Prevention and Wellness

Answers to Common Headache Questions

Premier Health Specialists’ doctors answer frequently asked questions about headaches.

What is a migraine?

A migraine is an intense headache that lasts for hours or days, and it is usually accompanied by a pounding feeling, according to the American Academy of Family PhysiciansOff Site Icon (AAFP). The pounding often starts in a person’s forehead, side of the head, or around the eyes.

Most migraines start off less strong and gradually get worse, according to the AAFP. Common parts of a persons’ day, including motion, activity, bright lights, and noise, all can make a migraine hurt worse.

In addition to pounding pain, migraines can cause a variety of other issues, according to the AAFP, including:

  • Depressed feelings
  • Irritability
  • Muscle weakness on one side
  • Nausea
  • Prickly, burning sensation
  • Restlessness
  • Trouble communicating
  • Vision issues
  • Vomiting

Migraines are more common in women than in men. While some people get migraines only a couple of times a year, others suffer from these intense headaches daily, according to the AAFP.

For more information about migraines, talk with your doctor.

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How is a migraine diagnosed?

Migraines are diagnosed by talking to your physician about your symptoms, according to the U.S. Department of Health and Human ServicesOff Site Icon (HHS).

Your physician will be able to review your symptoms, family history, medical history, and maybe conduct some medical tests – including blood work, an MRI, and a CAT scan – to decide if your symptoms line up with migraine symptoms, according to the American Academy of Family PhysiciansOff Site Icon (AAFP).

A physical exam will also likely be part of diagnosing your migraine, according to the AAFP.

Talk to your doctor for more information about how migraines are diagnosed.

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How is a migraine treated?

There are a variety of ways to treat migraines, both with behavior changes and medication, according to the American Academy of Family PhysiciansOff Site Icon (AAFP).

Your doctor might have you keep a headache journal to try to help pinpoint what environmental, behavioral, and lifestyle factors are triggering your migraines, according to the AAFP. Avoiding these triggers can help avoid migraines.

Some common triggers, according to the AAFP, include:

  • Bright lights
  • Dehydration
  • Dieting
  • Flashing lights
  • Hormone changes
  • Illnesses, including cold and flu
  • Loud noise
  • Some drinks
  • Some food
  • Some types of medication
  • Stress

If your doctor recommends medication, it might be used to help relieve migraine pain or to help stop migraines before they start.

Other steps the AAFP recommends to help manage migraine pain include:

  • Lying in a dark, quiet room
  • Massaging the scalp with lots of pressure
  • Putting pressure on your temples
  • Sleeping
  • Using a cold compress on your forehead or behind your neck

For more information about treating migraines, talk with your doctor.

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What are the most common types of headaches?

Dr. Richard Kim discusses the most common types of headaches. Click play to watch the video or read the transcript.

 

There are two common types of headache. Tension headaches can affect about 70 to 80 percent of the population. Migraine headaches affect about 12 percent of people. 

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Describe a tension headache. 

Dr. Richard Kim discusses tension headaches. Click play to watch the video or read the transcript.

 

A tension headache lasts anywhere from 30 minutes to seven days. Pain is usually felt on both sides of the head. The headache is mild to moderate in intensity. Tension headaches are not aggravated by physical activity and usually have a pressing or tightening quality to them. Patients may experience light or sound sensitivity. There is no associated nausea or vomiting. People often describe a tension headache in terms of what a migraine is not. A tension headache is not one-sided. It's not pulsating or throbbing. It's not severe and movement does not aggravate it. 

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What are some common symptoms of tension headaches?

Dr. Richard Kim discusses the symptoms of tension headaches. Click play to watch the video or read the transcript.

 

Symptoms of tension headache can include tenderness in the muscles around the head, neck and shoulders. People often describe tension headaches as feeling like there is a band pressing around their head. 

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What are the treatment options for tension headaches? 

Dr. Richard Kim discusses treatments for tension headaches. Click play to watch the video or read the transcript.

 

There is acute therapy for when you get a headache and preventive therapy. If you get tension headaches less than 15 days a month, we use medicines such as over-the-counter NSAIDS, or non-steroidal anti-inflammatory drugs like Ibuprofen or Tylenol. If you experience chronic tension-type headaches, meaning you get headaches 15 or more days a month, we look to try to prevent and decrease the number of headaches from occurring. We use certain medicines like tricyclic anti-depressants and some muscle relaxers. 

