Skip to main content

Headaches

Headaches - Imgflip

What's the deal with headaches?

- 96% of people get headaches at some point in their life.  The other 4% are probably just liars.

- There is an International Classification of Headache Disorders in case you ever feel like giving yourself a headache.  (It's actually a pretty nice site)

- Everyone worries that their headache is due to a brain tumor but in truth, less than 1% of brain tumors show up as headaches.  The ones that should prompt you to call me sooner than later are if you've never had one before and you're over 50, the headache is at its most painful as soon as it starts, it only comes on with exercise or straining, it wakes you up from sleeping at night, or you have anything else going on in your body - fever, stiff neck, rash, weakness, cancer, prenancy, etc.  Those are the times we worry about something else going on - it's not always the case, but those are more concerning.

- You can divide headaches up into primary (tension headaches and migraines are the most common) and secondary (headaches due to another medical or psychiatric condition or trauma).  We don't really know why people get the primary headaches, hence the name, but I'll talk mostly about them here.

- Most people get tension-type headaches.  It's the dull, vice-like sensation around your whole head that you can usually work with to get through your day.  It's typically triggered by physical or emotional stress, excessive caffeine, and a few other things.  Usually these will resolve within a few hours.  Relaxation techniques and biofeedback help a lot and the over-the-counter pain medications like Tylenol (acetaminophen), aspirin and ibuprofen or Aleve (naproxen) help some as well if used occasionally.

- There are some people who get frequent or chronic tension-type headaches, much more frequently and with more impact on their lives.  For these cases, we talk more about daily medications and/or behavioral therapies (cognitive behavioral therapy, acupuncture, physical therapy).

- Migraines are less common than tension headaches but under-diagnosed as about 10-15% of all people get them.  These are different in that they are usually one-sided, pulsating and you need to stop what you're doing because they are that intense.  Sometimes they come along with nausea or strange visual symptoms or a host of other neurologic signs.  They can last for a few hours to a few days and lots of triggers can be involved - smells, foods, stress, lights - pretty much anything.  And then sometimes they just happen for no good reason

- We kinda understand part of why migraines happen - something triggers the release of a bunch of proteins in the brain that start spreading out through the blood vessels which is why for many people it starts with a painless aura before the pain and headache set in.  Imagine a dam springing a leak and then slowly spreading out with the cracks getting bigger.  And just like that situation, the earlier you get there the better.  A few different things help in shutting down this process - caffeine, NSAID's like ibuprofen or naproxen or aspirin and prescription strength medications called Triptans (Imitrex, Amerge, Maxalt are examples).

- "Sinus headaches" in most people are actually migraines and have little or nothing to do with the sinuses or sinus infections.  This is important because these often don't receive the right treatment if you call them sinus headaches.  Lots more information on this here if you're interested or know someone who talks about this.

- There are a bunch of other rare primary headaches that have lots of acronyms and latin names, but they are best saved for Trivia Nights.  Except of course for Stimulus-Induced headache, which you have had if you've ever eaten ice cream too fast or worn a ponytail that was too tight.

- Medication-overuse headaches are another common one out there that is more of a secondary headache syndrome.  If you use any medication for stopping (not preventing) a headache for more than 15 days a month, the thought is that it starts sensitizing you to get headaches more frequently.  These are tough to treat so try not to get to that point.

- We do have some good resources to help out with headaches here if you are interested

A good podcast on headache management (and also some other podcast topics)

Guided meditation for headache management

Some ways to help avoid headache triggers

Labels:

Popular posts from this blog

NSAIDs

Advil and Motrin are ibuprofen, then you have Aleve (naproxen).  Those are the over-the-counter ones.  Prescriptions are Mobic (meloxicam), nabumetone, indomethacin, Toradol (ketorolac), diclofenac, Lodine, and the list goes on.  All of these medications are in a class called non-steroidal anti-inflammatory drugs (NSAIDs). I'm giving you this list because there is mounting evidence that these medications a) don't work as well as we'd thought and b) have some very serious long term side effects we're finding out more about. NSAID's act by reducing the amount of prostaglandins you make in order to reduce inflammation.  However, prostaglandins have a ton of other effects and are involved in the maintenance of just about AIDs and also stronger if they are taken every day and/or around-the-clock.  every other organ system that you have.  The effect is stronger with higher doses of NS NSAID's work best and are best indicated for times when something is r...
Read more

Kidney Stones

I've written about this previously , but it's often hard to explain to people what a 10 is on the "1-10" pain scale if they haven't been in that spot before.  For women who have had children, they generally know what a 10 is, but for men it's a little harder.  When I was a medical student on my psychiatry rotation, we had a patient calmly sitting there saying his pain level was at a 10 and our resident, who was an ex-military sniper with a large skull tattoo on his forearm and a crosshair through the eye, calmly leaned forward and asked, "so if I lit you on fire and ran you over with my truck, you could not be in more pain than you are now, correct?"  The patient changed his answer. Getting to the point, a kidney stone is about the close I can come to describing a 10/10 pain to people who haven't gone through childbirth.  The fundamental issue is similar - your body is trying to move a big solid thing through an opening that was not really desig...
Read more

Pain

Sorry to be a pain I would say about 90% of the comments I hear from people about their pain threshold is that they think they have a high pain tolerance.  Which is statistically impossible unless I just attract people who have a high pain tolerance. We traditionally ask people to rate their pain on a 1-10/10 scale and while we hear a lot of 9's and 10's, I would say that, having been present for a number of them, a 10/10 would be giving birth to a first child.  For those who haven't experienced that, my old psychiatry resident described it as "so if I lit you on fire and ran you over with my truck, you would not be in any more pain than you are now" (he was also a former Marine sniper which might explain that). But this is pretty pervasive throughout the medical system and got me wondering as to how people's understanding of what their pain threshold was matched up to what it really was.  Fortunately, there were researchers who had a yen to poke peopl...
Read more