Headaches are one of the most common medical concerns reported in the healthcare setting today. The World Health Organization (WHO) reports that almost half of all adults worldwide will suffer from a headache in any given year.1 When headaches are recurrent, they are referred to as headache disorders. Headache disorders are often associated with significant pain, disability, decreased quality of life, and financial cost (WHO).1 Although they can be quite debilitating, most headaches are not life-threatening.
Headaches are categorized as primary, when they are not caused by another condition, or secondary, when there is another underlying cause.2 There is a long list of secondary headaches, but the most common type of secondary headache is medication over-use headache (MOH). MOH is caused by chronic and excessive use of medication to treat headache.
Common primary headaches include tension headaches, cluster headaches, and migraines.1 While this newsletter focuses on migraines, a summary of common primary headaches are as follows.
Tension headaches are the most common form of primary headache. These headaches normally begin slowly and gradually in the middle of the day and can be either episodic, lasting for a few hours, or chronic, occurring for 15 or more days a month for a period of at least 3 months.1 Symptoms can feel like having a tight band around the head, a constant, dull ache on both sides, or pain spread to or from the neck.1
Cluster headaches usually last between 15 minutes and 3 hours, and occur suddenly once per day up to eight times per day for a period of weeks to months.1 The pain caused by cluster headaches is: one-sided, severe, often described as sharp or burning, typically located in or around one eye.1 The affected area may become red and swollen, the eyelid may droop, and the nasal passage on the affected side may be congested.1
Migraine headaches may cause a pulsating, throbbing pain usually only on one side of the head.1 The aching may be accompanied by blurred vision, light-headedness, nausea, and sensory disturbances known as auras1. A migraine can last from a few hours to between 2 and 3 days.1 People with migraines tend to have recurring attacks triggered by a number of different factors, including stress, anxiety, hormonal changes, bright or flashing lights, lack of food or sleep, and dietary substances.1 Migraine in some women may relate to changes in hormones and hormonal levels during their menstrual cycle.1
There are two ways to approach the treatment of a migraine headache: prevent the attacks, or relieve the symptoms during the attacks.4 Prevention involves the use of medications and behavioral changes. Erenumab (Aimovig) is a medication that has been approved to prevent migraine in adults. It works by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks.4 Drugs originally developed for epilepsy, depression, or high blood pressure have also been found to be extremely effective in preventing future attacks.4 In addition, Botulinum toxin A (Botox®) has been shown to be effective in prevention of chronic migraine.4 Relief of symptoms during acute attacks consists of sumatriptan, ergotamine drugs, and analgesics such as ibuprofen and aspirin.4 The sooner these treatments are administered, the more effective they are. Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle.2
Several therapies can be used along with medical treatment in people with headache. Stress management strategies, such as exercise, relaxation techniques, biofeedback mechanisms, and other therapies designed to limit daily discomfort, may reduce the number and severity of migraine attacks.4 Some simple lifestyle adjustments can also help to reduce the frequency of headaches. These include:5
- Stop smoking
- Reduce the amount of alcohol you drink
- Decrease or stop drinking/eating caffeine
- Eat and sleep on a regular schedule
- Maintain adequate hydration
- Exercise several times per week
- Make a log of personal triggers of migraines and avoid these triggers
- Loose weight if you are obese
While most headaches are not life threatening, it is important to see your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate a more serious medical problem:
- Worst headache ever, or an abrupt, severe headache like a thunderclap
- Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
- Headache after a head injury, especially if the headache gets worse
- A chronic headache that is worse after coughing, exertion, straining or a sudden movement
- New headache pain if you’re older than 50
Migraines are often undiagnosed and untreated. With the proper combination of drugs and behavioral changes, most individuals can overcome much of the discomfort and disability of migraine headaches. Your healthcare provider is the best source of information for questions and concerns related to your medical problem. If you regularly experience signs and symptoms of migraine or would like more information about headache disorders, make an appointment with your healthcare provider today.
©2022HealthSpot References: (1) World Health Organization. 2016. Headache disorders. Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/headache-disorders (2) Mayo Clinic. 2018. Migraine. Retrieved from https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201 (3) International Headache Society. 2018. The International Classification of Headache Disorders. Retrieved from https://www.ichd-3.org (4) National Institute of Health, National Institute of Neurological Disorders and Stroke. 2018. Migraine information page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page (5) UpToDate. 2018. Patient education: Migraine in adults. Retrieved from https://www.uptodate.com/contents/acute-treatment-of-migraine-in-adults?search=migraine&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1