Headaches: Treatment depends on your diagnosis and symptoms

Your head hurts. Again. The first step in foiling your frequent headaches is determining what type of headache you have. Sometimes headaches are a symptom of another disease or condition; sometimes there’s no clear cause.

Take a close look at your headache signs and symptoms. Keeping a headache diary might help determine your headache type. Note when your headaches occur, your symptoms, and potential triggers, such as food, stress or changes in sleep.

There are many types and sub-types of headaches. Chronic daily headaches, which occur 15 days or more a month, are one sub-type. Tension-type headaches and migraines are also common sub-types of headaches. They can both be chronic, though they aren’t always. Other types of chronic daily headaches include:

• Hemicrania continua, a one-sided headache that can feel like a migraine
• Primary stabbing headaches, which last for a few seconds and can occur several times throughout the day
• Primary exertional headaches, caused by exercise
• Chronic paroxysmal hemicranias, sharp, one-sided headaches that can cause tearing or a congested nose
• Medication overuse headaches, which occur from overusing pain medications for headaches for at least three months. These headaches occur at least 15 days out of the month.

Other headache types include:

• Cluster headaches, which cause severe pain on one side of the head and occur off and on for weeks over the course of a few months. Cluster headaches are associated with one or more signs and symptoms, such as tearing, nasal congestion and nasal discharge. These occur on the same side as the pain.

Tension-type headaches, the most common variety of headaches:

• Might be felt as a tight band of pain around your head, a dull ache or pressure
• Might cause mild to moderate pain on both sides of the head
• Vary widely in frequency
• Can be occasional
• May occur more than 15 days a month (chronic)
• Last from 30 minutes to a week

Treatment

Most occasional tension-type headaches are easily treated with over-the-counter medications, including:

• Aspirin
• Ibuprofen (Advil, Motrin IB, others)
• Acetaminophen (Tylenol, others)

Daily prescription medications, including tricyclic antidepressants, might manage chronic tension-type headaches. Alternative therapies aimed at stress reduction might help. They include:

• Cognitive behavioral therapy
• Biofeedback
• Massage therapy
• Acupuncture

Migraines are another common type of headache. They affect three times more women than men. Migraines typically:

• Cause pain that is moderate to severe
• Pulsate
• Cause nausea, vomiting, or increased sensitivity to light or sound
• Affect only one side of your head, but can affect both sides
• Worsen with activity such as climbing steps
• Last from four to 72 hours without treatment

Treatment

Migraine treatment is aimed at relieving symptoms and preventing additional attacks. If you know what triggers your migraines, avoiding those triggers and learning how to manage them can help prevent migraines or lessen the pain. Treatment might include:

• Rest in a quiet, dark room
• Hot or cold compresses to your head or neck
• Massage and small amounts of caffeine
• Over-the-counter medications such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) and aspirin
• Prescription medications including triptans, such as sumatriptan (Imitrex) and zolmitriptan (Zomig)
• Preventive medications such as metoprolol (Lopressor), propranolol (Innopran, Inderal, others), amitriptyline, divalproex (Depakote), topiramate (Qudexy XR, Trokendi XR ,Topamax) or erenumab-aooe (Aimovig)

Seek emergency care if you have:

• A very severe, sudden headache
• Headache after a head injury or fall
• Fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
• Pain that worsens despite treatment

These symptoms suggest a more serious condition, so it’s important to get a prompt diagnosis and treatment.

Almost everyone gets headaches, and many are nothing to worry about. But if headaches are disrupting your activities, work or personal life, it’s time to see your doctor. Headaches can’t always be prevented, but your doctor can help you manage the symptoms.