Do you ever feel nauseated due to your headaches? How does your headache make you feel? How long do they last? Do you keep a headache diary? If you live with headaches, regardless the type...how are you managing? Do you know what causes your headaches? Do you know the stages of a headache? What helps you to soothe the ache in your head? Just a few questions to get you thinking as you read the information.
If you live with chronic daily headaches I hope the following information will answer some questions you may have. Please do not use this information to self-diagnose your pain...but if you do notice yourself and your pain in this entry...please contact your doctor and or medical treatment team.
Chronic Daily Headache
Do you get regular headaches? If you get them for 4 hours or longer at least half of each month, and for more than 3 months, you might have what doctors call a "chronic daily headache." There are treatments that can bring relief, but first you need to figure out what type you've got.
When you get a tension headache, you may have a constant, aching pressure that feels like a band or vise around your head.
Many things can trigger it, such as:
- Too little rest
- Poor posture
Tension headaches affect both sides of your head. You can treat them with over-the-counter painkillers, including:
If these don't work well, your doctor may prescribe drugs, such as the antidepressant amitriptyline. They can reduce the number of headaches you get and make them less severe. They can also prevent the headache from starting.
Your doctor may also suggest combining your drug treatment with relaxation and stress relief techniques.
This type of headache gives you throbbing pain, often on one side of your head. Other symptoms include:
- Sensitivity to light, noise, and smells
- Nausea and vomiting
- Blurred vision or seeing spots, dots, or zigzag lines. These are called "auras" and are usually followed by a severe headache on one side of the head.
Migraines can last from half an hour to several days. Your doctor may use a two-step approach to them:
- Medications to shorten a migraine attack
- Daily pills to reduce their frequency, while avoiding migraine triggers
You may also get relief from over-the-counter drugs that contain:
If over-the-counter meds don't help, you might need stronger prescription drugs. Some prevent attacks, while others can stop a migraine if you take them at the first signs that one is starting up.
Your doctor may also give you medicine to get rid of nausea from migraines.
Other therapies can help:
- Hormone therapy for women whose migraines are linked to their menstrual cycle
- Relaxation in a dark, quiet room
- Stress management, including exercise, relaxation, and biofeedback
Medication Overuse or Rebound Headache
If you use pain medications too frequently to treat your headaches, you could actually make the problem worse. You could get what's called medication overuse or rebound headaches.
Rebound headaches can get worse until you get the right treatment. You can usually bring them under control if you gradually cut back on the amount of your pain drugs and take preventive medicine. Work with your doctor to get the right strategy for you.
Some people with severe rebound headaches need to "detox" in a hospital. With careful monitoring, a headache specialist will help wean you from the painkillers.
You might have increasing headaches during the first several weeks of treatment. Eventually, the headaches will end and you'll only have them on occasion. Your doctor may prescribe preventive medications to keep you free of headaches.
This is a rare type of headache, but it causes pain that's usually on the same side of your face and head. A small group of people with this headache have pain on both sides of the head.
Your doctor may diagnose hemicrania continua if you have head pain continuously for at least 3 months without the pain shifting sides or ever going away completely. It's usually moderate, but can fluctuate in severity, at times worsening into brief, piercing head pain.
You may have other symptoms, too, including:
- Eye redness or tearing
- Stuffy or runny nose
- Drooping eyelid
- A small pupil (the black circle in the center of your eye)
Fortunately, hemicrania continua can be treated with a nonsteroidal anti-inflammatory drug (NSAID) called indomethacin (Tivorbex). Usually, this drug provides quick relief, but it can cause stomach side effects, so you might need an acid-suppressing drug.
Another NSAID, celecoxib (Celebrex), can also treat your pain if you can't tolerate indomethacin's side effects. Sometimes, doctors also prescribe tricyclic antidepressants, such as amitriptyline, to prevent these headaches.
About 1 out of 8 Americans has migraines. They usually begin during the teenage years. After puberty, migraines are more likely to affect girls and women.
Experts still aren't sure what causes these headaches. But they seem to involve a wave of unusual activity in brain nerve cells, along with changes in blood flow in the brain.
Though migraines can trigger severe pain in the head, they aren't simply headaches. They often also cause other uncomfortable symptoms, such as:
- Unusual sensitivity to light, noises, and smells
A migraine episode can be a complicated event, with symptoms that change over hours or even days. Migraines tend to progress through several stages:
- Prodromal phase before the migraine
- Aura phase
- Attack phase
- Postdromal phase after the migraine
Early Warning Signs Several hours before the migraine begins -- and sometimes even the day before -- many people with migraines notice unusual sensations. They may feel:
- Either unusually energetic and excitable or depressed
- Cravings for certain foods
- Sleepy, with frequent yawning
- Need to urinate more
In some cases, these symptoms before the headache can help health care providers diagnose the problem as migraines.
