To say, “I have a headache,” is one thing. To say, “I always have headaches,” is another. The latter is often more concerning.
Most people get headaches from time to time. They usually go away with or without any treatment. Frequent headaches are much less common and much more serious. They can disrupt your work or personal life. They can also be a sign of an illness or injury.
“Unfortunately, many people don't seek help because they think they can cope on their own,” says Christy Jackson, MD, a neurologist and director of the Donald J. Dalessio Headache Center at Scripps Clinic. “They may rely on over-the-counter pain relievers instead of getting medical help. In some cases, headaches are not properly diagnosed.”
Consult with your primary care doctor if your headache symptoms get worse or occur more often despite treatment at home. Your doctor may refer you to a headache specialist.
“No one should go through life suffering from chronic headaches,” Dr. Jackson says. “Not when they are treatable.”
Headache specialists at Scripps help people who suffer from recurring, chronic headaches through a combination of traditional and complementary care with a focus on prevention and lifestyle changes.
“We evaluate your symptoms and design a treatment plan that targets the underlying physical, psychological and environmental causes of your headaches.” Dr. Jackson says.
“There are many effective treatments to relieve symptoms and prevent future attacks,” adds Robert Bonakdar, MD, a pain specialist at the Scripps Center for Integrative Medicine. Treatments may include medication, biofeedback, and other therapies.
Dr. Bonakdar stresses the importance of clear and open communication between doctor and patient. “Correct diagnosis depends largely on the information you share with your health care provider.”
It’s important to understand your diagnosis as much as possible, including what type of headache you have and what is causing it. There are many types of headaches, levels of frequency and severity.
Headache pain can range from mild to disabling. Headaches can be episodic or chronic. Episodic headaches occur occasionally. Chronic headaches are more consistent. They can strike for 15 days or more in a month.
Headaches are divided into two main types: primary and secondary. Primary headaches are those that are not caused by another medical condition. Migraine and tension headaches are the most common.
Secondary headaches are symptoms of another health problem, such as a fever, infection, stress or a head injury.
Tension headaches, which are the most common type of headache, cause mild to moderate pain. They often present as a dull, constant pain felt on both sides of the head, and have no other symptoms.
They’re caused by tightening or tension in the muscles in the head, neck and scalp. They can be brought on by stress, noise, fumes and even long periods of watching TV or computer screens. They’re easier to handle than other types of headaches because they usually just come and go. Chronic tension headaches are much less common.
Migraine is the most disruptive type of primary headache. It is often marked by a throbbing pain that is moderate to severe. It can last four to 72 hours and happen one to four times a month.
Migraines often include other symptoms. Someone with a migraine may be sensitive to light and sound. They may prefer to be in a dark, quiet space. They may also experience nausea and vomiting and visual disturbances (aura).
Women are more likely than men to get migraines. Migraine attacks may also run in a family and begin at an early age.
Certain environmental factors are common triggers, such as sleep disruption, dehydration, skipped meals, some foods, hormone fluctuations and exposure to chemicals.
“The goal is to treat migraine symptoms right away, and to prevent symptoms by avoiding or changing triggers,” Dr. Jackson says.
Cluster headaches are more severe but less common. They often begin on one side of the head and recur for days or weeks. Attacks can last between 15 minutes to three hours and occur every day.
They tend to affect men between the ages of 20 and 50, and smokers. People who experience these types of headaches are often restless, agitated and sweat profusely. Alcohol can trigger an attack.
Also known as rebound headaches, they are caused by an overuse of pain medications, such as aspirin, acetaminophen and ibuprofen. Women are affected more often than men.
When over-the-counter medicine fails to work and headaches become more frequent, medication and other therapies may be prescribed.
Medications to prevent frequent migraines include antidepressants and Botox injections and newer medications.
In 2018, the Food and Drug Administration (FDA) approved a new class of medications that modulate a neuropeptide, known as calcitonin gene-related peptide (CGRP), that is believed to play a key role in migraine. Neuropeptides are small protein-like molecules used by neurons to communicate with each other.
For treatment of migraines as they occur, your doctor may prescribe triptans for relief.
Medication for frequent headaches may be combined with non-medication options, such as biofeedback, relaxation, bio stimulation and diet therapy.
Biofeedback uses electronic monitoring to help teach individuals how to control certain physical responses, such as muscle tension.
Many different relaxation therapies are available and can be individualized.
“Manual and massage therapy can be especially helpful for those with significant muscle tension or neck stiffness related to headache,” Dr. Bonakdar says.
For those who may have significant stress and sleep issues, one of the most powerful techniques is mindfulness. “This technique helps individuals increase awareness to manage triggers and automatic responses that often lead to the next headache.”
Mindfulness is typically offered at Scripps as an 8-week stress reduction course.
Biostimulation is a broad term that encompasses therapies such as acupuncture, which involves the use of needles to stimulate specific points of the body to alleviate pain.
“With a treatment course, acupuncture has been found to be as helpful as medication in the prevention of migraines,” Dr. Bonakdar says.
Electrical stimulation and other techniques can also be used. The most recent is the Nerivio wearable device, which was one of Time magazine’s Best Inventions of 2019.
Many headache sufferers often report a diet-related trigger. “When this is the case, the solution may be as simple as identifying and avoiding these triggers or finding a diet or supplement regimen that can fill gaps created by long-term headaches,” Dr. Bonakdar says.
While many foods can cause headaches, some are more common than others. Dr. Bonakdar works closely with the center’s dietician to help patients identify and avoid individualized triggers, which typically fall into a few categories:
- Allergenic foods which may take testing to confirm, such as peanuts and foods made with gluten
- Additives, such as those found in pre-packaged and processed foods
- Artificial sweeteners, such as those found in diet foods to reduce calorie content
- Aged foods, including wine, cheese, sauerkraut and cured meats.
“Diet is just one component of headache management,” he adds. “It’s important to look at the whole person to develop a treatment plan that includes a healthy lifestyle, integrative therapies — and when appropriate — medication.”