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House Call: Understanding cause of headaches can help with treatment

UPDATED: Mon., March 27, 2017, 6:41 p.m.

Rick Nease color illustration of person with agonizing headache holding on to her cracking skull. (Rick Nease / MCT)
Rick Nease color illustration of person with agonizing headache holding on to her cracking skull. (Rick Nease / MCT)

Let’s spend some time talking about headaches. They vary quite a lot, with pain that may described as dull, throbbing, sharp, grinding or something else.

I divide headaches into the broad groups called primary and secondary. A primary headache is caused by an underlying problem in the pain systems in the brain while secondary headaches are caused by an underlying problem that may need to be treated to treat the headache. An example of a secondary headache would be a headache caused by an infection. Some, like a sinus infection, will likely get better on its own, while others like infection caused by meningitis must be treated or it is life-threatening.

A headache of sudden onset that is severe or that is “the worst headache of your life” may be dangerous and needs emergency evaluation in the ER and may even warrant a 911 call. Other danger signs are that require emergency evaluation are:

Confusion

Difficulty understanding speech

Fainting

Numbness, weakness or paralysis on one side of the body

Neck stiffness

Trouble seeing, speaking or walking

Nausea or vomiting not connected to the flu, hangover, or a known pattern of migraines.

Primary headaches include migraines, tension and cluster headaches. Headaches brought on by excessive coughing, sneezing, straining, sustained strenuous exercise or sex are also generally considered primary headaches. Often primary headaches are migraine or tension headaches triggered by things like too much alcohol, aged or processed meats that contain nitrites, red wine, inadequate sleep, dehydration and, of course, stress.

Migraine headaches typically are accompanied by light and noise sensitivity and when severe cause nausea and vomiting. If you get migraines, try keeping a diary to help you identify triggers. Not everyone can identify triggers, but for those who do, identifying and avoiding them helps immensely.

Many kinds of headaches respond well to relaxation techniques such as meditation and yoga. I have patients with migraine and muscle tension headaches that respond well to chiropractic treatment. Acupuncture has also been shown to be of use for some.

Most primary headaches will usually respond to medications like Tylenol, Advil or Aleve. We are moving away from prescribing narcotic pain medication for most headaches as research has shown that they do not work better than over the counter medications, do not decrease the frequency of headaches over time, and may make them worse. In addition they are sedating, addictive and can be dangerous.

The occasional headache is best treated early with an over the counter medication. Some people get frequent mild and occasional bad headaches. Fear of the occasional bad headache may cause them to over-treat the mild headache in order to avoid that occasional bad one. They are better off ignoring the mild headache as taking even over the counter pain medicine frequently (as in daily or almost daily) can convert the generally mild headache to a more severe chronic daily headache that we call a medication overuse or “rebound” headache. Getting off of daily pain medication is the best treatment for this kind of headache. If you are not able to do that on your own there are treatment protocols that your primary care provider can use to help you.

When should you see your provider for headaches? Aside from the emergency situations that I discussed above, I’d get seen if these are occurring:

Your headache happens more often than usual

Are consistently more severe than they used to be

Get worse or do not improve with over-the-counter pain medication

Prevent you from working, sleeping, or participating in your usual activities.

Remember that we are all different, and what works for one person’s headache may not work for yours. Be open-minded to trying new things to ease your headache pain. If you are not improving over time or are getting worse, see your medical provider.

Dr. Bob Riggs is a family medicine physician practicing at Kaiser Permanente’s Riverfront Medical Center. His column appears biweekly in The Spokesman-Review.


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