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    Understanding Headache -- Treatment

    How Do I Know if I Have a Headache Problem?

    Most headaches can be diagnosed by a medical history and physical exam. To rule out other causes of headaches such as an aneurysm, tumor, or structural abnormality, a doctor may call for vision tests, X-rays, a CT scan, MRI, a lumbar puncture, or an EEG.

    What Are the Treatments for Headaches?

    There are many headache remedies. What works for one person may not work for another. However, almost all practitioners consider lifestyle changes that help control stress and promote regular exercise to be an important part of headache treatment and prevention. Avoiding situations that trigger your headaches is also vital.

    Medications for Headaches

    A number of medications can help treat and prevent migraines and tension headaches.

    Most tension headaches can be helped by taking pain relievers such as aspirin, naproxen (Aleve), acetaminophen (Tylenol), or ibuprofen (Advil, Motrin). But be careful! Taking too many of these easy-to-buy pills is a major cause of new, more-difficult-to-treat headaches called rebound or pain reliever-induced headaches. If you need to take these drugs often or regularly, see your health care provider. Do not use aspirin in anyone under age 19, because it may increase the risk for Reye's syndrome.

    A class of drugs known as triptans have become the mainstay of migraine treatment. These drugs include naratriptan (Amerge), sumatriptan (Imitrex, Zecuity), rizatriptan (Maxalt), zolmitriptan (Zomig), eletriptan (Relpax ), and others. These drugs come in several forms, including pills, injections, and skin patches.

    Ergotamine is also an effective drug for many headache sufferers. It's available as a suppository if the vomiting caused by 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 nonsteroidal anti-inflammatory drugs (NSAIDs), if taken at the first sign of a migraine attack, also can be effective.

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

    • Blood pressure drugs such as propranolol, verapamil, and others
    • Antidepressants
    • Antiseizure drugs
    • Muscle relaxants
    • Relaxation and biofeedback techniques
    • Avoidance of certain foods
    • Cefaly, a small headband device that gives electrical impulses on the skin at the forehead. This stimulates a nerve associated with migraine headaches.
    • Cerena, a small device for people who have an aura before their migraine. It is held at the back of the head at the first sign of a headache and gives off a magnetic pulse that stimulates the brain’s occipital cortex. 
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