Glasgow Daily Times, Glasgow, KY


May 29, 2011

Headaches are common ER complaint

GLASGOW — One of the most common complaints for primary care and emergency room physicians is headaches.  For National Headache Awareness Month, I believe it is important to discuss the most common types of headaches and their treatments. Headaches, especially migraines, are a common cause of lost workdays, lowered quality of life, and economic burden. Hopefully, with some education on causes and treatments, we can alleviate these challenges patients face with chronic headaches.

TENSION headaches — Stress, tension, and muscle tightness are often experienced before a tension headache.  These headaches cause mild to moderate pain often described as tightness or pressure around both sides of head or neck.  The pain waxes and wanes and is usually not worsened by activity.  There are no associated symptoms of nausea, vomiting, or light sensitivity such as with migraines and duration is variable.  Treatment is most effective with aspirin, acetaminophen (Tylenol), or anti-inflammatory drugs such as ibuprofen or naproxen.  If unrelieved by these medications, occasionally a combination of acetaminophen-aspirin-caffeine (Excedrin) can be helpful as the caffeine may have an enhancing effect on the medications.  Occasionally, you may need preventive medications (those taken every day to prevent headaches) if you find yourself taking these medications more than nine times per month.  If you have recurrent tension headaches, discuss with your healthcare provider about options for prevention.

MIGRAINE headaches — These headaches are the second most common headache and lead to the most disability and missed work. Migraine headaches can have many different variations. In about 20 percent of migraines, you may have an aura. An aura is symptoms preceding the migraine which may include flashing lights, spots or zig zag lines in your vision, numbness or tingling, muscle weakness, or change or slurring of speech. The aura may last 20-60 minutes and the pain of a migraine begins shortly thereafter.  The pain from migraine headache usually begins gradually and intensifies to a dull, deep and sometimes throbbing or pulsatile pain which in many patients can be on one side or less often the entire head.  It is usually worsened by light, sneezing, straining, motion, or physical activity and you may want to simply lie in a quiet, dark room. You may also have associated nausea or vomiting. The headache usually lasts hours but occasionally may last for up to three days. Treatment involves both acute and preventive treatment and avoidance of triggers.  Acute treatment involves an anti-inflammatory (ibuprofen or naproxen), aspirin or acetaminophen, anti-nausea medications, and triptans (i.e., Imitrex, Maxalt, Zomig, Relpax, etc.) most commonly used to successfully abort migraine headaches.  Triptans are available in oral, nasal, and injectable preparations.  If you are experiencing migraine headaches more often than nine times per month, then preventive medications should be discussed with your primary care physician or neurologist. Also, you may find certain foods, medications, perfumes, cigarette smoke, or alcohol may trigger your migraine headaches and avoidance of these may cut down on your need for medication. This can often be accomplished by keeping a headache diary as you may notice an association of these triggers with your headaches.

CLUSTER headaches — These headaches are uncommon affecting less than one percent of people with men affected more commonly than women with peak age of onset at 25 to 50 years of age.  As with the name, these headaches occur in “clusters” for weeks to months before relenting to a period of no headaches. These are severe, debilitating headaches that occur quickly without warning signs or symptoms and reach a peak within minutes. They are always on one side and usually around one eye or your temple with the pain of a cluster headache described as deep, continuous, excruciating, and explosive pain.   You may have associated tearing and redness of the affected eye, stuffiness and runny nose with neurologic symptoms being rare.   They are usually short in duration (30 minutes to 3 hours) but may happen up to 8 times per day.  Drinking alcohol has been shown to be a headache trigger.  Treatment involves both acute and preventive therapies. Acute therapies include inhaling 100% oxygen via a face mask for 20 minutes in a medical setting or triptans (usually through injection or nasal spray) as are used for migraines.  Most people with cluster headaches require some preventive treatment until the “cluster” of headaches has passed.  For more information on prevention, please discuss with your primary care provider.

OTHER headaches — Chronic daily headaches are usually a type or some combination of the headaches previously discussed and occurs more than 15 days for at least 3 months. Often, you may find with this diagnosis a vicious cycle leads to medication-overuse headaches or MOHs.

MOHs occur in patients who have frequent migraine, cluster, or tension headaches leading to overuse of pain medications and rebound headaches. You may prevent these headaches by avoiding butalbital (Fiorinal, Fioricet, Dolgic) and narcotics (hydrocodone, oxycodone, etc.) which are habit forming and leading to MOHs.  Do not use triptans or Excedrin for more than nine times per month and an anti-inflammatory (ibuprofen) for more than fifteen days per month.

Sinus headaches as the name suggests are associated with sinus infections and are described as a dull ache and pressure over the sinuses. Post-Trauma headaches occur one to two days after a head injury and described as a generalized dull ache, constant and worsen intermittently.  It may occur up to months, but should resolve.  Traumatic headaches that do not resolve or worsen warrant further evaluation.

The vast majority of headaches are not life threatening.  In addition, the majority of headaches are not brain tumors. Roughly 50 percent of patients with brain tumors have daily headaches associated with nausea or vomiting and are often worsened with bending or movement.  People evaluated for headaches rarely are found to have tumors.  However, there are danger signs with headaches that should signal you to seek immediate medical attention.


— Sudden headache, severe in seconds to minutes, and “worst headache of your life”

— Severe headache with fever and stiff neck

— Headache with seizure, loss of consciousness, or confusion

— Headache after strenuous exercise or head injury

— New headache with weakness, numbness, or visual changes

The many types of headaches often make a diagnosis and treatment difficult. Hopefully, with this information, you can take steps to better improve your quality of life and live an uninterrupted life without headaches.

Dr. Andy Turner specializes in Internal Medicine and is a member of TJ Health Partners. For more information, please call Dr. Turner at (270) 659-3163.

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