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?
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?
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?
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?
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?
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
Simple lifestyle changes and natural approaches can often make a difference when you’re seeking migraine relief. Here are 8 self-care techniques that may help…
What do you do once you feel the throbbing pain and other symptoms that accompany migraine headaches?
Whether you run for a dark room or to the medicine cabinet, you might consider one more approach: self-care therapies. They can ease pain and reduce the frequency of migraine attacks.
Migraines are vascular headaches, meaning they’re triggered by the temporary narrowing of blood vessels in your head. This reduces the flow of blood-transporting oxygen to your brain, producing many unpleasant symptoms. They can include severe pain, light and noise sensitivity, auras, nausea and vomiting. Often, the pain is felt on just one side of the head, according to the National Institute of Neurological Diseases and Stroke (NINDS).
Many migraine patients use self-care techniques along with medication to relieve migraine symptoms. In fact, about half of patients reported using at least one non-pharmaceutical therapy to self-treat their migraines, according to a 2013 study published in Headache: The Journal of Head and Face Pain.
Here are 8 self-care techniques that experts say may help.
1. Keep a migraine diary.
You might think that migraines are unpredictable. But 70% of migraine sufferers experience early warning symptoms that may be identified with a headache diary, according to a 2009 Georgia State University study.
“Keep a really good diary or journal,” advises Sheena Aurora, M.D., clinical professor of Neurology and Neurological Sciences at the Stanford University School of Medicine in California.
“This is where you can log your medication use, how often you’re having headaches, your diet and any other triggers or patterns that you see,” she says.
Share this information with your doctor at each appointment.
2. Work out regularly.
Moderate exercise may reduce frequency, intensity and length of migraine attacks, according to a 2011 study in Cephalalgia, a peer-reviewed medical journal.
“Take a walk in a casual, yoga-like fashion for 30 minutes a day – or even a 15-minute outdoor walk on your lunch break – to [give] your body the benefits of modest exercise and your brain space and relief,” suggests Richard P. Kraig, M.D., Ph.D., director of the migraine headache clinic at the University of Chicago Medicine.
This process will help release stress, improve concentration and reduce excitability or tension, Dr. Kraig says.
“We’ve found that exercise, plus environmental enrichment [spending time in pleasant or interesting surroundings], makes the brain stronger against migraines,” he says.
3. Snuggle up with your partner.
Many people avoid sexual activity during migraine attacks. But engaging in it may actually lead to partial or complete relief, German researchers found in 2013.
That’s because physical intimacy produces a rush of feel-good hormones called endorphins, your body’s own natural painkillers.
“Although the science on this is limited, it’s intriguing that it might work for some individuals,” Dr. Aurora says. “I’ve actually heard about this approach being used by patients.”
4. Consider supplements.
Migraines are sometimes caused by vitamin or mineral deficiencies or imbalances, and many patients who take riboflavin or magnesium supplements find relief with minimal side effects, according to a 2012 study published in the journal Biological Trace Elements Research.
Ask your doctor before taking any supplements.
Taking 50 mg of riboflavin daily is enough to treat mild migraines; 500 mg of magnesium has been shown to reduce migraine frequency and severity, Dr. Aurora says.
“I tell those with regular migraines to start taking a supplement and keep a log to see if certain symptoms subside,” she adds.
5. Clean up your sleep act.
If you often wake up with a headache, this is a sign that your sleep patterns may be the culprit.
In fact, the onset of nearly half of all migraines occurs between 4 and 9 a.m., according to the American Headache Society Committee on Headache Education, a nonprofit educational resource for health professionals.
Being sleep deprived, over-sleeping or suffering from sleep disturbances, such as obstructive sleep apnea or restless leg syndrome, may trigger a migraine, according to the American Migraine Foundation.
In turn, headache sufferers are also at higher risk of developing a sleep disorder.
Establish regular sleep hours to lower your chances of experiencing sleep-related migraines.
“Stability with sleep is crucial with migraines,” says Dr. Aurora. “Going to bed and getting up at the same time each day is generally more important than the total number of hours you’re sleeping at night.”
6. Practice mindfulness meditation or yoga.
One of the biggest migraine triggers is stress, but it’s often the hardest one to manage. Luckily, a variety of stress-reduction techniques can help.