Strange Sensations Arise About 1 in 5 people with migraine develop an "aura" that begins before the headache or starts along with it. An aura may not occur with every headache.
An aura can include:
Changes in vision. Often visual symptoms begin first during the aura phase. During a migraine you may experience these vision changes:
- A flickering, jagged arc of light. This may take a complicated shape. It usually appears on the left or right side of your vision. Over a few minutes, it may spread in size.
- An area of vision loss. This problem -- combined with the flickering lights -- can make driving or focusing your eyes on small objects difficult.
- "See" images from the past or hallucinations.
These symptoms may continue to grow more severe over the next several minutes.
Skin sensations. This part of the aura may cause tingling or "pins and needles" sensations in the body. It may also cause numbness. These feelings often affect the face and hands but can spread out across the body. The sensations may continue to expand over the next several minutes.
Language problems. During the aura phase of a migraine, you may have trouble communicating with others. Symptoms may include:
- Difficulty expressing thoughts while speaking or writing
- Trouble understanding spoken or written words
- Trouble concentrating
The Headache Begins The attack portion of a migraine episode can last for a few hours to several days. During this phase of the migraine, the person usually wants to rest quietly and finds normal activities difficult.
A defining quality of migraines is their pain. The pain of a migraine:
- Usually begins above the eyes
- Typically affects one side of the head, but it may strike the entire head or move from one side to the other. It may also affect the lower face and the neck.
- Tends to have a throbbing intensity
- May throb worse during physical activity or when you lean forward
- May get worse if you become physically active
Other symptoms that may arise during this phase include:
- Unusual sensitivity to light, sounds, and smells
- Light-headedness and fainting
- Nausea and vomiting
After the Storm Following the most severe phase of the migraine, you may not feel well for up to a day. Symptoms of this post-migraine phase may include:
- Extreme tiredness
- Head pain that flares up when you lean over, move quickly, or experience a rush of blood to the head
Your overall experience with migraines may change over time. They can change in frequency or severity, and attacks may not always include all of these stages. Also, you may eventually develop the migraine aura without actually having a headache.
Migraine and Headache Symptoms
There are many different types of headaches. Although not all headaches are the same, they all share at least one thing in common -- they cause pain. But many headaches also cause other unwanted symptoms, including nausea and vomiting. This article addresses the most common headache symptoms associated with the different types of headaches.
Tension Headaches People with tension headaches commonly report these symptoms:
Episodic Tension Headaches (occur less than 15 days per month)
- Pain is mild to moderate, constant band-like pain or pressure
- Pain affects the front, top or sides of the head.
- Pain usually begins gradually, and often occurs in the middle of the day
- Pain may last from 30 minutes to several days
Chronic Tension Headaches (occur more than 15 days per month)
- Pain may vary in intensity throughout the day, but the pain is almost always present
- Pain comes and goes over a prolonged period of time
Associated Symptoms of Tension Headaches include:
- Headache upon awakening
- Difficulty falling asleep and staying asleep
- Chronic fatigue
- Disturbed concentration
- Mild sensitivity to light or noise
- General muscle aching
The symptoms of migraine headaches can occur in various combinations and include:
- Moderate to severe pain (often described as pounding, throbbing pain) that can affect the whole head, or can shift from one side of the head to the other
- Sensitivity to light, noise or odors
- Blurred vision
- Nausea or vomiting, stomach upset, abdominal pain
- Loss of appetite
- Sensations of being very warm or cold
- Fever (rare)
- Bright flashing dots or lights, blind spots, wavy or jagged lines (aura)
- Intense one-sided pain described as having a burning or piercing quality that is throbbing or constant
- Pain is located behind one eye or in the eye region, without changing sides.
- Pain lasts a short time, generally 30 to 90 minutes (but can last for three hours); the headache will disappear, only to recur later that day (most sufferers get one to three headaches and some up to eight per day during a cluster period).
- Headaches occur very regularly, generally at the same time each day, and they often awaken the person at the same time during the night.
- Deep and constant pain in the cheekbones, forehead or bridge of the nose
- The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.
