Lasting relief
Starts with deciphering your headache pain
by Polly Turner
Not all headaches are created equal. Some are dull, some are throbbing, some grip your temples like a vise. There's the headache from a stuffy nose, or from a conflict with your boss, or from squinting all day at a computer screen. Some of the worst headaches-like migraines-seem to drop out of the blue.
So why identify the type of headache you have? Sometimes it's the only route to lasting relief. Depending on the specific cause of your pain, the ideal remedy may not be an over-the-counter pain pill, but rather anything from managing stress to avoiding a certain food. It could require taking an antihistamine, or getting a prescription for a powerful, targeted drug.
"Even if you have suffered from headaches for years, chances are good they can be successfully treated once you and your doctor identify what's causing them," says Peter Ham, M.D., a family medicine doctor at the University of Virginia Health System's Crossroads Family Practice in North Garden.
Ham is quick to assure that most headaches benefit from a simple solution; "Over-the-counter analgesics like aspirin, ibuprofen, acetaminophen can be great for pain relief, as long as you follow the label directions," he says. But if you have severe or chronic headache pain that interferes with your daily life, chances are good you'll benefit from seeking professional help.
Headache Crash Course
Some of the more common types of headache include:
Rebound headaches Maybe you've never heard of these, but rebound headaches are an unrecognized epidemic, experts say. Even many physicians miss the clues. That's because the sustained headache itself is caused by overuse of prescription or over-the-counter painkillers that are being taken to treat the headache-meaning too much of the cure is the culprit. According to Ivan S. Login, M.D., a neurologist at UVA Health System, "If you are taking more than one or two tablets a day for more than two or three days a week, for months or years regularly, you are at risk." Treatment options vary widely but usually involve discontinuing the offending medications, and substituting a pain reliever with less risk of rebound.
Migraine headaches Typically these arise without any clear trigger but sometimes can be triggered by stress, bright lights or certain foods. Then the classic symptoms arise-starting with a dull ache and progressing to throbbing pain, often on one side of the head. Pain is often accompanied by nausea, vomiting, and sensitivity to sound or light. Preventive measures always include avoiding the triggers and making healthy lifestyle changes. Prescription medications also are available to prevent or treat migraines.
Tension headaches These are caused by muscle tension, which in turn may be linked to physical or psychological stress. These headaches often come with a tightening, band-like sensation around the head. Improved posture or stress-management techniques may ease pain and help prevent future attacks.
Acute Sinusitis This can happen when you have an inflamed sinus brought on by an allergic reaction or an infection. Typically, infection will be accompanied by a yellowish-green nasal discharge with sore throat and fever. Your doctor can easily rule out a sinus infection in an office visit by shining a light through your sinus cavities. The vast majority of so-called sinus headaches are actually migraine, research shows. Even many doctors make this error.
Anytime a headache starts affecting your work or personal life, don't hesitate to get it checked out. Your doctor can help you decipher the pain and find lasting relief.
When When Should I See a Headache Specialist?
"If you feel your primary care physician is on top of the problem and you are comfortable with your level of treatment, that's terrific," says Ivan S. Login, M.D., a UVA Health System neurologist who specializes in severe headaches. "But if your headaches aren't improving or they are worsening, or if there are unusual symptoms surrounding them, that's the time to get help from a neurologist or other specialist."
These doctors devote their careers to diagnosing and treating headaches. They can work to pinpoint the cause of your pain, determine an effective drug or non-drug treatment, or fine-tune your current treatment plan.
Sometimes diagnostic testing may be recommended to rule out a tumor, aneurysm, or other serious potential causes. Painless tests that provide a comprehensive image of the brain include computerized tomography (CT) scans, which rely on computer-directed X-rays; and magnetic resonance imaging (MRI) scans, which use magnetism, radio waves and computer technology.
Adds Login: "We aim to return patients back to their primary care team when the situation has stabilized and hopefully improved."
If you'd like to make an appointment with Dr. Login, ask your doctor to call UVA's Physician Referral line at 1-800-552-3723
This article appeared in the spring 2008 issue of Vim & Vigor, a family health magazine sponsored by UVA Health System. If you don't already receive it at home, sign up today. It's free.