| What is headache?Headache is a term used to | | | | often as once or twice a week, but not daily. |
| describe aching or pain that occurs in one or more | | | | Women who have migraines often find that their |
| areas of the head, face, mouth, or neck. | | | | headaches occur or worsen around the time of |
| Headache involves the network of nerve fibers in | | | | their menstrual periods.One unique feature of |
| the tissues, muscles, and blood vessels located in | | | | migraines is an unusual sensation that a migraine is |
| the head and at the base of the skull.Almost | | | | about to occur. This sensation is called a |
| everyone has occasional headaches, especially | | | | prodrome. Prodrome symptoms can include |
| when they are sick, tired or otherwise under | | | | fatigue, hunger and nervousness. Not all people |
| stress. Headache is the result of pain signals | | | | who get migraines have prodromes.An aura is a |
| caused by interactions between the brain, blood | | | | complex of neurological symptoms that occur just |
| vessels, and surrounding nerves. During a | | | | before or at the onset of migraine headache. An |
| headache, the pain comes not from the brain. It | | | | aura involves a disturbance in vision that may |
| comes from specific nerves surrounding the skull, | | | | consist of brightly colored or blinking lights in a |
| head muscles, and blood vessels that are | | | | pattern that moves across the field of vision. |
| activated and send pain signals, interpreted by the | | | | Most patients with migraine have attacks without |
| brain as a headache. The reasons why these | | | | aura. About one in five migraine sufferers |
| nerves are activated are not clearly understood. | | | | experiences an aura.TreatmentHow your |
| Most headaches go away on their own or are | | | | migraines are treated will depend on the |
| easily treated with over the counter (OTC) | | | | frequency and severity of attacks. People who |
| drugs.Headache typesThere are two main | | | | have a headache several times per year often |
| categories of headache: primary and | | | | respond well to nonprescription pain |
| secondary.The major types of primary headaches | | | | relievers.There are two types of medications to |
| include: | | | | treat migraines: |
| | | | |
| Tension headache | | | | abortive medications - drugs that are taken |
| Cluster headache | | | | when a headache starts |
| Migraine | | | | preventive medications - drugs that are taken |
| Primary headaches are not caused by other | | | | every day to prevent migraines |
| underlying medical conditions. More than 90% of | | | | Abortive MedicationsMigraine-specific abortive |
| headaches are primary.SecondarySecondary | | | | medications usually are necessary for moderate |
| headaches result from other medical conditions, | | | | to severe migraine headaches. When possible, an |
| such as cerebrovascular disease, head trauma, | | | | abortive medication should be taken immediately |
| infection, tumor, and metabolic disorder. These | | | | after an aura or migraine headache starts. |
| account for fewer than 10% of all headaches. | | | | However overusing abortive medications can lead |
| Head pain also can result from syndromes | | | | to chronic headaches, that occur day after day |
| involving the eyes, ears, neck, teeth, or sinuses. In | | | | without a specific cause or diagnosis. Several |
| these cases, the underlying condition must be | | | | prescription and nonprescription drugs are used as |
| diagnosed and treated. Also, certain types of | | | | abortive medications: aspirin, ibuprofen (Advil, |
| medication produce headache as a side | | | | Apsifen, Motrin, Nuprin and other brand names) or |
| effect.Many people have occasional headaches | | | | naproxen (Aleve, Anaprox, Naprosyn)Effective |
| that get better on their own or go away with | | | | agents available by prescription include: |
| OTC drug treatment. Most of these people never | | | | |
| see a healthcare provider for their headaches, | | | | Triptans - sumatriptan (Imitrex), naratriptan |
| however, there are several circumstances in | | | | (Amerge), zolmitriptan (Zomig) and rizatriptan |
| which an evaluation by a physician may be useful | | | | (Maxalt). Triptan drugs are effective in 60% to |
| or important: | | | | 65% of patients, completely or significantly |
| | | | relieving migraine pain and associated symptoms |
| Headaches that are getting worse over time | | | | within 2 hours of administration. Triptans reduce |
| Severe headaches that start suddenly | | | | inflammation and constrict the blood vessels. The |
| Headaches that start after a head injury | | | | triptan with the longest history of use is |
| Headaches that always occur on the same side | | | | sumatriptan (Imitrex). |
| of the head | | | | Ergots - sublingual ergotamine (Ergomar) and |
| Headaches that are not responding to treatment | | | | dihydroergotamine (Migranal). Ergots cause |
| Severe headaches that interrupt work or the | | | | constriction of blood vessels, but ergots tend to |
| enjoyment of daily activities | | | | cause more constriction of vessels in the heart |
