Headaches. We’ve all had them. They can feel like a cloud stuck inside your head, they can be a crushing or pressured feeling, intense or stabbing. They can be triggered by many different 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 clinical setting and the best form of treatment.

Migraine Headaches

Migraine headaches are more common in women than men. It is thought to be a hereditary trait passed by the mother. However, there are other causes of migraines, such as a concussion or a brain tumor. They can last a lifetime, can occur at any time, and can last from hours to months. The location of a migraine are typically unilateral, but can be bilateral. Sensations experienced by most patients include pulsating, throbbing, and mild to severe head pain made worse by movement, sound, and light. Symptoms may include nausea, vomiting, and sensitivity to light and sound. Some patients may experience auras (flashing lights) but this is not always the case.  Migraines are triggered by stress, lack of sleep, and unusual odors.


By the time I see patients with migraine headaches, they have already tried over the counter medications (OTC) such as Excedrin and Advil, and are either being followed 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 simple. Resting in a quiet and dim environment is very 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 amount of medications used to treat migraines, and improve their quality of life. 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 the resultant pain triggered by migraine headaches. I recently began prescribing these medications to my patients with mixed results and 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, annoying cerebral pain. Though there is no excuse for bad behavior, try to realize what they are experiencing. Be empathetic and compassionate. Depending on the severity of migraine headaches, a psychiatric referral may be needed to treat depression and mood.

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. Patients will experience a band-like sensation (nicknamed the baseball cap headache) with a gradual onset that progressively gets worse with increased activity. It’s triggered by stress, lack of sleep, and trauma. The best treatment for a tension headache is rest, relaxation, and over the counter (OTC) NSAIDs such as Aleve, Advil, Ibuprofen, or Tylenol.

Aneurysms (Subarachnoid Hemorrhage)

If you, a family member, or anyone for that matter 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 someone that you love may be experiencing a ruptured brain aneurysm. An aneurysm occurs when the blood vessels rupture and bleed in the spaces surrounding the brain. There is a low survival rate. Your health can deteriorate very quickly and is why it is very important to call 9-1-1 rather than drive to the nearest emergency room (ER) yourself. Symptoms include a 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, and 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. Survivors of a brain aneurysm have told me that they felt as if their head was going to explode. Consequently, be mindful of how you are feeling if you or anyone has a headache.

Unruptured brain aneurysms do exist. Small or large, they are often discovered when patients are being tested for another condition. There are many causes for brain aneurysm that may include drug and alcohol abuse, increased stress, a head injury, excessive physical activity, increased caffeine intake, and high blood pressure.

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


American Migraine Foundation. (2019). Navigating Life with Migraine. Retrieved from https://americanmigrainefoundation.org/living-with-migraine/migraine-essentials/ NIH. (2019). Cerebral Aneurysm Fact Sheet. Retrieved from

NIH. (2019). Cerebral Aneurysm Fact Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Cerebral-Aneurysms-Fact-Sheet

Peterschreiber.media. (2019). Man with a headache – Stroke -3D Illustration [Illustration ].