Headaches: Treatment depends on your diagnosis and symptoms

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Headaches: Treatment depends on your diagnosis and symptoms

Your head hurts. Again! The first step in thwarting your recurring headaches is to determine what type you have. Sometimes headaches are a symptom of another disease or condition. In other cases, no clear cause can be found.

To better understand your headaches, take a close look at your signs and symptoms. To aid in diagnosis, your doctor may suggest you keep a headache diary in which you note when your headaches occur, what your signs and symptoms are and any triggers you can identify.

Are the headaches dull and achy?

Tension-type headaches, the most common variety of headaches:

  • Often feel like a tight band around your head
  • Usually cause mild to moderate pain on both sides of the head
  • May be triggered by stress, neck strain, missed meals, depression, anxiety or lack of sleep
  • May occur occasionally or more than 15 days a month (chronic)
  • Can last from 30 minutes to an entire week

Most intermittent tension-type headaches are easily treated with over-the-counter medications, including:

  • Aspirin
  • Ibuprofen (Advil, Motrin IB, others)
  • Acetaminophen (Tylenol, others)

In addition, alternative therapies aimed at stress reduction may help. They include:

  • Meditation
  • Relaxation training
  • Cognitive behavioral therapy
  • Biofeedback
  • Massage

Are the headaches throbbing and severe?

Migraines affect three times more women than men. Migraines:

  • Often are accompanied by nausea, vomiting, or increased sensitivity to light or sound
  • May affect only one side of your head
  • May include pain that worsens with routine activity
  • Untreated, typically last from four to 72 hours

Migraine treatment is aimed at relieving symptoms and preventing additional attacks. If you know what triggers your migraines, avoiding those triggers will help prevent headaches. Treatment may include:

  • Over-the-counter medications
  • Prescription medications
  • Rest in a quiet, dark room
  • Hot or cold compresses to your head or neck
  • Massage and small amounts of caffeine

Do the headaches recur for weeks at a time?

Cluster headaches, which are rare, occur off and on for weeks at a time. At least one episode usually occurs at the same time of day or night. During a cluster period, which can last for several months, you may experience one or more cluster headaches a day. These headaches, which occur more often in men than in women and more often in smokers:

  • Typically begin quickly without warning and reach maximum intensity within minutes
  • Usually affect just one side of your head
  • May be accompanied by tearing or redness of the eye or a droopy eyelid on the affected side of the head and a runny or stuffy nose
  • Typically last from 15 minutes to three hours
  • May cause a sense of agitation

Because the pain of a cluster headache strikes suddenly and may subside quickly, over-the-counter pain relievers aren't effective. Steps that may help include:

  • Preventive medications
  • Injectable medications, such as sumatriptan (Imitrex, Sumavel Dosepro, others), for quick relief during an attack
  • Prescription triptan nasal sprays, such as zolmitriptan (Zomig) or sumatriptan (Imitrex)
  • Inhalation of 100 percent oxygen through a mask
  • Pacing, rocking or head rubbing because most people feel restless during a cluster headache

Do you have headaches nearly every day?

Chronic daily headaches are headaches that occur 15 days or more a month. The term encompasses different types of headaches that are characterized by their frequency and duration. The signs, symptoms and time frame vary depending on the type of headaches you have, and the pattern of signs and symptoms may change over time. An accurate description of your headache symptoms will help your doctor diagnose your condition and determine the best course of treatment.

Treatment for any underlying diseases or conditions often stops chronic daily headaches. When no underlying diseases or conditions are present, treatment focuses on preventive medication.

Do you take pain medication more than 2 or 3 days a week?

Medication-overuse headaches can affect anyone who has migraines, tension-type headaches or other chronic headaches and uses pain relievers several times a month. Sometimes called rebound headaches, medication-overuse headaches:

  • Are often described as dull, achy, throbbing or pounding
  • May awaken you early in the morning and continue throughout the day
  • May be most severe at first, when the medication begins to wear off
  • Occur daily or nearly daily
  • May involve nausea or irritability

The only way to stop medication-overuse headaches is to reduce or stop taking the medication that's contributing to these headaches. Talk to your doctor about whether you should quit taking the medication or taper off gradually.

Do the headaches follow a specific activity?

Uncommon primary headaches, also known as exertional headaches, can occur as a result of exercise, sex, bouts of coughing or other activities. Before diagnosing an uncommon primary headache, your doctor may recommend tests, such as an MRI, to determine that nothing serious is causing your headaches. Each type of exertional headache has its own set of characteristics.

Exercise-induced headaches:

  • Are often described as throbbing
  • Affect both sides of your head
  • May last from several minutes to 48 hours

Sex headaches:

  • May begin as a dull ache, with the pain escalating just prior to orgasm
  • May be explosive and throbbing, occurring just at the moment of orgasm
  • Can last from a few minutes to a few hours, depending on what type you experience

Cough headaches:

  • Are typically sharp and stabbing in quality
  • Affect both sides of your head
  • May last from a few seconds to a few minutes

Uncommon primary headaches are unusual, but if your headaches are predictable or chronic, your doctor may prescribe preventive medicine.

Recognize emergency symptoms

Seek emergency evaluation if any of the following features are present.

  • Sudden onset of severe headache
  • Onset after a head injury or fall
  • Fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
  • Pain worsens despite rest and over-the-counter pain medication

These symptoms suggest a more serious underlying condition, so it's important to get prompt diagnosis and treatment.

Take control

Almost everyone gets headaches, and most are nothing to worry about. But if headaches are disrupting your daily activities, work or personal life, it's time to take action. Headaches can't always be prevented, but your doctor can help you manage the symptoms.

Last Updated: 2012-08-17
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