Adults found relief from migraine symptoms when they participated in 8 weeks of a mindfulness-based stress reduction program, according to a 2014 study conducted at Wake Forest Baptist Medical Center in Winston-Salem, N.C. After using meditation and yoga principles, subjects reported fewer migraine attacks, less pain, reduced stress, anxiety and disability, and a better quality of life.
People with migraines “are often anxious people,” Dr. Kraig says. “Since migraines and anxiety are [associated medical conditions], finding a way to relax, like yoga, will help calm the winding up of the string of stressors that can trigger migraine attacks.”
7. Get a massage.
Massage can be an effective complementary therapy for treating migraines, especially those brought on by stress or sleep issues.
“Massage works mostly as a de-stressor,” explains Dr. Aurora. “As women get older, we hold more pressure in our necks, and that seems to be a hot-spot trigger for migraines.”
The neck-brain stem connection stores tension and pressure that can be released with physical manipulation from a massage.
You don’t need a daily massage, but the healing touch might be just enough to keep symptoms at bay when you feel the warning signs of a migraine attack. Just make sure you choose a licensed massage therapist.
8. Learn biofeedback.
Biofeedback, a pain management intervention, may work to lessen the stress and muscle tension that can trigger migraine, according to a 2010 study reported in Cleveland Clinic Journal of Medicine.
Although there are home programs available, biofeedback is traditionally done with a psychologist who uses a computer monitor device that illustrates what happens when your brain responds to stress. The aim is to help patients learn to control specific body functions, including breathing rate, muscle tension and heart rate.
“It’s very valuable to learn biofeedback and muscle relaxation with a practitioner first and be taught the techniques properly,” says Dr. Aurora. “Then, they can be effective self-care tools that you may use on your own.”
Migraine Relief: 10 Myths and Facts
By Diane Wedner
Migraines are more than just bad headaches. But many people – and even some doctors – don’t fully understand this complex condition or what’s required for migraine pain relief.
You wake up to throbbing pain on one side of your head. The sun streaming through the bedroom window scorches your eyes like a lightning flash. Moving your head even slightly is excruciating.
Like 35 million other Americans, you’re in the throes of a migraine – the most common cause of disabling headaches. About 18% of women and 6% of men experience the brain disorder, according to the Migraine Research Foundation (MRF), a Manhattan-based nonprofit organization that provides information and support.
Even some physicians don’t recognize the cluster of symptoms that makes up migraines – such as headache, nausea, vomiting, visual disturbances and sensitivity to noises and smells. As a result, they may dismiss a severe migraine headache and other symptoms as “women’s problems,” such as premenstrual syndrome (PMS) or depression.
“Because the problem is related to their head, patients sometimes feel that doctors think they’re making the symptoms up, causing their own headaches, or overreacting,” says Cathy Glaser, MRF co-founder and president.
Lack of training is a pervasive problem, says neurologist Peter Goadsby, M.D., Ph.D., director of the University of California, San Francisco Headache Program.
“If physicians aren’t exposed to current information, they have to fill in the blanks themselves,” he explains.
The result: Along with debilitating symptoms, migraine patients often endure a variety of myths about the condition.
If you suffer from migraines, it’s important to stay informed.
Migraine pain myth #1: Migraines are just bad headaches.
Reality check: Not so! Migraine is a syndrome in which “multiple symptoms often occur simultaneously because of a cascade of brain events,” says Joel R. Saper, M.D., director of the Michigan Head-Pain & Neurological Institute in Ann Arbor, Mich.
Those brain events release pain-producing inflammatory substances around the nerves and blood vessels of the head.
The cause is unknown, but the result isn’t: Disabling symptoms that often send sufferers to bed.
Interestingly, some people don’t have pain, though severe pain is the most common symptom of a migraine. In such cases, people often have visual auras and other migraine symptoms, such as nausea.
“But if they do [have pain], it might be minor compared to the drama of nausea, stroke-like symptoms and memory changes,” Dr. Saper says.
Though ordinary headaches result from a narrowing of blood vessels and can often be eased with aspirin, migraines are caused by the expansion of blood vessels. Certain treatments may provide migraine relief, but there’s no cure.
