Questions for Your Doctor: Headache


Are your headaches just a nuisance or a medical warning? And what remedies can ease the pain? Learn when to see a doctor and what to ask about the newest treatments…

Many headaches can be treated with over-the-counter painkillers. But if you’re debilitated by severe headaches or are popping painkillers for them three or more times a week, it’s time to visit your doctor.

You could have a simple tension headache, migraines or even a brain tumor, but only a physician can say for sure.

These 8 questions will get you on the road to recovery:

1. What over-the-counter medications should I take?
Why ask: All drugstore headache medications aren’t appropriate for every headache.

“It depends how severe and how frequent your headaches are,” says interventional pain physician Andrea Trescot, M.D., past president of the American Society of Interventional Pain Physicians (ASIPP).

Doctor’s Rx: “Someone with a day of headaches once a month should start with over-the-counter medications,” she says. “But someone who’s throwing up and goes to bed for three days needs a more effective medication only available by prescription.”For mild headaches, take over-the-counter medications such as aspirin, Excedrin [acetaminophen], Aleve [naproxen] or Motrin [ibuprofen], says Stephen D. Silberstein, M.D., director of the Jefferson Headache Center in Philadelphia.

If your headaches are stress-related, try nonmedical approaches first.

“Take a break and relax,” says Neil Martin, M.D., chairman of neurosurgery at UCLA’s David Geffen School of Medicine in Los Angeles. “Try relaxed breathing or meditation.”

2. How can I find out what’s causing my headaches?
Why ask: Because treatment depends on the type of headaches you’re having, Trescot says.

“A bucket of water for a little fire is plenty, but it does nothing for a big fire,” she says.

For example, a migraine may need a stronger and different treatment than a tension headache would.

The more clues you can provide about the source of your pain, the more accurate the doctor’s diagnosis. Doctor’s Rx: “Keep a headache diary,” Trescot says. She suggests writing answers to these questions:

  • What time do they occur?
  • How long do they last?
  • How quickly do they come on?
  • Do headaches wake you at night?

Also note the position of your computer monitor: Bright glare or poor eyesight can make you squint, which can compress nerves in the forehead and trigger headaches, she says.

“Sometimes a solution may be as simple as moving the monitor,” she adds.

3. How can I tell if my headache is dangerous?
Why ask:
If you can recognize the warning signs of headaches that signal dangerous conditions, you can seek emergency treatment immediately.

Doctor’s Rx:
Ninety percent of headaches are benign,” Martin says.Translated, that means 10% signal a serious medical condition in your brain.

“But if you get a sudden, worst headache of your life, often on one side, that’s potentially a warning of something acute occurring in the brain, such as a hemorrhage from an aneurysm or a stroke,” he says. “Call 911.”

Your headache is life-threatening if the pain moves from zero to 10 in one second.

“If that’s accompanied by collapse or difficulty with speech, or paralysis, then it’s a red-hot medical emergency,” Martin says.

A headache that gets progressively worse each day or doesn’t resemble those you’ve had before may be a symptom of a brain tumor.

Though it’s not a medical emergency, see your doctor immediately.

4. Are my headaches just run-of-the-mill or migraines?
Why ask:
Migraines may require more powerful and different treatment from usual headaches.You have to match treatment to the headache’s severity.

Doctor’s Rx: “If your headaches interfere with life, they are probably migraines,” Silberstein says. “They’re disabling – you don’t want to move.”

Three times more women than men get migraines. “Why is unknown, but it’s thought to be due to the fluctuating estrogen levels women have during childbearing years,” he says.

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“When women are pregnant, headaches commonly go away due to sustained high estrogen levels,” he says. “When estrogen falls in postpartum,” they often return.

5. What should I do if I feel a migraine coming on?
Why ask:
The sooner you get on top of pain, the easier it is to quell.“The most important thing is to know what works,” Silberstein says.

Doctor’s Rx: If noise and smell affect you, get away from the source. Lying down and placing cold compresses on your head may also help.

Among over-the-counter remedies, Excedrin Migraine, which has caffeine and aspirin, is the only one approved by the Food and Drug Administration (FDA) for migraines. Caffeine narrows blood vessels, which may help relieve a headache and boost the pain relievers’ effectiveness.

Your doctor may prescribe medications that have combinations of butalbital, aspirin and caffeine (such as Fiorinal), or butalbital, acetaminophen, and caffeine (Fioricet).

“Butalbital is a calming medicine,” Trescot says.

Others include a prescription nonsteroidal anti-inflammatory drug (NSAID) or diclofenac potassium (Cambia), which was approved by the FDA for migraines in 2010 and is taken dissolved in water. Another option: triptans, which come in tablets, injections or nasal sprays, and narrow the brain’s blood vessels.

Botox, a popular anti-aging therapy, was also approved in 2010 for people with chronic migraines – 15 or more days a month.

“If you have recurring tension headaches, [Botox injections near the temples] can relax the muscles,” Martin says.

6. What are side effects of headache medications?
Why ask:
If you have side effects, let your doctor know; there may be other medications you can try that won’t have such effects.Doctor’s Rx: Many headache medications – including drugstore remedies – have a drawback: Take them more than three days a week and you can get rebound headaches, says Silberstein.

Essentially they turn off the body’s pain-control system.

Also, NSAIDs like ibuprofen and naproxen can raise the risk of gastrointestinal distress and even bleeding.

Acetaminophen taken in large doses or with alcohol can lead to liver damage.

Most migraine medications, which clamp down on blood vessels, can diminish blood flow to your arms, legs, mouth and heart, causing tingling and even chest pain, Trescot says. “These shouldn’t be used in people with heart disease or a history or risk of stroke.”

Of course, side effects depend on which you’re taking and the dose, says Martin. “They range from nausea to dizziness to a stroke.”

7. If lifestyle changes and medication don’t work, what’s my next step?
Why ask:
It’s important not to give up, Trescot says.Doctor’s Rx: “You can [take] preventive medications … to calm the brain,” Silberstein says. These include amytriptaline, a tricyclic antidepressant; beta blockers, which are blood-pressure medications; and topiramate and depakote, seizure medications.

Another possibility: See an interventional pain doctor to discuss more invasive treatments, such as nerve blocks or radiofrequency lesioning, a procedure that involves heating the nerve causing the pain, which interrupts and lessens the ache in that area.

8. Are there any new, experimental treatments for the headaches I’m having?
Why ask:
New treatments are always in the pipeline, and one might work better for you.

Doctor’s Rx: Researchers are looking at isolating, freezing and killing nerves outside the skull that cause chronic headaches, Trescot says.

Another promising treatment: placing electrodes under the skin at the base of the skull that can replace headache pain with a tingling sensation.
By Dorothy Foltz-Gray