Q&A with a headache specialist

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Headache is one of the most common health problems in the world. Some 40 million Americans suffer from headaches, but this suffering is often misunderstood.

Because pain is subjective, it is difficult for people who do not suffer from headaches to appreciate its severity and relentlessness. Additionally, there is a stigma attached to complaints of headaches. But headaches, and migraines in particular, reduce quality of life, prevent full participation in work and activities, and even affect mood. Migraine is the most common disabling brain disorder.

Headache specialists, such as internist Chantel Strachan, MD, are part of initiatives to educate more primary care physicians about headaches and migraine. Strachan, who completed a fellowship in headache and facial pain, shared the basics with us.

What is a headache?

Headaches occur when an unknown mechanism activates nerves in your body that send pain signals to the brain. This mechanism is activated by a variety of factors, including stress, sleep deprivation, hunger, alcohol, computer screens, and teeth grinding, to name a few.

A headache can be its own medical condition, and a headache can be a symptom of something else, including:

  • Dehydration
  • Medication side effect
  • Medication overuse
  • High blood pressure
  • Sinus congestion
  • Tumor
  • Migraine

Migraine is not the name of a type of headache. It is a neurological condition that causes recurrent, debilitating headaches and other symptoms, such as nausea and sensitivity to light and/or sound, and each episode can last for weeks.

How can I get rid of a headache?

The most common type of head pain is a tension headache, which can be caused by physical and emotional stress, anxiety, or a head injury. Tension headaches can usually be treated with acetaminophen (Tylenol) or ibuprofen (Advil).

Some people need stronger medications, such as Excedrin for migraine or other over-the-counter medications with added caffeine, and sometimes prescription medications.

Many people find relief through massage, acupuncture, and eating fresh, healthier foods.

When should I see a doctor for headaches?

If a headache does not go away within three days with one of these methods, contact your doctor. It may be a sign that something more than a headache is going on.

When should I go to the emergency room with a headache?

If a headache does not respond to over-the-counter medications and is so severe that it interferes with all activity for a few hours, contact a doctor or go to the emergency room.

If you or someone around you has a headache, watch for other symptoms, such as vision changes, weakness on one side of your face or body, confusion, or changes in walking.

If you notice any of these or other unusual or severe symptoms, contact a doctor or go to the emergency room immediately.

What is migraine?

Migraine is a neurological disease that causes a variety of symptoms, including headaches. Migraine attacks occur when nerves in and near blood vessels are activated and send pain signals to your brain.

The main symptoms of a migraine are intense, throbbing headaches, usually on one side of the head, and the following:

  • sensitivity to light and/or sound
  • blurry vision
  • dizziness
  • upset stomach, including nausea, vomiting, and loss of appetite

Migraine phases

Migraine has four phases. Not all migraine sufferers experience the four phases, and each attack can be different. Some symptoms may occur in more than one phase.

  1. Pre-watch: can be felt up to seven days before the onset of head pain. Signs include cravings, irritability, and fatigue.
  2. Aura: About 17% of migraines include an aura. The most common is visual, usually accompanied by weakness. The aura can last up to 60 minutes before the head pain starts.
  3. Headache: What most people associate with migraine is the third phase, which can include nausea, vomiting, and the need to lie down. The pain lasts at least four hours. The longer you wait to treat the migraine, the longer it will last.
  4. Postdrome: After the headache, symptoms may still be intense, including feelings of confusion or brain fog, similar to a hangover.

The whole migraine attack process can take weeks.

Over the past decade, after more has been discovered about the biochemistry of migraines, new drugs have become available for migraine treatment and prevention. Many drugs aim to reduce the amount of CGRP – the peptide linked to the calcitonin gene – which plays a role in pain in the brain and nervous system. Talk with your doctor if these are good treatment options.

Should I see a headache specialist or neurologist if I suffer from headaches?

If your headache does not warrant a direct visit to the ER (again, watch for unusual symptoms, such as changes in mobility), see a primary care physician first, ideally someone who specializes in headache. A primary care physician can determine if something else is going on, such as high blood pressure, anemia, or depression. A primary care physician is trained to see the big picture, not just to focus on the headache.

Neurologists are great and you may need them, but don’t self-diagnose. Let another doctor refer you to the right specialist.

Headaches can be serious. If you don’t get the help you need, don’t give up. More and more doctors are being trained to provide support.


What do you know about headaches?


Provided by Columbia University Irving Medical Center

Quote: Why does your head hurt? Q&A with a Headache Specialist (September 12, 2022) Retrieved September 13, 2022 from https://medicalxpress.com/news/2022-09-qa-headache-specialist.html

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