You’ve probably experienced a headache — almost everyone has. But when is a headache not just a headache? When does it suggest a more serious medical concern?
What is a headache?
“Headache is a generic term for pain in the head,” explained Susan M. Rubin, MD, a neurologist with Endeavor Health Medical Group. “There are different types of headaches, including migraines, tension headaches, cluster headaches, and secondary headaches due to other causes such as sinus infections, brain tumors, and meningitis.
Migraines are a common type of headache with at least two of the following characteristics:
- Pain on one side of the head or the other
- Throbbing pain
- Pain that is moderate to severe in intensity
- Pain that is worsened by movement
Migraines also have one of the following secondary symptoms:
- Nausea and/or vomiting
- Sensitivity to light and sound
In contrast, tension headaches are typically characterized by pressure pain on one side or the entire head without nausea, vomiting or sensitivity to light or sound.
“Most headaches are on a spectrum,” said Dr. Rubin. “Sometimes, your headache may have more of a migraine quality, while on other days it might be more tension.”
What are common headache triggers?
Common migraine triggers include:
- Changes in the weather
- Alcohol (particularly red wine)
- Hormone fluctuations in a woman’s menstrual cycle
- Stress
- Fatigue
- Skipped meals
- Dehydration
Because hormone fluctuations are a common trigger for headaches, women are more susceptible to headaches than men. Headaches also run in families, so you are more likely to develop them if one of your parents regularly experiences headaches.
Traumatic brain injuries can also increase the risk for migraines, as can certain medications or medical conditions like sleep disorders.
How are headaches treated?
Most headaches are treated similarly, regardless of what type they are. Dr. Rubin explains that doctors mainly determine the best course of treatment based primarily on the intensity of the pain.
“I divide treatment into four main categories: trigger management, abortive therapy, preventative therapies, and alternative treatments,” said Dr. Rubin. “We often need to combine them to get good control.”
- Trigger management. Avoiding the triggers mentioned above can help lessen headaches, although this strategy is often the least effective. “Avoiding triggers can help decrease headaches,” said Dr. Rubin. “However, because many triggers are tough to avoid or headaches may be caused by a combination of triggers, that it is often hard to do.”
Abortive therapy. There are many medications that treat the pain once a headache begins. Abortive therapy aims to stop symptoms before they worsen. “You want to pick the most effective medication and take it at the onset of a headache to get the best response,” said Dr. Rubin.
“You also need to be aware of any other medical conditions since many migraine-specific medications are not safe for patients with heart problems.” Fortunately, new calcitonin gene-related peptide (CGRP) inhibitor pain relievers are safe for many patients with cardiac issues.
Preventative therapies. If someone has frequent headaches, just taking pain relievers can run the risk of tolerance and rebound headaches. Dr. Rubin recommends using preventive prescription medications that help stop headaches before they happen. These can include beta-blockers, topiramate, and tricyclic antidepressants.
It’s important to talk to your doctor as some of these medications can exacerbate certain medical issues. CGRP inhibitor preventatives appear to have limited side effects besides constipation. People with predictable headaches, like menstrual migraines, can use a preventative medication around their period or use hormones to prevent the period from happening.
- Alternative treatments. You can also explore alternative treatments that can help alongside or in place of medication, including supplements like magnesium B2 and butterbur, acupuncture, biofeedback, yoga and stress management.
When should you see a headache specialist?
Dr. Rubin recommends seeing a neurologist or headache specialist if your headaches occur once a week or more, or if they are severe enough that you miss out on activities because of the headaches.
“You should also see a specialist if your headaches are new onset over the age of 50, or they are associated with other neurologic symptoms like numbness, weakness in the face or extremities, difficulty speaking, vertigo, or trouble seeing or hearing,” said Dr. Rubin. “You should go to the emergency room if you suddenly experience the ‘worst headache of your life’.”
While headaches are common, they can also be debilitating. Thankfully, a headache specialist can help you figure out what lifestyle changes or medications can help stop headaches from disrupting your normal life.
“New medications have significantly improved the treatment of headaches — migraines in particular,” said Dr. Rubin. “We have so much more to offer patients than we did even 10 years ago, so talk to your doctor to get your headaches under control before they become chronic.”
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