Carolyn A. Bernstein, MD
Headaches are very common, they are probably the number one or two complaint that people present with to their primary care doctors. There are very few people in this country who haven't had some sort of headache at some time.
Headaches can be caused by all kinds of things. We tend to think of them as either primary or secondary. What that means is that a headache, such as a migraine or a tension headache, would be a primary headache. It’s just a headache in and of itself. Secondary headaches are headaches that come from something else, like head trauma, from a tumor inside the brain, from some sort of infection or other process going on within the body.
There are many different kinds of headaches. Most people have heard of a migraine headache, that's very common. There's also a headache called a tension headache. Many people have suffered from tension headaches at some point in their lives. The old name for tension headaches was a hatband headache. That's the kind of pain that we all get when we're tired or when we've been working hard. It feels like something squeezing our brain, going around our head. There are headaches called cluster headaches where a person will have tearing in one eye and their nose may run on the same side. These are shorter headaches but they're very intense and very, very painful.
Some people are more susceptible to developing headaches than others. Migraines are genetic. They run in families. Even if someone didn't have a clear diagnosis of migraine, a patient may remember a parent or grandparent who had what used to be called a sick headache, where they'd have to go to bed and lie down in the dark. Oftentimes that implies that there's family history of migraine.
With migraines, in particular, there's a real difference between men and women. Women tend to have headaches three times as frequently as men do. We think the reason for that is hormonal. A lot of women who do have migraines notice that their migraines get much less frequent once they go through menopause.
Migraine headaches are often one sided and they're accompanied by vomiting and by light sensitivity. Sometimes people experience changes before they get the headache where they'll see flashing lights, they'll have trouble speaking, or they may get numb on one side of their body or the other.
And then there are headaches that go along with other processes. Headaches sometimes accompany a stroke. That's a good reason why it's important, if you've never had this kind of headache before, to see a doctor or to at least talk with one of your medical professionals.
If a person gets a headache where he or she is suddenly paralyzed on one side of his or her body, develops numbness on one side of the body, discovers they can't speak, or feel like their head is about to explode, or they lose consciousness, even if it's just for a few seconds, that's when it’s important to go to the emergency room and seek immediate medical attention.
An important part of headache management is trying to find out what triggers your particular headaches. It could be bright lights, it could be certain foods that you eat, although not all foods are triggers for all people, it could be the amount of time that you sleep, it could be something as simple as just getting dehydrated. The more that you can work to identify what those triggers are and avoid them, the better you're going to feel.
Medical treatments for headaches include lots of different kinds of medications. I tell people that every medication has side effects and it's really important to ask your health care professional to explain those to you and to give you some written information about potential side effects. There are treatments such as botulinum toxin that can be injected into your head in multiple sites. It can really help if you have a lot of migraines. There is a procedure called a nerve block where half of your head can be almost anesthetized so that you don't feel the pain.
And then there are lots of integrative therapies such as acupuncture, yoga, Tai Chi, changing how you eat, paying attention to your lifestyle. Oftentimes it's a combination of these things that will help someone to feel better.
People often ask if there are long-term health implications from having headaches. Research is beginning to tell us that yes, for certain types of headaches there may be increased health risks, such as cardiovascular risk for women who have migraines. So if you have headaches, you really want to talk to your primary care doctor about it and ask if a referral to a headache specialist is appropriate for you.
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