Care for Headaches

Do you have a sudden, severe headache now? A sudden, severe headache with no known cause is a symptom of stroke and aneurysm. Call 9-1-1 immediately.

Approximately 30 to 40 million Americans suffer from chronic, recurring headaches that interfere with their ability to function well and enjoy life. Fortunately, most headaches are not signs of a more serious condition. However, you should see your family doctor or internist if any one of the following statements is true:

• You have three or more headaches per week.
• You must take pain reliever every day or almost every day.
• You need more than recommended doses of over-the-counter medications to relieve headache symptoms.
• You have a stiff neck and/or fever in addition to a headache.
• Your headache is accompanied by shortness of breath, fever, and/or unexpected symptoms that affect your eyes, ears, nose or throat.
• You are dizzy, unsteady or have slurred speech.
• You experience confusion or drowsiness with your headache.
• Your headaches begin and persist after a head injury.
• Your headache is triggered by exertion, coughing, bending or sexual activity.
• Your headache keeps getting worse and won’t go away.
• Your headaches have changed in character.
• You have persistent or severe vomiting along with your headache.
• You have your “first and/or worst” headache.
• Your headaches begin after you reach age 50.

What Type of Headaches Do You Have?

Not all headaches are alike. Doctors typically group them into four categories:

Tension-type headache

• Usually temporary and harmless, often requiring no professional treatment
• More than 90 percent of adults have experienced them
• Pain is steady and aching on both sides of the head
• May become chronic and require evaluation and treatment

Chronic daily headache

(Sometimes also called a “transformed migraine”)

• Begins early in life and becomes chronic by age 30-40
• Pain is dull to moderate, but can escalate to severe
• Interferes with daily activities
• Patients frequently take pain medication, which can lead to rebound headaches

Migraine headaches

• Less common than tension headaches
• Affects more women than men
• Throbbing pain affects one side of the head
• Involves sensitivity to light and may cause nausea without vomiting
• Patient may see an “aura” before pain begins (patient sees circles, zigzags)

Cluster headaches

• Relatively rare, about 1 percent of population
• Mostly affects men
• Come in groups, or clusters, lasting weeks or months
• Pain centers around one eye, which may be inflamed or watery
• Pain is severe, but brief, lasting no more than two hours
• “Alarm clock” headache—awakens one from sleep

If your doctor’s treatment doesn’t relieve your headaches, your doctor may refer you to Lehigh Valley Hospital and Health Network’s Headache Center. Ask your doctor about our program; we require a physician referral. Your first visit will be detailed and thorough, lasting from 1 to 1-1/2 hours. It includes:

• Detailed headache and medical history
• Review of previous diagnoses and treatments
• Neurological and physical exam

In most cases, your treatment will be planned during this first visit. However, sometimes we need additional tests, and you’ll have to come back for another meeting with the headache team. Be sure to bring:

• A list of your current and past prescriptions and over-the-counter medications, including dose and frequency
• Information about your medical and surgical history
• X-rays, scans and/or copies of other doctors’ records, if you have them
• Your insurance card and any referral forms required by your insurance

Treatment

Your treatment plan will be individualized based on your current and past symptoms and treatments. We have many different tools we can use to help you fight your headaches, including:

• Drug Therapy -- This is based on your diagnosis and your previous responses to therapy. Botulism toxin (Botox®) treatments are used for certain types of headaches.
• Lifestyle Modification -- Nutrition and sleep education may help you understand the causes of your headaches and the basis for effective treatment.
• Biofeedback Training -- This nondrug therapy helps you be an active participant in reducing your headache symptoms.
• Physical Medicine and Activity Therapy -- This includes physical therapy, exercise, stress management and relaxation techniques, including massage and acupressure, which are extremely helpful to many patients.
• Acupuncture, Acupressure and Pain Management -- Some patients benefit from acupuncture and trigger-point injections by pain management specialists.
• Psychological Treatment -- Doctors may recommend group therapy sessions or individual psychological or psychiatric counseling.

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