompanied by symptoms such as nausea or increased sensitivity to noise or light. Headaches can be so debilitating for some people, that they cannot go to work or attend school.
The International Headache Society has classified more than 150 types of headaches. They have categorized them primarily as "primary headaches" or "secondary headaches". It is possible for people to have more than one type of headache at the same time.
Primary headaches occur independently and are not caused by another medical condition. The most frequent type of primary headaches are:
It's uncertain what causes a primary headache, but there a series events change the flow of blood in the vessels inside and outside the head, causing pain signals to be sent to the brain. There are also changes in nerve cell activity and the levels of brain chemicals called neurotransmitters.
Certain types of primary headache, such as migraines, run in families. Episodes of headache may ease or even disappear for a time and recur later in life.
Secondary headaches are the result of a different medical condition causing pain-sensitive nerve endings to be pressed on or pulled or pushed out of place. They may result from underlying conditions including fever, infection, medication overuse, stress or emotional conflict, high blood pressure, psychiatric disorders, head injury or trauma, stroke, tumors, and nerve disorders (particularly trigeminal neuralgia, a chronic pain condition that typically affects a major nerve on one side of the jaw or cheek).
Not all headaches require a doctors's attention. However, some headaches can signal a more serious medical disorder that requires prompt medical care. Immediately call or see a physician if you or someone you're with experience any of these symptoms:
How and when a person experiences a headache is very important information for making a diagnosis and following treatment. Keeping a headache diary can be helpful for recording your headache symptoms and identifying a trigger. After a period of time, you may begin to see a pattern.
In most cases, a physical exam, medical history, and headache history can provide enough information for your doctor to diagnose your type of headache and determine the best treatment. However, in some cases, additional tests may be ordered to identify the cause or rule out other medical conditions. Some specific tests that may be ordered in select cases include:
You and your doctor can usually develop a treatment plan that leads to fewer, less severe headaches. This can take time, and may require a trial period of different treatment options.
The headache treatment your doctor recommends depends on several factors.
At-home headache treatments may be effective for mild headaches and include simple relaxation techniques, such as resting with your eyes closed and head supported. A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches.
Over-the-counter medications, such as acetaminophen, aspirin, or ibuprofen may also be helpful. (Do not give aspirin to children.)
If over-the-counter remedies do not control your pain, you may benefit from a prescription headache medication.
Prescription medications used for migraine headaches include ergotamine, dihydroergotamine, ergotamine with caffeine (Cafergot®), isometheptene (Midrin®), and triptans, such as Axert® (almotriptan), Imitrex® (sumatriptan), Maxalt® (rizatriptan), Relpax® (eletriptan), Treximet® (sumatriptan and naproxen), and Zomig® (zolmitriptan).
Medications may also be used to relieve other migraine symptoms, such as nausea and vomiting.
If you get headaches often, your doctor may prescribe medication to prevent headaches before they occur. It is important to take these medicines every day as prescribed, even when you are not having a headache.
People who take pain medications regularly for 3 or more days a week may develop medication overuse, or rebound, headaches. All types of pain pills (including over-the-counter drugs) can cause rebound headaches. If you think this may be a problem for you, talk to your health care provider.
Additional treatment options for headaches include making dietary changes and biofeedback.
Keeping a headache diary can be helpful for recording your headache and monitoring your response to treatment.
You should talk to your doctor about making changes to your headache treatment plan if your headaches do not become less frequent or less severe.
Headaches can often result from a sleep disorder. For example, tension-type headache is regularly seen in persons with insomnia or sleep-wake cycle disorders. Nearly three-fourths of individuals who suffer from narcolepsy complain of either migraine or cluster headache. Migraines and cluster headaches appear to be related to the number of and transition between rapid eye movement (REM) and other sleep periods an individual has during sleep. Hypnic headache awakens individuals mainly at night but may also interrupt daytime naps. Reduced oxygen levels in people with sleep apnea may trigger early morning headaches.
Getting the proper amount of sleep can ease headache pain. Generally, too little or too much sleep can worsen headaches, as can overuse of sleep medicines. Daytime naps often reduce deep sleep at night and can produce headaches in some adults. Some sleep disorders and secondary headache are treated using antidepressants. Check with your doctor before using over-the-counter medicines to ease sleep-associated headaches.
Reference: National Institute of Neurological Disorders and Stroke (NINDS)