Headache Types

Many types of headaches syndromes bother individuals: Tension-type headaches, trigeminal autonomic cephalagias, morning headache, cluster headaches, exertional (exercise) headaches, medication side effect headache, cold stimulus headaches, headaches associated with sexual activity, hypnic (alarm clock) headache.

Some headache conditions onset young and are persistent throughout life while others have an onset in midlife or later.

Chronic and especially new onset headaches are best evaluated and treated by a medical professional.

Some headaches syndromes need to be evaluated with imaging, CT scans or MRI’s prior to treatment initiation.

Danger Signs

Danger signs and symptoms associated with headache include:

• fever
• history of malignancy
• new or sudden onset, age > 50
• decrease in alertness
• new weakness in the body
• change in the pattern of chronic headaches
• medication overuse headache (analgesic rebound headache)
• positional headache
• painful eyes with headache
• impaired vision or seeing halos around lights
• nausea or vomiting associated with headache
• history of immune disease with concurrent headache

The good news is there is now an array of helpful treatment options even compared to the options just a few years ago.

Treatment

Modern day treatment of headaches and migraines can be multifaceted, including proper nutrition, dietary supplementation, and reduction in triggers, e.g., stress, strain, poor sleep, lack of exercise.

Various pharmacologic therapies are available for both the prevention of headaches and migraines. Other pharmacologic therapies are available as abortive (migraine stopping therapies) to resolve a breakthrough episode once it has started. The goal of treatment is to lessen an individuals total migraine days per month including the number of days a migraine both occurs and lasts. Lessening the disabling side effects which headaches and migraines cause is also a priority with treatment.

I typically recommend pharmacologic therapy to prevent migraines when an individual suffers more than 4 migraine days per month.

Some individuals may be candidates for procedures like peripheral nerve blocks and/or Botox injections which can lessen or cease headaches and migraines.

Peripheral nerve blocks (local anesthetic injection) can target the occipital or trigeminal nerves and prevent migraines.

Opioids ought to be avoided in the management of headaches and migraines as there is no high quality evidence supporting their efficacy. Non opioid treatment modalities have been proven to be more effective and safe compared to opioids.