Almost everyone has had a headache. Not only is it the most common form of pain, it’s a major reason people miss days at work or school or visit the doctor. Last week I explained the different types of headaches. Now let’s discuss how they are diagnosed, treated and when to seek medical help.
Diagnosing your headache
How and under what circumstances a person experiences a headache can be key to diagnosing its cause. Keeping a headache journal can help providers diagnose the type of headache involved and determine the best treatment. After each headache, note the time of day when it occurred; its intensity and duration; any sensitivity to light, odors, or sound; activity immediately prior to the headache; use of prescription and nonprescription medicines; amount of sleep the previous night; any stressful or emotional conditions; any influence from weather or daily activity; foods and fluids consumed in the past 24 hours; and any known health conditions at that time. Women should record the days of their menstrual cycles. Include notes about other family members who have a history of headache or other disorder. A pattern may emerge that can be helpful to reducing or preventing headaches.
Since a headache can sometimes be a symptom of a disease or other medical condition, underlying causes need to be ruled out through a comprehensive medical history and physical exam. Diagnostic tests such as x-rays, labs, and scans may also be recommended.
A healthy lifestyle and plenty of sleep can help prevent many headaches. Some key steps a person can take to reduce their chances of experiencing a headache include:
Avoiding diet-related food triggers
While these can vary from person to person, foods known to trigger headaches include aged cheeses, wine, cashews, onions, chocolate, processed meats, dark beers, food additives, dairy, and wheat. Whenever possible, a person should avoid food additives and eat whole foods.
Avoiding excess caffeine intake
Drinking four or more cups of coffee a day can lead to chronic headaches due to withdrawal episodes. Limiting caffeine to two to three cups per day (or none at all) is the best option.
Getting enough sleep
Lack of sleep is a common headache trigger. To help prevent headaches, getting a good nights sleep is a must. As stated in previous posts 7-9 hours a is recommended for overall good health. And sticking to a routine that encourages the same 7-9 hours is even better.
Using mind-body practices for headache prevention
People with tension headaches can benefit from using techniques like progressive muscle relaxation and guided imagery. These techniques involve focusing the mind on the body, deep breathing, and imagining each tense muscle in the body relaxing and becoming pain free.
Physical therapy for myofascial pain release and learning techniques to stretch and mobilize on your own can be effective. Other manual therapies such as massage, acupuncture/ acupressure, and biofeedback may also help prevent headaches in some people. Always clear with your healthcare provider first.
Exercise at least three times a week for 30 minutes. This can help relieve stress and tension that may otherwise trigger headaches. Even if you’re short on time, breaking up exercise sessions into 5 or 10 minute segments can help. Read our posts on Tuesdays for great ideas when short on time, equipment or space. Again always clear with your healthcare provider first.
Hot or Cold therapy
Cold or hot therapy involves applying a heating pad, ice pack or towel to your head for 5 to 10 minutes, multiple times a day. Alternating ice and heat when one alone doesn’t work can help surge nutrient filled circulation to the areas of spasm and help them to release and relax.
As I’ve shared, taking a long hot bath or shower is my go-to mechanism for pain relief. It can help relax tense muscles. Add some Epsom salts, lavender candles and soft music to improve its effect and you’ll love it as much as I do.
Medications are used when headaches occur three or more times per month. Sumatriptan is a drug that’s commonly prescribed for the control of migraine headaches. Others that can be used to treat or prevent chronic migraine or cluster headaches are:
- beta blockers (propranolol, atenolol)
- verapamil (calcium channel blocker)
- methysergide maleate (helps to reduce blood vessel constriction)
- amitriptyline (antidepressant)
- valproic acid (anti-seizure medication)
Botox has also become popular as a treatment for chronic debilitating headaches. Botox is a brand of botulinum neurotoxin (BoNT), a protein substance originally derived from the bacterium Clostridium botulinum. In its original form it was the toxin responsible for botulism, the paralyzing illness often caused by eating contaminated food. Studies show it has been used successfully who have suffered from headaches more than 15 days a month, for more than three months. It has become a common treatment in headache centers in the U.S. and appears to be well-tolerated, beneficial, and safe for long-term management of chronic migraines.
When you should worry about headaches
- Headaches that first develop after age 50
- Headaches that start in a person who never gets headaches
- A major change in the pattern of your headaches
- An unusually severe headache
- Head pain that increases with coughing or movement
- Headaches that get steadily worse
- Changes in personality or mental function
- Headaches that are accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness, or seizures
- Headaches that are accompanied by a painful red eye
- Headaches that are accompanied by pain and tenderness near the temples
- Headaches after a blow to the head
- Headaches that prevent normal daily activities
- Headaches that come on abruptly, especially if they wake you up
- Headaches in patients with cancer or impaired immune systems
For most of us, an occasional headache is nothing more than a temporary speed bump in the course of a busy day. Often we can ease the problem with simple lifestyle changes and nonprescription medications. But for others, headaches are a huge and intrusive problem. Learn to recognize warning signs that call for prompt medical care. Work with your healthcare provider to develop a program to prevent and treat migraines and other serious headaches. And don’t fall into the trap of overusing medications; for some, rebound headaches are the biggest pain of all.
There are solutions that can help. Ask your provider which may be best for your needs.