| Daily headaches | | | | and other parts of the body than the triptans, |
| Aggravated by exertion, coughing, bending, or | | | | and their effects on the heart are more |
| sexual activity | | | | prolonged than the triptans. Ergots are not as |
| Tension HeadacheTension headaches are the | | | | safe as the triptans. |
| most common type of headaches. They affect | | | | Midrin. It is a combination of isometheptene (a |
| up to 75% of all headache sufferers. Tension | | | | blood vessel constrictor), acetaminophen (a pain |
| headache is usually episodic but may be chronic, | | | | reliever), and dichloralphenazone (a mild sedative) |
| occurring daily or almost daily for more than 15 | | | | Preventive MedicationsPreventive medication are |
| days a month. This type of headache is linked | | | | prescribed when migraine attacks that don't |
| with tension in neck and scalp muscles, affecting | | | | respond well to abortive medications or adverse |
| blood flow within the skull.Tension headaches | | | | reactions to abortive medications occur, migraine |
| often start in the afternoon or early evening. The | | | | attacks occur too often, complicated migraines. |
| pain is typically on both sides of the head, | | | | Many drugs are listed as potentially useful to |
| pressing or tightening. Some people get tension | | | | prevent recurrent migraine attacks. The drugs in |
| headaches in response to stressful events. | | | | the following classes are useful to prevent |
| Tension headaches usually do not get worse with | | | | recurrent migraine attacks: |
| physical activity (such as walking or climbing | | | | |
| stairs).TreatmentThe occasional tension headache | | | | Beta-blockers. Propranolol (Inderal) and nadolol |
| can be alleviated by a hot shower, massage, | | | | (Corgard) have a good track record of being safe |
| sleep, and through patient recognition and | | | | and effective. Metoprolol (Lopressor) and atenolol |
| avoidance of stress factors.For episodic tension | | | | (Tenormin) are reasonable alternatives. |
| headaches that occur less than three times per | | | | Beta-blockers have been used for many years to |
| week, OTC pain relievers such as aspirin, | | | | prevent migraine headaches. It is not known how |
| acetaminophen (Tylenol) or ibuprofen (Advil, | | | | beta-blockers prevent migraine headaches. |
| Motrin) are convenient and effective. Combination | | | | Tricyclic antidepressants. These medications are |
| products of pain medication with caffeine may | | | | very effective, but often have troublesome side |
| help some people, but also may be habit forming. | | | | effects such as sedation, blurred vision, dry |
| Use of any OTC pain reliever should be limited to | | | | mouth and constipation. The first choice is often |
| no more than two or three days per week. If | | | | amitriptyline (Elavil). Nortriptyline (Pamelor, |
| pain medications are overused, rebound | | | | Aventyl), doxepin (Sinequan), imipramine (Tofranil) |
| headaches may occur on the days that | | | | also can be tried. |
| medications are not taken.Chronic tension | | | | Anticonvulsants. Of the drugs in this class, |
| headaches are more difficult to treat, because | | | | valproate (Depakote, Epival) has the best |
| rebound headaches are common when pain | | | | evidence to support using it for prevention. |
| relievers are stopped. The most effective | | | | Gabapentin (Neurontin) and topiramate (Topamax) |
| medications for treatment of chronic tension | | | | also are effective. It is not known how |
| headaches are tricyclic antidepressants | | | | anticonvulsants work to prevent migraine |
| (amitriptyline HCl, doxepin HCl, nortriptyline HCl). | | | | headaches. |
| However, it is often more effective to prevent | | | | Serotonin antagonists. Methysergide (Sansert) |
| these headaches than to treat them.Some people | | | | has been available for many years and is very |
| are able to treat their tension headaches without | | | | effective. Methysergide prevents migraine |
| medications. An ice compress, a heating pad or a | | | | headaches by constricting blood vessels and |
| massage to any tight areas in the neck and | | | | reducing inflammation of the blood vessels. |
| shoulders can be extremely helpful. Relaxation | | | | However, this medication has side effects that |
| techniques, such as deep breathing exercises or | | | | are potentially very serious and therefore is not |
| acupuncture, may help to decrease the frequency | | | | widely used. |
| of headaches.Cluster HeadacheCluster headaches | | | | Rebound HeadacheIncreasing headache over time |
| are relatively rare, affecting about 1% of the | | | | with repeated use of pain medicines can lead to a |
| population. They are distinct from migraine and | | | | rebound headache. The headache is typically |
| tension headaches. Cluster headaches primarily | | | | located on both sides of the head and is described |
| affect men between the ages of 20 and 40. | | | | as a pressing or tightening type of pain. When |
| Attacks usually occur in a series, or "clusters" of 1 | | | | headache sufferers use too much pain medicine, |
