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My Head Still Hurts

What To Do When Headache Treatments Don't Work
By
WebMD Health News

April 9, 2003 -- If nothing helps your headache, don't give up. The treatment is out there, experts say.

The experts are five leading headache specialists. Writing in the April 8 issue of the journal Neurology, they have two words of advice for other doctors. When faced with patients who say nothing helps their headaches, they say: Keep trying.

"Even for the most difficult-to-treat patients, 90% -- and up -- are very substantially better after a period of good specialty care," researcher Richard B. Lipton, MD, tells WebMD. "Usually, when the patient says they have tried everything, they either have tried a small fraction of available treatments or have an undiagnosed condition that's making the problem worse."

This means that there are lots of people needlessly suffering headache pain, says Lipton, professor of neurology, epidemiology, and social medicine at Albert Einstein College of Medicine in New York.

"We see patients who have suffered for years and years," he says. "They go to their primary care doctor, try a treatment, and fail. Later they go to a general neurologist, and try and fail. Some 30 years later they turn up in headache specialty practices where they get proper care."

When to See a Doctor

What do you do when you have a headache? Nearly everybody first tries an over-the-counter headache treatment. If that doesn't work -- or if the headache comes back when the drug wears off -- it might be time to get help.

"You should go to a doctor if you have headache red flags," Lipton says. These warnings include:

  • A new kind of headache in anyone over the age of 50.
  • Headaches that become more and more frequent or more and more severe.
  • Headache together with a fever, a stiff neck, weight loss, or other medical symptoms.
  • Headache that comes out of nowhere. "If it begins absolutely suddenly; if you go from no pain to severe pain instantly, that is a sign of something bad," Lipton says.
  • Headache in people with underlying conditions such as HIV infection or cancer.

You should also see a doctor if you have any kind of head pain that interferes with your life. If a headache interferes with work, study, or your social life, it's time to get help.

What Kind of Doctor Should I See?

"People who seek medical care for headaches should start with their primary doctor," Lipton says. "The overwhelming majority of patients can be well managed in primary care settings. Most don't need neurologists or headache specialists."

That's also the experience of Donald B. Penzien, PhD, director of the head pain center at the University of Mississippi Medical Center, Jackson.

"You don't have to be a rocket scientist to diagnose and treat most headaches," Penzien tells WebMD. "But it's not always easy to tell what causes a headache. Your primary care doctor may not have the time or training to delve deeply into it."

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