Sorry, I Have a Headache

By Sally L Harris MD, President, Sandia Neurology PC, Albuquerque, NM


Have you ever said this? Do you miss work or social events because of a headache? Has your family changed plans because you had a headache? Do you ever feel these have taken over your life? Ten percent of people, including children, have had migraines and 14 million people have daily headaches. If that’s you or someone you know, then read on.


Before we go any further, if you ever have the worst headache of your life, go to the emergency department or urgent care. Also, if you suddenly have daily headaches for no reason, call your primary care provider or neurologist to discuss.
There are many different types of headaches and each person’s experience is unique. Typically, a migraine is severe pounding pain with nausea and vomiting, usually worse on one side, aggravated by light and noise, lasting between four hours to three days. You may experience warning signs like visual changes, blind spots or tingling. A tension type headache is often less severe or a different duration. Headaches can be caused by trauma, alcohol, lack of sleep, neck spasm, TMJ, eyestrain, foods, sulfites, nitrites, MSG, preservatives, environmental chemicals, odors, and medications.


To better understand your headache, start by keeping a very basic log indicating the date of each headache, how severe it is, and exactly what you took for it. At the end of one or two months, count your monthly total. If you have recorded about 2-3 headache days a month, that is fairly typical, and you can go on to identifying triggers. If you have 15 or more, and they last over 4 hours at a time, you have a chronic headache pattern that will require lifestyle changes and potentially professional medical assistance. Continue to keep the log so you can see if you have any improvement with various strategies.


If you took over eight doses of medication in a one month period, you are at risk for Analgesic Rebound Headache, or headache caused by taking too much headache medication. The brain is prone to becoming dependent on headache medication, and often gives you a headache to remind you to take your next. This is also called Medication Overuse Headache, which is very common, and causes headaches to get worse, not better. Treatment requires you to detox for 2 months by taking less than 8 doses of headache medication a month.





Tips to Reduce Headaches:


1. Get enough sleep, ideally 7-8 hours a night.2. Stay hydrated, especially in dry climates, drinking 8 glasses of water a day or more. When you feel a headache coming on, start by drinking a large glass of water. Often dehydration is the cause of your headache.
3. Avoid overuse of pain medications and over-the-counter pain relief.
4 Try topical ointments on head and neck instead of pills like Tiger Balm, Sore No More, Head On, etc.
5. Try heat or ice pack and massage.
6. Get exercise every day. Walk at least 15 minutes, and work up to 90.
7. Stop smoking, and avoid smoke and air pollutants.
8. Get your eyes checked to make sure you don’t have eyestrain.
9. Discuss any jaw pain with your dentist to rule out TMJ.
10. Work to reduce your stress.
11. Reduce caffeine gradually to minimal or none.
12. Don’t miss meals.
13. Pay attention to your triggers so you can avoid them. There are many possible triggers including foods, alcohol, lights, movements, trauma, hormones, and medications, amongst many others.
14. Just do the best you can. If you make a mistake, just remember learn from the outcome and go on.
15. If you have done all of these and you still have a headache, it is time to call your doctor.


There are dozens of good headache prevention medications that are well tolerated and can be used for the time it takes to get you out of the vicious headache cycle. These can usually be stopped at any time and sometimes more than one medication is used. We order MRIs on patients who do not fit any common headache pattern or whose headaches are associated with any other neurological symptoms. Nerve blocks may help, trigger points may help, or even Botox, which was FDA approved for chronic migraine in 2010.


Controlling frequent headache is a very personal battle, but when you are ready to tackle it, there are many things that can help you even before you see your doctor. Just do your best, and go at your own speed. The battle is yours alone, but your health care providers are there to help you if needed.