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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. Rarely, 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 regular exercise 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, Aleve, Tylenol, or Advil. 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, see your health care provider.

A class of drugs known as triptans have become the mainstay of migraine treatment. These drugs include Amerge, Imitrex, Maxalt, Zecuity, Zomig, 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.

Simple pain relievers 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, Sansert, and lithium can help cluster headaches. So can some of the calcium channel blockers and vasoconstrictors that are used for migraines.

Decongestants -- and sometimes antibiotic treatment -- can relieve sinus headaches.

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

If you identify factors that trigger your headaches -- such as certain foods, caffeine, alcohol, or noise -- try to avoid these triggers. To learn more about what triggers your headaches, keep a headache diary that includes answers to these 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, for example?

 

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