Migraine pain myth #2: Migraines occur only in women.
Reality check: Under age 12, an equal number of boys and girls have migraines, Dr. Saper says. After the onset of puberty, men still get them, but women with the condition outnumber them 3-1. The main reason is estrogen and progesterone, which play a significant role in the disorder, according to epidemiological and clinical studies.
The two hormones help regulate pregnancy, during which migraines may “settle down,” Dr. Goadsby says. Menopause may also bring migraine relief, he adds.
Higher estrogen levels sometimes improve migraines, while lower levels may make them worse, according to the Mayo Clinic in Rochester, Minn.
Some women get their first migraine headache after starting on birth control pills; for others, oral contraceptives improve the headache pattern, the clinic says.
Migraine pain myth #3: Premenstrual syndrome (PMS) causes migraines. Reality cheek: The two conditions are sometimes connected, but “not all women with periods have PMS, and not all women with migraines have PMS,” Dr. Saper says. Migraines are sensitive to hormonal fluctuations, which occur before a woman’s period. An attack that comes within two days before or three days after a period, known as a “menstrual migraine,” is similar to other migraines but usually doesn’t include an aura (visual disturbances).
Women who experience menstrual migraines can sometimes get relief from continuous birth control pills, which reduce the number of periods to four per year.
Here are other treatments for menstrua] migraines.
Migraine pain myth #4: Women get migraines because they’re more emotional. Reality check: “That’s nonsense,” Dr. Goadsby says. “The ‘hysterical female’ argument is embarrassing.”
“Women, like men, get migraines because something’s going on in their brains,” says Glaser of the MRF. “They’re usually born with that trait. The question is: If you have the trait, what triggers the migraine?”
For both men and women, emotional stress may release chemicals that provoke migraine-causing vascular expansion in the brain, according to Harvard Medical School’s Beth Israel Deaconess Medical Center (BIDMC).
“If life is stressful – you have a bad marriage, you’re hurt – you may be more vulnerable to migraines,” Dr. Saper says.
The letdown after a stressful period also may be a migraine trigger.
Remember, though, that “lots of women are stressed and don’t get migraines,” Glaser says. “You have to have the trait.”
Migraine pain myth #5: Painkillers are enough for migraine relief.
Reality check: Because migraines can provoke multiple symptoms, one pain medicine won’t necessarily sweep them away, Dr. Goadsby says.
“There are more than 100 treatments and prevention methods for migraines,” Glaser says. “If patients could pop just one pill, they’d be doing it.”
Although painkillers often are prescribed for migraines, they’re not the most effective treatment, experts say. They don’t work, for example, against triggers such as movement or noise, which may exacerbate symptoms.
Other medications can target symptoms in addition to migraine headache. But some have serious side effects, especially if patients also use painkillers regularly.
“The more painkillers you take, the greater the potential for more headaches,” Dr. Saper says.
Called medication overuse headaches, or rebound headaches, these are more like tension headaches than migraines, Dr. Saper says. Using painkillers 2-3 times weekly over several months may make patients more vulnerable to them. There are serious health dangers from painkiller overuse.
Pain relievers such as ibuprofen (Advil) and acetaminophen (Tylenol) help relieve mild migraine symptoms, but they shouldn’t be used to treat moderate or severe migraines, according to the Mayo Clinic.
Synthetic narcotics known as opioids, such as hydrocodone (Vicodin), can be more effective, but they “change the nervous system and make it easier to get the next attack,” Dr. Saper warns. They also can be addictive.
Other drags may help patients with more severe symptoms, including:
- Triptans: They work with brain chemistry to constrict blood vessels, helping relieve migraine pain, nausea and sensitivity to light and sound.
- Ergot: These combine caffeine with ergotamine, another blood-vessel constrictor, and work best in patients who have pain lasting more than 48 hours.
- Dexamethasone: This corticosteroid reduces inflammation and maybe used with other medications for migraine pain relief; it’s taken infrequently because of the risk of side effects.
- Tricyclic antidepressants: This form of antidepressant medication may help prevent migraines by altering brain chemistry, whether or not you have depression.
- Beta blockers: Commonly used to treat high blood pressure and coronary heart disease, these drags reduce the frequency and severity of migraines.
