My Head Hurts: When to Take Action

Have a headache? Rest assured, you have something in common with fifty percent of the world’s population. According to the World Health Organization, about half of adults have at least one headache each year.

When that familiar pain starts creeping up the side of your head, or settling in the center of your forehead, you’re looking for instant relief. But not all headaches are created equal—read on for answers to your top headache questions, including when you can try over-the-counter medicine and when you should seek immediate medical attention.

I’ve got a headache! What’s going on in my brain?

Although it may feel like it, a headache is not actually a pain in your brain. The brain tells you when other parts of your body hurt, but it can't feel pain itself. Most headaches happen in the nerves, blood vessels (that are inside and outside), and muscles that are outside of a person's head and neck. Sometimes the muscles or blood vessels swell, tighten or go through other changes that stimulate the surrounding nerves or put pressure on them. These nerves send a rush of pain messages to the brain, and this brings on a headache.

What are the common types of headaches and what’s the best way to treat them?

Migraines: A migraine is more than just a regular headache. It is a complex neurological condition in which a bad headache is only one of the symptoms and require diagnosis by a healthcare provider. They tend to run in families and are more common in women than men. Migraines can be preceded by aura, which is a sensory disturbance that can include flashes of light, blind spots and other vision changes or tingling in your hands or face. Preventive medication, rescue medication or a combination of the two might be recommended. Other treatments, such as Botox, nerve blocks, antibody therapy and neurostimulation are also available.

Sinus headaches- Decongestants and other sinus medications will do little to treat the sinus congestion associated with migraines. It’s important to get a diagnosis from a doctor so you can get the proper treatment, which may include preventive or rescue medication from your Primary Care Provider or referral to an ENT provider.

Tension headaches- Over-the-counter non-narcotic pain relievers can be used to treat the occasional tension headache. However, using aspirin, ibuprofen or acetaminophen more than two times per week can result in rebound headaches, so don’t overdo it. Tension headaches can also be relieved with rest, hot or cold showers or placing a cool cloth on your forehead. If they persist, a doctor may prescribe preventive medication in addition to prescription strength non-narcotic pain relievers, nerve blocks, or even manual manipulation with physical therapy or massage.

Cluster headaches- Cluster headaches, a series of relatively short but extremely painful headaches every day for a period of time, require medical intervention, and sometimes brain imaging. Treatment may include prescription medication, oxygen therapy, nerve stimulation or surgery.

When is a headache an emergency?

A headache can be a symptom of a serious condition, such as a stroke, meningitis or encephalitis. Go to a hospital emergency room or call 911 if you're experiencing the worst headache of your life, a sudden, severe headache or a headache accompanied by:

• confusion or trouble understanding speech
• fainting
• high fever
• numbness
• weakness, or paralysis on one side of your body
• stiff neck
• trouble seeing, speaking or walking
• severe nausea or projectile vomiting

What are the latest advancements in treating headache disorders?

There are some devices that can relieve headache pain: the use of a device that targets the nerves in the forehead that has shown success in treating episodic migraine. Another device recently available is a vagus nerve stimulator, which has been used for both migraine and cluster headaches, which can be used to reduce the impact of active headaches. Trials of magnetic stimulation have been shown to relieve migraine with aura. There are newer antibody therapies that have been approved by the FDA which are becoming more widespread and successful in use.

It’s important to discuss headache concerns with your doctor to develop a care plan that works best for you.