Headaches: Treatment depends on your diagnosis and symptoms
Your head hurts. Again! The first step in foiling your frequent headaches is determining what type of headache you're battling. Sometimes headaches are a symptom of another disease or condition; sometimes there's no clear cause.
Take a close look at your headache signs and symptoms. Your doctor may suggest you keep a headache diary to help diagnose your headache type. Write down when your headaches occur, accompanying symptoms, and any potential triggers such as food, changes in sleep or stress.
Are the headaches dull and achy?
Tension-type headaches, the most common variety of headaches:
- May be experienced as a tight band of pain around your head, a dull ache or pressure
- May cause mild to moderate pain on both sides of the head
- May be triggered by stress, neck strain, missed meals, depression, anxiety or lack of sleep
- Vary widely in frequency
- Can be occasional
- May occur more than 15 days a month (chronic)
- Last from 30 minutes to a week
Most intermittent tension-type headaches are easily treated with over-the-counter medications, including:
- Ibuprofen (Advil, Motrin IB, others)
- Acetaminophen (Tylenol, others)
Daily prescription medications, including tricyclic antidepressants, may manage tension-type headaches. Medications combined with behavior therapies may be more effective.
In addition, alternative therapies aimed at stress reduction may help. They include:
- Relaxation training
- Cognitive behavioral therapy
- Massage and gentle neck stretches
- Heat therapy (warm compress or shower)
Are the headaches throbbing and severe?
Migraines affect three times more women than men. Migraines may:
- Cause pain that is moderate to severe and may pulsate
- Cause nausea, vomiting, or increased sensitivity to light or sound
- May affect only one side of your head or may affect both sides of your head
- Worsen with daily activity
- Last from four to 72 hours without treatment
Migraine treatment is aimed at relieving symptoms and preventing additional attacks. If you know what triggers your migraines, avoiding those triggers and learning how to manage them may help prevent and lessen migraine pain. Treatment may include:
- Rest in a quiet, dark room
- Hot or cold compresses to your head or neck
- Massage and small amounts of caffeine
- Over-the-counter medications such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others), and aspirin
- Prescription medications including triptans, such as sumatriptan (Imitrex) and zolmitriptan (Zomig)
- Preventive medications, such as metoprolol tartrate (Metoprolol, Lopressor), propranolol (Propranolol HCL), amitriptyline, divalproex sodium (Depakote, Depakote ER, Depakote Sprinkle) or topiramate (Topamax)
- Transcranial magnetic stimulation (therapy using electrical currents to stimulate nerve cells in the brain) for migraine with aura
Do you have headaches nearly every day?
Chronic tension-type headaches and chronic migraines are both types of chronic daily headaches, which are those that occur 15 days or more a month. Other common types of chronic daily headaches include hemicrania continua (a one-sided headache that may feel like a migraine) and new daily persistent headache (headaches that generally occur in people who do not ordinarily have headaches and occur daily).
These types of headaches are characterized by their frequency and duration. The symptoms and characteristics vary between chronic daily headache types and over time.
There are also several types of rare chronic daily headaches, including hypnic headaches, which generally occur after the age of 50 and can wake you from sleep, earning it the nickname the "alarm clock headache." Primary stabbing headaches (which last for a few seconds and may occur several times throughout the day), primary exertional headaches (from coughing or exercise) and chronic paroxysmal hemicranias (sharp, one-sided headaches that may cause tearing or nasal congestion) are also types of chronic daily headaches.
Treating an underlying disease or condition often stops chronic daily headaches. If headaches aren't caused by another health problem, treatment focuses on preventive medication.
For chronic migraines, for example, tricyclic antidepressants (Amitriptyline) may help prevent future migraines.
Do the headaches recur for weeks at a time?
Cluster headaches occur off and on for weeks at a time over the course of a few months. These headaches are rare, but most often affect men and smokers. Cluster headaches:
- Begin and evolve quickly, becoming intense within minutes
- Tend to develop at the same time of day or night
- Can occur several times per day during a cluster period
- Usually affect one side of your head, often behind an eye
- May occur with tearing, redness or swelling of the eye on the affected side of the head
- Cause a runny or stuffy nose
- Typically last from 15 minutes to three hours
- May cause agitation or a restless feeling
Cluster headaches tend to subside quickly, so treatments need to be fast-acting. Treatments may include:
- Injectable medications, such as sumatriptan (Imitrex, Sumavel Dosepro, others), for quick relief during an attack
- Prescription triptan nasal sprays, such as zolmitriptan (Zomig NS) or sumatriptan (Imitrex Nasal Spray)
- Oxygen therapy (breathing pure oxygen via mask)
- Preventive medications, such as verapamil (Verapamil HCL, Verelan, others)
Do you take pain medication more than 2 or 3 days a week?
Medication-overuse headaches occur from overuse of pain relieving medications for headaches for at least three months. They develop at least 15 days out of the month, and often occur along with chronic daily headaches. Taking pain medication several times per month can increase the risk of developing medication-overuse headaches.
Sometimes called rebound headaches, medication-overuse headaches:
- Feel dull, achy, throbbing or pounding
- May awaken you early in the morning and persist all day
- May be most painful when medication first wears off
- Occur daily or nearly daily
- Sometimes cause nausea, trouble concentrating or irritability
Typical treatment involves discontinuing the medications that cause these headaches. Sometimes medications need to be tapered off, and sometimes they are stopped altogether.
You may need preventive medications or other treatments, called bridge therapy, to help control pain as you stop taking the medications that caused your medication-overuse headaches. Your doctor can help you come up with the best plan.
Recognize emergency symptoms
Seek emergency evaluation if you experience:
- A very severe, sudden headache
- Headache after a head injury or fall
- Fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
- Pain that worsens despite treatment
These symptoms suggest a more serious underlying condition, so it's important to get a prompt diagnosis and treatment.
Almost everyone gets headaches, and most are nothing to worry about. But if headaches are disrupting your daily activities, work or personal life, it's time to take action. Headaches can't always be prevented, but your doctor can help you manage the symptoms.
Last updated: July 28th, 2015