- Anti-nausea medications: These help with the migraine symptoms of nausea and vomiting.
There’s another drag treatment that you may not be aware of — one popularly known to fight wrinkles:
Following two clinical studies published in the medical journal Cephalalgia in 2010, the FDA approved Botox (OnabotulinumtoximA) for the treatment of chronic migraine headaches.
The studies were double-blind, randomized, placebo-controlled with more than 1,300 study participants. At the end of the two clinical trials, the researchers concluded that Botox is safe and effective, for the prevention of chronic migraines in adults.
Multiple studies since have shown the continuing effectiveness of Botox treatment for chronic migraines.
New treatments for migraine sufferers are emerging all the time. The latest was just announced by the FDA in March 2014. It is the first medical device approved to prevent migraines in adults, providing an alternative to medication.
According to the FDA, Cefaly is a small, portable, battery-powered, prescription device that resembles a plastic headband worn across the forehead and atop the ears. The user positions the device in the center of the forehead, just above the eyes, using a self-adhesive electrode.
The device applies an electric current to the skin and underlying body tissues to stimulate branches of the trigeminal nerve, which has been associated with migraine headaches. The user may feel a tingling or massaging sensation where the electrode is applied. It is directed for use once per day for 20 minutes.
Migraine pain myth #6: Migraines aren’t hereditary.
Reality check: The child of one parent with migraines has a 50% chance of having them too, and the risk climbs to 75% if both parents experience them, according to BIDMC. The risk is 20% if even a distant relative has the disorder.
A boy may inherit the gene, but is less likely to get migraines, Dr. Goadsby says. But he can pass the trait on to his daughters, who are more likely to experience symptoms.
Migraine pain myth #7: Migraines are caused by psychological problems.
Reality check: Migraines, depression and anxiety often travel together. The causes may overlap – a
risk of depression, for example, can also be hereditary – but one condition doesn’t lead to the others.
Not everyone with depression gets migraines, and vice versa, Dr. Saper says.
“You can treat someone with depression with antidepressants, but that doesn’t mean it will help the migraine,” Dr. Goadsby says. And “you can give anti-migraine medications to a migraine patient, but she’ll still have depressive disorder.”
“The two are related only by shared brain chemistry,” he says.
Migraine pain myth #8: Caffeine helps relieve migraines.
Reality check: It helps some people – but for others, it’s a migraine trigger, according to BIDMC.
Caffeine can help relieve a mild or moderate migraine headache if you don’t consume much of it daily, Dr. Saper says.
But 4-5 cups of coffee per day may foster a caffeine dependency, and overnight withdrawal from the stimulant could trigger a migraine the next morning.
To help determine whether caffeine affects your condition, keep a headache diary to note if you get migraine symptoms after consuming caffeinated beverages, BIDMC suggests.
Migraine pain myth #9: Certain foods trigger migraines. Reality check: Some migraine patients are sensitive to:
Cheese, which contains a natural compound called tyramine
Chocolate, which has caffeine
Processed meats made with nitrates
But many others never suffer a migraine headache from food, Dr. Saper says. “It could be 100 different triggers,” he says. “It’s hard to identify them.”
If you often get symptoms after eating a particular food, keep a diary to track what you’ve eaten when you develop symptoms, Glaser advises. These 5 foods can ease migraines.
It also matters when you eat. Inconsistent mealtimes can set off migraines.
“Eat at the same time every day,” Dr. Saper advises. “Missing or delaying meals are often a key migraine trigger.”
Exercising and going to bed at the same time daily is also wise, he adds.
Migraine pain myth #10: Overachieving women get migraines from too much multitasking.
Reality check: Stress can be a migraine trigger, but “it doesn’t matter whether a woman is under stress in an office or at home with kids,” Dr. Goadsby says.
Stress-reducing techniques, such as meditation, may help manage migraines.
It isn’t just a women’s issue either.
“It’s a myth that stress applies to women more than men,” Dr. Saper says.
Don’t let this, or any other migraine myth, deter you from living your life and getting proper treatment, Dr. Goadsby says.
“You’re not crazy, weak or second-rate if you have migraines,” he says. “You have a genuine, biologically determined problem. Don’t believe anything else.”