| - 8 headaches per day over a period of several | | | | their headaches often recur. This leads to a |
| weeks to months. The pain is extremely severe | | | | repeated cycle of taking more medicines and still |
| but the attack is brief, lasting 15 minutes to 3 | | | | having headaches. Rebound headache may appear |
| hours. The pain of cluster headache almost always | | | | if: |
| occurs on one side of the head. During cluster | | | | |
| headaches, the eye on the same side as the pain | | | | taking analgesics on 15 or more days per month |
| may become teary or droopy or develop a small | | | | for more than 3 months |
| pupil. There may also be nasal congestion on the | | | | taking opioid or combination medication 10 or |
| affected side of the face.About 80% of cluster | | | | more days per month for more than 3 months |
| headaches occur at night, and in about 70% of | | | | When analgesics are discontinued, the headache |
| patients, drinking alcohol can trigger a cluster | | | | may get worse for several days and it may take |
| headache. Unlike migraine sufferers, those with | | | | up to 30 days to recover from the rebound |
| cluster headache often feel better if they keep | | | | process. Non-drug approaches, such as |
| moving during the headache.TreatmentIt is difficult | | | | biofeedback, relaxation therapy, and exercise, can |
| to stop the pain of a cluster headache that is in | | | | be helpful in reducing both headache frequency |
| progress, because the headache usually | | | | and need for medication.Headache |
| disappears by the time the patient reaches the | | | | TriggersTriggers are not direct causes of the |
| emergency room or doctor's office. Because the | | | | headache, but they facilitate or provoke the |
| onset of cluster headache attacks is rapid and | | | | beginning of an attack. Anything that stimulates |
| may occur several times a day, the best | | | | the pain receptors in the head and neck can |
| approach to treatment is with daily preventive | | | | cause a headache. Some of the more common |
| drugs to decrease the severity and frequency of | | | | triggers for headache: |
| headaches. Lithium (Carbolith, Duralith, Lithane, | | | | |
| Lithobid, Lithonate and others) and verapamil | | | | Emotional triggers: problems at work, success at |
| (Isoptin, Calan, Chronovera, Verelan, | | | | work or school, anticipation, anxiety, an emotional |
| Novo-Veramil) are the two drugs that are most | | | | crisis, a new job. Emotions can bring on |
| effective at accomplishing this. Other drugs used | | | | headaches, keep them going, and make them |
| for this purpose include prednisone (Deltasone, | | | | worse. Emotions don't cause your headaches, |
| Meticorten, Orasone 1, Winpred and others), | | | | they just make you more vulnerable to them. |
| cyproheptadine (Periactin) and methysergide | | | | Environmental triggers: bright light, different kinds |
| (Sansert). Prophylactic medications usually are | | | | of aromas like perfume, tobacco, odors (such as |
| begun early during a cycle of cluster headaches | | | | gasoline), loud noises, altitude, barometric pressure |
| and continued for two weeks longer than the | | | | changes. |
| usual cycle.Abortive treatments include inhalation | | | | Stress triggers: strenuous exercise, excessive |
| of 100% oxygen. Inhaling 100% oxygen for about | | | | physical work at the work place or at school, |
| 15 minutes through a facemask has proven to be | | | | physical sickness, not enough sleep or too much |
| helpful when it is done at the first signs of an | | | | sleep |
| attack. This oxygen must be prescribed by a | | | | Chemical triggers: changes in hormone levels (that |
| doctor and obtained through a medical supplier. | | | | occur during the premenstrual period, during the |
| Other types of drugs that may be effective | | | | post-menstrual period), low blood sugar. |
| when used at the outset of cluster pain include | | | | Food and beverage triggers: caffeine, alcohol |
| the triptans (Imitrex, Maxalt, Zomig, Axert, | | | | (especially red wine), hard cheese, vinegar, hot |
| Amerge), ergotamine (Cafergot) and indomethacin | | | | dogs, chocolate, nuts, MSG (monosodium |
| (Indocin).Migraine HeadacheMigraine headaches are | | | | glutamate), pizza, pork. Foods containing nitrites as |
| less common than tension headaches. About 6% | | | | preservatives can also trigger headaches. Fasting |
| of all men and 18% of all women experience a | | | | or missing meals is a major headache trigger. |
| migraine headache at some time. Migraine | | | | Changes in the weather can change body |
| headache occurs on one or both sides of the | | | | chemistry, and have been known to trigger |
| head. The pain is typically pulsating or throbbing in | | | | headaches. |
| nature. Nausea, with or without vomiting, as well | | | | Heavy cigarette smoking. |
| as sensitivity to light and sound often accompany | | | | Yury Bayarski is the author of - a prescription |
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| migraine attacks are occasional, or sometimes as | | | | headache relief prescription drugs. |