Sometimes, it's more than just a headache
"When I do routine physicals, I'll ask about headaches," says Michael Munger, a primary-care physician in Overland Park, Kan. He is always surprised that many of his patients report frequent headaches when asked, but never bring them up otherwise. "Some people just live with it."
Tension headaches, sinus headaches and migraine headaches are among the most common varieties.
Tension headaches affect 30 to 70 percent of the population, says Nauman Tariq, director of the Headache Center at Johns Hopkins Medicine in Baltimore. These are usually mild and can be alleviated with non-prescription pain relievers.
Migraine headaches affect 12 to 27 percent of people, Tariq says. These range in severity and frequency, "from two headaches a year to daily headaches," he says. Over-the-counter drugs are used for migraines, as are prescription drugs, such as the triptan group of medications including Imitrex, Zomig and Maxalt.
Sinus headaches are a result of excess mucus in nasal passages and are typically associated with allergies, colds or flu. Antihistamines or decongestants can relieve the pressure and pain.
Munger, who is also the president of the American Academy of Family Physicians, says headaches often are innocuous, but they can be symptomatic of more-serious conditions, such as brain tumors or aneurysms. "You don't want people to over-react, but you also don't want them to under-react."
So, should you see a doctor for your headaches? It depends, of course, on frequency and severity — how much they interfere with your life and whether you can manage them through self-care or by taking over-the-counter analgesics, such as aspirin, ibuprofen, acetaminophen and naproxen.
However, these drugs come with their own risks. "Over-the-counter drugs seem safe, but not so when they're taken frequently," Tariq says. "Long-term or frequent use can be more damaging than the headache itself."
For instance, aspirin and ibuprofen can cause gastrointestinal bleeding, ulcers and kidney problems with long-term use; Tylenol can cause liver damage with high doses.
When to see a doctor? Munger advises the rule of twos: "More than two headaches a week for more than two weeks." That rate of occurrence doesn't mean it's an emergency, he says, but it's worth checking out.
A doctor's visit is likely to include questions about the individual's headaches — when they happen, what they feel like and what triggers them.
When headaches happen can lead to indications about triggers. Munger says patients often have some clue about these already. "The goal is to avoid triggers," Tariq says, citing some common ones (not all of which can be avoided): Certain foods, dehydration, alcohol, sleep deprivation, weather changes, menstrual cycle, work and stress.
The location of pain on a patient's head gives clues as to the type of headache. Tension headaches derive from muscle tension, and they "start at the back of the head, then radiate up and over the crown," Munger says. Sinus headaches, in contrast, tend to affect people on the face, commonly above or below the eyes. Migraine or vascular headaches often are localized to one side of the head and can be accompanied by nausea and visual oddities, such as flashes and blind spots. Munger says some patients report very specific locations for their migraines, such as "on the left side of my head over my ear."
Doctors will look for red flags, too, asking about numbness or tingling, nausea, speech disturbances or memory problems. Such symptoms may indicate — or rule out — a more serious condition. They may ask about conditions associated with headache. For instance, "50 percent of people with chronic headache also have anxiety and depression," Tariq says. "Addressing those issues, with psychotherapy and/or meds, can help headache."
Your doctor may suggest a prescription medicine, such as a muscle relaxant for tension headaches or one of the migraine drugs. Steroid or antihistamine nasal sprays may be recommended for sinus headaches.
Drugs are not the only solution. Tariq says certain procedures interfere with the transmission of pain. With a treatment called nerve block, an injected deadening agent — anesthetic, steroids or Botox — can quiet nerve activity. Alternatively, neurostimulation techniques use vibration or cold to compete with pain messages, he says.
For tension headaches — or, as Munger calls them, muscle headaches — neck and shoulder massage can help, as can changing the position at your desk. Studies have shown the benefits of certain physical therapy techniques in easing headaches.
Stress relief plays a role, too, Munger says.
"If you're under an inordinate amount of stress, try relaxation techniques, such as yoga or meditation."
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