Understanding Headache - Treatment

How Do I Know If I Have a Headache Problem?

Most headaches can be diagnosed by history and physical exam. Rarely, to rule out possible organic causes of headaches — an aneurysm, tumor or structural abnormality — a physician may call for vision tests, X-rays, a CT scan, MRI, a lumbar puncture, or an EEG.

What Are the Treatments?

There are many headache remedies. What works for one person may not work for another. However, almost all practitioners consider relaxation beneficial for tension and migraine headaches. Regular aerobic exercise is a mainstay of headache management.

Most tension headaches can be helped by analgesics such as aspirin, acetaminophen, or ibuprofen. But be careful! Taking too many of these easy-to-buy pills is a major cause of new, more-difficult-to-treat headaches called withdraw headaches. If you need to take these drugs often, see your doctor.

A number of medications can help treat and prevent migraines and tension headaches. Decongestants — and sometimes antibiotic treatment — can relieve sinus headaches.

If you have three or more severe, prolonged migraines per month, your doctor may suggest using preventive treatments on a continual basis. These include:

• Blood pressure drugs such as propranolol, verapamil, and others
• Antidepressants
• Antiseizure medications
• Muscle relaxants
• Relaxation and biofeedback techniques

New migraine drugs known as triptans have become the mainstay of migraine treatment. These drugs include Amerge, Imitrex, Maxalt, and Zomig.

Ergotamine is also an effective drug for many patients. It's available as a suppository if the vomiting caused by your migraines prevents you from keeping a pill down. A therapeutic nasal spray based on the serotonin-inhibiting drug dihydroergotamine (DHE 45) acts quickly to constrict blood vessels and reduce inflammation. Aspirin, and other NSAIDS if taken at the first sign of an attack, can be effective.

Simple analgesics do little for cluster headaches because they do not act quickly enough. However, doctors have found that inhaling pure oxygen can be highly effective in providing relief. A short course of corticosteroids, methysergide maleate, and lithium carbonate can help cluster headaches. So can some of the calcium channel blockers and vasoconstrictors that are used for migraines.

Keeping a headache diary can help you pinpoint the factors causing your specific headache patterns. This will help you avoid these "triggers." The diary should provide answers to these 10 questions:

• When did you first develop headaches?
• How often do you have them?
• Do you experience symptoms prior to the headaches?
• Where is the pain exactly?
• How long does it last?
• At what time of day do the headaches occur?
• Does the eating of certain types of food precede your headaches?
• If you're female, at what time in your monthly cycle do they occur?
• Are the headaches triggered by physical or environmental factors, such as odor, noise or certain kinds of weather?
• What words most accurately describe the pain of your headache: throbbing, stabbing, blinding, piercing, ...?