woman with headache
"The number one trigger is stress because it is thought to produce muscle tension and change the chemical function of our brain,” said Dr. Marc Sharfman of the Headache and Neurological Treatment Institute in Longwood, Fla. Other causes include injuries, like car accidents, slip and falls and work injuries, or genetics may be to blame. And sometimes, there is no explanation.
Headaches come in types and some are more prevalent than others. “The most common that brings patients to the office is migraine because it disables them,” said Sharfman. “With migraine you have pain level, nausea, and light and noise sensitivity that disable you and you may miss time from work, your child’s activities, or your social activities.”
Help your doctor help you by providing as much information as you can. Keep a diary of your symptoms, the frequency of the headaches, as well as what makes them better and what makes them worse, he advised.
When a patient comes in with migraine, the first thing the doctor does is try to rule out other disease. “We do a four-stepped approach: we look to see if there is a reason or cause by our examination; educate patients on the non-drug treatment options; look to see if they are a candidate for a preventive medicine; and see if they need to have their eyes examined, check their jaw or look for another cause of headache,” said Sharfman.
During menstruation, pregnancy or menopause, hormones can be unbalanced which can lead to migraine attack. According to the National Headache Foundation, about 75% of women with migraine report attacks related to their menstrual cycle. Triptans are the newest class of abortive medications specifically targeted to treat migraines. The idea is that they work on receptors in the brain to help restore balance of the neurotransmitter called serotonin, since changing levels of serotonin are thought to be the main cause of migraine.
“We encourage … the non-drug treatments like diet, exercise, and some type of physical therapy but most people come looking for a medicine,” he said. There are two categories of drugs: symptom and preventive. Treatment depends on frequency. “If you have one to two headaches per week you want to take something each day to prevent them,” he said.
Generally speaking, prevention can be divided into non-drug treatments, drug treatments, and injection treatments. “For non-drug there are physical therapies like massage, acupuncture, and chiropractic; for medicines, there are four drugs that have been proven to prevent headache; and for injections, Botox has been studied for chronic migraine,” said Sharfman.
Interestingly, most preventive migraine medications originally were developed to treat other diseases like seizures, depression or hypertension. These include antidepressants, beta blockers, calcium channel blockers, and non-steroidal anti-inflammatory drugs. Antidepressants can help reduce migraine frequency by regulating chemical levels in the brain. If you are looking for alternative therapies, some herbs are believed to make a difference as well.
Stress can cause tension headaches. “It is a bilateral, steady pain that does not have migraine features,” said Sharfman. “Biofeedback is one of our best treatments where you learn relaxation techniques.” If that does not work, anti-inflammatories and muscle relaxants often are effective.
Cluster headaches are as they sound—attacks that come in groups. Pain comes with little if any warning and is usually on just one side of the head. It is thought to be the most intense and severe of any headache, and typically is treated with prescription medication and oxygen.
Sinus headaches can also be troubling, as inflammation causes localized pain and you may have a fever. Treatment entails antibiotics for infection as well as antihistamines or decongestants.
Do not try to self-treat. The Chicago-based National Headache Foundation warns that the pattern of taking acute headache medications too often, meaning more than two days per week or in doses larger than the label advises, can lead to a condition known as rebound headache. Medications will stop relieving pain but also may cause headaches. Regularly overusing medication is dangerous because it can increase your potential for side effects. The good news is that in roughly 80% of patients the doctor can reduce the frequency and severity of headaches so you probably do not have to suffer.
Jamie Lober, author of Pink Power provides information on women’s and pediatric health topics.