Headaches

Headaches, we have all had them. Everyone describes them differently. According to the Mayo Clinic, “Headache is pain in any region of the head. Headaches may occur on one or both sides of the head, be isolated to a certain location, radiate across the head from one point, or have a viselike quality. A headache may appear as a sharp pain, a throbbing sensation or a dull ache.” They can be triggered by diverse sources: high blood pressure, lack of sleep, sinus infections, unusual odors, poor vision, and the common cold. In this article, I will discuss the most common headaches seen in the clinic setting and the best form of treatment.

Migraine headaches …

● Are more common in women than men.
● Are thought to be a hereditary trait passed by the mother.
● Can be caused by a concussion or a brain tumor.
● Can last a lifetime, occur at any time, last from hours to months.
● Can have a unilateral location.
● Are described by most patients as pulsating, throbbing, mild to severe head pain that is made worse by movement, sound, and light.

Signs and symptoms

● Nausea
● Vomiting
● Sensitivity to light and sound
● Auras (flashing lights) but not always the case

Triggers

Stress, lack of sleep, and unusual odors

Treatment

By the time I see patients who have migraine headaches, they have already tried over the counter medications (OTC) such as Excedrin and Advil and are either being treated by a neurologist or seeking a neurology consult.

● The best treatment for migraine headaches is to identify the triggers and avoid them. However, this may not always be so simple.
● Resting in a quiet and dim environment is highly effective.
● The most common medications prescribed in the clinical setting include Fioricet (Butalbital/Caffeine/Acetaminophen), Sumatriptan, Maxalt, Cambia, Frova, and Butorphanol.
● There are newer medications on the market that are designed to reduce the amount of migraine headaches that patients have in a month, help reduce the amount of time missed from work, reduce the number of medications used to treat migraines, and improve quality of life.
o These are the CGRP Inhibitors (Aimovig, Ajovy, and Emgality) that act on the CGRP peptides to prevent vasodilatation of the blood vessels in the brain and the spread of inflammation and pain triggered by migraine headaches.
o I recently began prescribing these medications to my patients and have seen mixed results but with very few side effects.

Please follow up with your healthcare provider for more information on these medications.

Patients with chronic migraines may have excellent coping skills, while others have depression and mood changes because they have constant cerebral pain. I am not making an excuse for them to behave certain ways, but I do want you to try to put yourself in their shoes. Be empathetic and compassionate.

Depending on the severity of the migraine headaches, a psychiatric referral may be needed to treat depression and mood.

Tension Headaches

What are tension headaches?

● Tension headaches are the most common type of headaches.
● They occur at any age, at any time, and can last from several minutes to several days.
● Tension headaches tend to affect the occipital and frontal temporal lobes of the brain.

Signs and Symptoms

● Patients will experience a band-like sensation (nicknamed the baseball cap headache) with a gradual onset that progressively gets worse with increased activity.

Triggers

● Stress, lack of sleep, and trauma

Treatment

● The best treatment for a tension headache is rest, relaxation, and over-the- counter (OTC) NSAIDs such as Aleve, Advil, or Tylenol.

Aneurysms (Subarachnoid Hemorrhage)

3.) What are aneurysms?

If you, a family member, or anyone ever says these words, “This is the worst headache that I’ve ever had,” I want you to call 9-1-1 immediately! You or some that you love may be experiencing a ruptured brain aneurysm, which occurs when the blood vessels rupture and bleed in the spaces surrounding the brain. (For safety’s sake, please do not drive yourself to the hospital!) Aneurysms have a low survival rate. Your health can deteriorate very quickly, which is why calling 9-1-1 is important.

Signs and Symptoms

● Sudden severe headache
● Nausea and vomiting
● Stiff neck
● Blurry vision
● Sensitivity to light
● Seizures
● Drooping eyelids
● Dilated pupils
● Pain located above and behind the eye
● Loss of consciousness
● Weakness
● Numbness

These complaints of symptoms should not be ignored! NSAIDs are not recommended because of their anticoagulant properties. Opioids are safe and effective in this situation and will be administered in the ER or during surgery.

A survivor of a brain aneurysm told me that he felt as if his head was going to explode. So please, be mindful of how you are feeling if you or anyone has a headache.

Unruptured brain aneurysms do exist. They can be small or enlarged and are often discovered when patients are being evaluated for another condition. There are many causes for a brain aneurysm: drug and alcohol abuse, increased stress, a head injury, excessive physical activity, increased caffeine intake, stress, and high blood pressure.

Treatment

● The best treatment plan is to live a healthy lifestyle and follow up with your primary physician
for annual physicals.