Diagnosing Migraines and Headaches
In order to receive proper treatment for headaches and migraines, a correct diagnosis must be made. That means your doctor will first ask you about the history of your headaches. It is important to describe your headache symptoms and characteristics as completely as possible.
Your headaches can be better diagnosed if you tell your doctor:
- How old you were when the headaches started
- How long you have been experiencing them
- If you experience a single type of headache or multiple types of headaches
- How often the headaches occur
- What causes the headaches, if known (for example, do certain situations, foods, or medications trigger the headaches?)
- Who else in your family has headaches
- What symptoms, if any, occur between headaches
- If your school or work performance has been affected by the headaches
It is also important to tell your doctor how you feel when you get a headache and what happens when you get a headache, such as:
- Where the pain is located
- What it feels like
- How severe the headache pain is, using a scale from one (mild) to 10 (severe)
- How long the headache lasts
- If the headaches appear suddenly without warning or with accompanying symptoms
- What time of day the headache usually occurs
- If there is an aura (changes in vision, blind spots, or bright lights) before the headache
- What other symptoms or warning signs occur with a headache (such as weakness, nausea, sensitivity to light or noise, appetite changes, changes in attitude or behavior)
- How frequently you get headaches
You should also tell your doctor if you've been treated in the past for headaches and what medications (both prescribed and over-the-counter) you have taken in the past and what medications are currently being taken. Don't hesitate to list them, bring the bottles, or ask your pharmacist for a printout.
Studies performed by other doctors who may have evaluated your headaches in the past, including X-rays and other imaging tests, are also very important; you should bring these to your appointment. This may save time and repeated tests.
Physical and Neurological Exams to Diagnose Headaches
After completing the headache history portion of the evaluation, the doctor will perform a complete physical and neurological exam. The doctor will look for signs and symptoms of an illness that may be causing the headaches, such as:
- Fever or abnormalities in breathing, pulse, or blood pressure
- Nausea, vomiting
- Changes in personality, inappropriate behavior
- Mental confusion
- Loss of consciousness
- Excessive fatigue, wanting to sleep all of the time
- High blood pressure
- Muscle weakness, numbness, or tingling
- Speech difficulties
- Balance problems, falling
- Vision changes (blurry vision, double vision, blind spots)
Neurological tests focus on ruling out diseases of the brain or nerves that may also cause headaches and migraines. The vast majority of headaches turn out to be benign in nature. Some of the tests look for a physical or structural abnormality in the brain that may cause your headache, such as:
- Brain abscess (an infection of the brain)
- Hemorrhage (bleeding within the brain)
- Bacterial or viral meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
- Pseudotumor cerebri (increased intracranial pressure)
- Hydrocephalus (abnormal build-up of fluid in the brain)
- Infection of the brain such as meningitis or Lyme disease
- Encephalitis (inflammation and swelling of the brain)
- Blood clots
- Head trauma
- Sinus blockage or disease
- Blood vessel abnormalities
- Aneurysm (a "bubble" in the wall of a blood vessel that can leak or rupture)
Psychological Evaluation for Diagnosing Headaches
An interview with a psychologist is not a routine part of a headache evaluation, but it may be done to identify stress factors triggering your headaches. You may be asked to complete a computerized questionnaire to provide more in-depth information to the doctor.
After evaluating the results of the headache history and physical, neurological, and psychological exams, your doctor should be able to determine the type of headache you have, whether a serious problem is present, and whether additional tests are needed. Possible additional tests you may be given include diagnostic tests.
Tests for Diagnosing Headaches
Additional tests may be needed to look for other medical conditions that may be causing your headaches or migraines. These tests are listed below. Keep in mind that most of these laboratory tests are not helpful in diagnosing migraine, cluster, or tension headaches.
- Blood Chemistry and Urinalysis. These tests may determine many medical conditions, including diabetes, thyroid problems, and infections, which can cause headaches.
- CT Scan. This is a test in which X-rays and computers are used to produce an image of a cross-section of the body. A CT scan of the head may be recommended to rule out other conditions if you are getting daily or almost daily headaches.
- MRI. This test produces very clear pictures, or images, of the brain without the use of X-rays. MRI uses a large magnet, radio waves, and a computer to produce these images. A MRI may be recommended if you are getting daily or almost daily headaches. It may also be recommended if a CT scan does not show definitive results. In addition, a MRI scan is used to evaluate certain parts of the brain that are not as easily viewed with CT scans, such as the spine at the level of the neck and the back portion of the brain.
