THE U.S. NATIONAL Library of Medicine reports that headache is "the most common form of pain. It's a major reason people miss days at work or school or visit the doctor." Headaches are common and we've probably all dealt with them at one point or another, but not all headaches are the same. Tension headaches – brought on by tight muscles in the shoulders, neck, jaw and scalp and often related to stress, anxiety or depression – are the most common. Tension headaches can also be triggered by missing meals, drinking alcohol, not getting enough sleep, hormonal changes, overexertion or even the weather. But they usually go away on their own or with an over-the-counter medication, such as acetaminophen or ibuprofen. Although tension headaches can be painful and annoying, most any migraine sufferer will tell you they pale in comparison to the pain and disability migraines can cause. Migraines are often thought of as very severe headaches, but a patient must experience certain additional symptoms beyond just head pain before being diagnosed with migraine, says Dr. Sana Ghafoor, a neurologist with a headache subspecialty at Geisinger in Danville, Pennsylvania. "You have to have headaches that are not just painful but have other neurological deficits, such as feelings of nausea and sensitivity to bright lights and noises." The National Institute of Neurological Disorders and Stroke reports that about 12 percent of the U.S. population experiences migraines, which often occur as "recurrent attacks of moderate to severe pain that is throbbing or pulsing and often strike one side of the head." These headaches can last up to three days and occur most frequently in the morning. Some people experience auras – visual disturbances that can include blind spots, flashing or bright lights or shimmering effects – immediately before a migraine commences. The key to zeroing in on a migraine diagnosis, Ghafoor says, is that "activity worsens the headache." Unlike for patients with tension headaches, "activity doesn't make a tension headache worse or better. But with migraine, activity almost always makes the headache or the other symptoms worse," and that activity can include anything from trying to work at a computer to exercising or even just making dinner. In the simplest terms, she says that if "every time you get a headache, you have to go sit or lie down in a dark, quiet room, you're probably dealing with migraine." You should consider seeking help for frequent headaches or migraine symptoms "when your headaches start interfering with your daily life, whether that's having dinner with a loved one, getting to work on time or being productive at work or school," Ghafoor says. "If you're requiring over-the-counter medication for headache management for more than two days in a week, you should probably seek help." She recommends starting with your primary care physician. Dr. Kevin Weber, assistant professor of neurology and director of the headache division at the Ohio State University Wexner Medical Center, also recommends checking in with your primary care or family medicine doctor when symptoms begin to interfere with the rest of your life. "I think primary care physicians have varying levels of comfort with headaches and migraine, but it's certainly one of the most common complaints. Migraine is very prevalent in the U.S. and something that most primary care physicians have seen." The American Migraine Foundation reports that 36 million Americans are living with migraine. Even so, depending on the doctor's experience and the severity or complexity of the problem, you may be referred to a specialist for additional treatment. Neurologists are the most likely specialist you'll be referred to for migraine. When looking for the right neurologist to help you with migraine, Weber says you should look for someone who has a subspecialty in headache or migraine. "Neurology is a very subspecialized field now. There are general neurologists who see all sorts of neurological problems, but there's also subspecialists – especially in big cities and academic centers." If you have that range of choice, opt for a doctor with headache or migraine subspecialty, rather than a doctor who focuses on multiple sclerosisor epilepsy, for example. "Generally, I would advise seeing a general neurologist or a headache specialist," he says. While a neurologist is the specialist you'll most likely see for headaches or migraine, there could be other specialists involved with your care, Ghafoor says. Because "headache is a symptom that can be caused by 100 different things," that could mean that other specialists may be called in to help solve the riddle of what's triggering your migraines and how best to treat them. "Sometimes we do a multidisciplinary approach to headache management, which means if you're having head pain, could it be a dental issue? Could it be ear, nose or throat problems? So, having those specialists involved in care with patients who have complicated or refractory cranial facial pain or headaches is incredibly important," she says. When you settle on the right doctor, Weber says one of the most helpful things you can do is bring a log of your symptoms and other details about the headaches you've been experiencing. Include details about how often and how severely you're having these headaches and how you've tried to manage them. "By the time [patients] get to me, they've often tried a number of medications, and sometimes insurance companies require proof or documentation of the previous treatments tried," before they will cover the cost of certain medications. If you have that information, bring it, because "it helps us rule out that we don't need to try again and it helps us out with insurance documentation," he says. Treatment for migraines can largely be lumped into two main categories: abortive, meaning the treatment curtails an attack already in progress; or preventive, which means the treatment keeps a migraine from starting. "Abortive therapy is usually for people who are having episodic migraines – migraines here and there once a month or once a week," Ghafoor says. If you experience headaches more than 15 days out of the month, you may be offered a preventive treatment that you would take every day to help decrease the number of days that you experience headaches. In addition, your doctor may prescribe other medications to help control other symptoms. In addition, "we'll use alternative medicines, alternative treatments, natural supplements, physical therapy and all sorts of different modalities," Weber says. You may also be advised to make lifestyle changes to remove migraine triggers. "For instance, some people identify their triggers as red wine and processed meats, and we eliminate triggers in their environment as much as we can. We encourage patients to improve their sleep, work on their mood, improve hydration, eat regular meals, keep their caffeine intake consistent, exercise" and make other small changes that can add up to substantial improvement. If headaches are a frequent problem for you, it's probably best to get it checked out, Weber says. "It's best to catch patients early on when they first start having severe migraines. It's much easier [treating a patient early on] than treating patients who've had migraines every day for decades." Ghafoor agrees, noting that if you're using a lot of over-the-counter medications to deal with frequent headaches, that can make treating your migraines even more difficult. "Rather than ignoring the headache or brushing it off and continuing to manage it on your own, I would recommend that patients seek out help sooner rather than later, because trying to get somebody off Tylenol or Aleve if they're taking 10 pills a day is incredibly difficult." She says these medications have side effects that we don't often think about and transitioning off them and onto prescription medications can delay relief for patients. When you do decide to visit a doctor, it's also important to realize that it might take some time to find the right management approach for you. But Weber urges you to "not give up." A new class of drugs called CGRP antibodies – which are the first drugs developed specifically for migraine – are just entering the market and offering new approaches to preventing migraine that may work better for some people than other therapies. "It's a pretty exciting time in our field, and we really can help people with their headaches. It's just a matter of getting to the right person if the headaches are disabling," he says. Source
