Headache

Alternative Names

Home Care

Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches. When a headache occurs, write down the date and time the headache began, what you ate for the past 24 hours, how long you slept the night before, what you were doing and thinking about just before the headache started, any stress in your life, how long the headache lasts, and what you did to make it stop. After a period of time, you may begin to see a pattern.

A headache may be relieved by resting with your eyes closed and head supported. Relaxation techniques can help. A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches.

Try acetaminophen, aspirin, or ibuprofen for tension headaches. DO NOT give aspirin to children because of the risk of Reye syndrome.

Migraine headaches may respond to aspirin, naproxen, or combination migraine medications.

If over-the-counter remedies do not control your pain, talk to your doctor about possible prescription medications.

Prescription medications used for migraine headaches include ergotamine, dihydroergotamine, ergotamine with caffeine (Cafergot), isometheptene (Midrin), and triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), eletriptan (Relpax), almotriptan (Axert), and zolmitriptan (Zomig). Sometimes medications to relieve nausea and vomiting are helpful for other migraine symptoms.

If you get headaches often, your doctor may prescribe medication to prevent headaches before they occur. Examples of these include:

• Antidepressants such as nortriptyline (Pamelor), amitriptyline (Elavil), fluoxetine (Prozac, Sarafem), sertraline (Zoloft), or paroxetine (Paxil) for tension or migraine headache
• Beta-blockers such as propranolol (Inderal) for frequent migraine headaches
• Calcium channel blockers such as verapamil for frequent migraine headaches
• Anti-epileptic medicines such as topiramate (Topamax)

If you are using pain medications more than 2 days a week, you may be suffering from rebound headaches. Rebound headaches are caused by a cycle of using pain medications for short-term relief, followed by the headache pain returning for increasingly longer periods of time despite taking more pain medications.

All types of pain pills (including over-the-counter drugs), muscle relaxants, some decongestants, and caffeine can cause this pattern. If you think this may be a problem for you, talk to your health care provider.

When to Contact a Medical Professional

Take the following symptoms seriously. If you cannot see your health care provider immediately, go to the emergency room or call 911:

• Your headache comes on suddenly and is explosive or violent.
• You would describe your headache as "your worst ever", even if you are prone to headaches.
• Your headache is associated with slurred speech, change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss.
• Your headache gets progressively worse over a 24-hour period.
• Your headache is accompanied by fever, stiff neck, nausea, and vomiting.
• Your headache occurs with a head injury.
• Your headache is severe and localized to one eye with redness in that eye.
• You are over age 50 and your headaches just began, especially with impaired vision and pain while chewing.

See your provider soon if:

• Your headaches wake you up from sleep.
• A headache lasts more than a few days.
• Headaches are worse in the morning.
• You have a history of headaches but they have changed in pattern or intensity.
• You have headaches frequently, and there is no known cause.

Your health care provider will obtain your medical history and will perform an examination of your head, eyes, ears, nose, throat, neck, and nervous system.

The diagnosis is usually based on your history of symptoms. A "headache diary" may be helpful for recording information about headaches over a period of time. Your doctor may ask questions such as the following:

• Is the headache located in the forehead, around the eyes, in the back of the head, near the temples, behind the eyeball, or all over?
• Is the headache on one side only?
• Is this a new type of headache for you?
• Would you describe the headache as throbbing?
• Is there a pressure or band-like sensation?
• When does the headache occur? How long have you had headaches? How long does each headache last?
• Does the headache awaken you from sleep? Are the headaches worse during the day and better at night?
• Did other symptoms begin shortly after the headaches began? Do headaches occur repeatedly?
• Does the headache reach maximum intensity over 1 to 2 hours?
• Are the headaches worse when you are lying down? Standing up?
• Are the headaches worse when you cough or strain?
• Do they occur at a specific time related to your menstrual period?
• What home treatment have you tried? How effective was it?

Diagnostic tests that may be performed include the following:

• Head CT scan
• Head MRI
• Sinuses x-rays
• Temporal artery biopsy
• Lumbar puncture

Prevention

The following healthy habits can lessen stress and reduce your chance of getting headaches:

• Getting adequate sleep
• Eating a healthy diet
• Exercising regularly
• Stretching your neck and upper body, especially if your work involves typing or using a computer
• Learning proper posture
• Quitting smoking
• Learning to relax using meditation, deep breathing, yoga, or other techniques

References

Lipton RB, Bigal ME, Steiner TJ, Silberstein SD, Olesen J. Classification of primary headaches. Neurology. August 10, 2004;63(3):427-35.

Snow V. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med. 2002; 137(10): 840-849.

Kaniecki RG. Migraine and tension-type headache: an assessment of challenges in diagnosis. Neurology. 2002; 58(9 Suppl 6): S15-20.