- Sinus X-Ray. Although the CT scan and MRI provide more details, your doctor may use this test if your symptoms seem to indicate sinus problems.
- EEG. Electroencephalogram is not a standard part of a headache evaluation, but may be performed if your doctor suspects you are having seizures.
- Eye Exam. An eye pressure test performed by an eye doctor (ophthalmologist) will rule out glaucoma or pressure on the optic nerve as a cause of headaches.
- Spinal Tap. A spinal tap is the removal of spinal fluid from the spinal canal (located in the back). This procedure is performed to look for conditions such as infections of the brain or spinal cord.
Migraine Headache Treatment
Medical Treatment Drugs for migraine headaches can relieve the pain and symptoms of a migraine attack and prevent further migraine attacks.
Migraines can be treated with two types of drugs: abortive and preventive.
Abortive: The goal of abortive treatment is to stop a migraine once it starts. Abortive medications stop a migraine when you feel one coming or once it has begun. Abortive medications can be taken by self-injection, mouth, skin patch, or nasal spray. These forms of medication are especially useful for people who have nausea or vomiting related to their migraine, and they work quickly.
Abortive treatments include the triptans, which specifically target serotonin. They are all very similar in their action and chemical structure. The triptans are used only to treat headache and do not relieve pain from back problems, arthritis, menstruation, or other conditions. People with certain medical conditions should not take these medications.
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Sumatriptan (Alsuma, Dosepro, Imitrex, Sumavel, Treximet)
- Zolmitriptan (Zomig)
The following drugs are also used for treatment:
- Acetaminophen-isometheptene-dichloralphenazone (Midrin)
- Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
- Ergotamine tartrate (Cafergot)
- Over- the-counter medications such as Advil Migraine (containing ibuprofen), Excedrin Migraine (containing aspirin, acetaminophen, caffeine), and Motrin Migraine Pain (containing ibuprofen)
The following drugs are mainly used for nausea related to migraine headaches, in addition to migraine treatment:
- Metoclopramide (Reglan)
- Prochlorperazine (Compazine)
- Droperidol (Inapsine)
Some drugs are used for headache pain, but are not specific for migraines. These include analgesics, narcotics, and barbiturates. Since they can be habit forming, they are less desirable than specific headache drugs listed above. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.
Preventive: This type of treatment is considered if migraines occur frequently, typically more than one migraine per week, or if migraine symptoms are severe. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Preventive treatment medications include the following:
- Medications used to treat high blood pressure: beta-blockers (propranolol (Inderal), timolol, metoprolol), calcium channel blockers (verapamil (Covera, Verapamil, Calan, Isoptin)
- Antidepressants: amitriptyline, nortriptyline (Pamelor)
- Antiseizure medications: gabapentin (Neurontin), topiramate(Topamax), valproic acid (Depakote)
Some nontraditional supplement treatments for migraine prevention include butterbur, coenzyme Q10, and feverfew. Whether they really help isn't known, because studies have shown mixed results.
If you can't take medication or wish not to, a device is worth considering. Cefaly is the first FDA-approved device for preventing migraines in people over age 18. The portable headband-like device gives electrical impulses on the skin at the forehead. This stimulates a nerve associated with migraine headaches. Cefaly is used once a day for 20 minutes, and when it's on you'll feel a tingling or massaging sensation.
Tips to Help Manage Migraines
Migraines are tough, but you can learn ways to help manage them. From medications, to alternative treatments, to new methods to ease stress and relax, try these tips to keep the pain at bay.
- Follow your migraine treatment plan. Don’t take medications your doctor didn’t order.
- Relieve emotional stress. Take time to unwind and step away from stressful situations. Learn skills that can calm you, like deep breathing and progressive muscle relaxation.
- Lower physical stress. Proper rest and sleep will help you relax and face a new day. If you sit for long amounts of time, get up and stretch often. Relax your jaw, neck, and shoulders.
- Exercise regularly. Try to get at least 30 minutes of exercise on most days of the week.
- Keep a routine. Eat meals and snacks at about the same times during the day. Go to bed and wake up at the same times.
- Quit smoking. It can bring on migraines and make any headache, especially cluster headaches, worse. Ask your doctor how to stop.
- Know your triggers. Keep a diary to learn what sets off your headaches. Avoid these things when possible.
- Practice prevention. If you get headaches around you menstrual period, take preventive medication when your time of the month is near. Your doctor may also prescribe it if your headaches are frequent or severe.
There are also organizations and support groups that may be able to help.
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