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Describe the symptoms of a migraine.

Dr. Richard Kim discusses migraine headaches. Click play to watch the video or read the transcript.

 

Migraine is a headache that lasts anywhere from four hours to three days. It's moderate to severe in intensity and has a pulsating or throbbing quality to it. Migraine pain is usually one-sided. It is aggravated by or causes avoidance of routine physical activity, such as going up and down stairs. Many patients have nausea and/or vomiting with the headache, and also may be sensitive to light and sound. 

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At what age do people most commonly develop migraines?

Dr. Richard Kim discusses when people usually develop migraine headaches. Click play to watch the video or read the transcript.

 

Migraines most commonly start before the age of 40, although they can occur at any age. Even children can get migraines as young as 4 years old.

Migraine headaches are more common in young females, and there is a large association between migraines and hormones. This is seen as we enter puberty, where migraines become more common in girls than in boys. Many women report their first migraine attack did occur around the time of their first menstrual period. 

This pattern of migraines being more common in girls than in boys persists throughout life. Migraines are about three times more common in women than in men. 

When migraines are associated with the menstrual cycle they are called menstrual migraines. Migraines can often settle down during pregnancy. When women go through the hormonal fluctuations of perimenopause, migraines can actually get a little worse. 

Later, when hormone levels settle down during menopause, the migraines often become less frequent or go away.

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Are there other conditions besides the menstrual cycle that can cause migraines? 

Dr. Richard Kim discusses other conditions that can cause migraines. Click play to watch the video or read the transcript.

 

There are many migraine mimics or other disorders that can cause migraine-like headaches. Some common ones are brain tumors, brain aneurysms and tears in blood vessels. Dental issues, such as TMJ (temporomandibular joint) disorders, can also be a trigger or cause of migraine headaches. Even a dental abscess or impacted tooth can trigger a headache.

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Is there is a genetic component to migraines?

Dr. Richard Kim discusses the genetics of migraines. Click play to watch the video or read the transcript.

 

There is a large genetic component to migraines. Migraines do run in families. About 80 percent of people with migraines do report a family history of migraine. Genes associated with migraines have also been identified.

What is a migraine with aura?

Dr. Richard Kim describes a migraine with aura. Click play to watch the video or read the transcript.

 

About 25 percent of people who have migraines experience what we call an aura. An aura is a reversible neurologic symptom associated with a migraine headache. Usually, this is a visual symptom. Some people report flashes of light, dark spots in their vision, or wavy or zigzag lines. Other types of aura can include sensory aura, which can be numbness or tingling in a part of the body, or even language symptoms like slurred speech or trouble getting words out. Auras usually develop slowly and last between five and 60 minutes. Typically they occur before the headache starts.

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What is chronic migraine?

Dr. Richard Kim discusses chronic migraine. Click play to watch the video or read the transcript.

 

Chronic migraine is when a patient experiences 15 or more headache days a month, with eight of those days meeting the criteria for migraine. The criteria for migraine include a headache that lasts between four hours and three days. The headache is typically one-sided, pulsating in nature and moderate to severe in intensity. The headache is aggravated by – or causes you to avoid – routine physical activities, such as going up and down stairs. Migraine headaches are also associated with nausea or vomiting, or light and sound sensitivity.

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What are some triggers for migraines?

Dr. Richard Kim discusses triggers for migraine. Click play to watch the video or read the transcript.

 

There are many types of triggers for migraines. They are often hard to study because not everyone has the same triggers, and people can have many different types of triggers. Some of the common triggers include things like alcohol, wine, aged cheese and stress. What we call stress letdown can also be a trigger. This happens when the stressful event is over. Poor sleep and skipping or delaying a meal can be a trigger. In women, hormonal changes or menstrual cycles can be a trigger.

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What are the treatment options for migraines?

Dr. Richard Kim discusses treatments for migraine. Click play to watch the video or read the transcript.

 

Treatment options for migraines are similar to those for tension-type headaches, and are divided into acute therapies and preventive therapies. For acute therapies we can use over-the-counter medicines like ibuprofen, Tylenol and Excedrin. There are also migraine-specific medicines called triptans, like Sumitriptan or Imitrex. Preventive medications for migraine include prescription medications, such as anti-seizure medications, beta blockers, anti-depressants and natural supplements, such as magnesium and Vitamin B2.

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What are your thoughts on alternative treatments to migraines, such as Botox?

Dr. Richard Kim discusses alternative treatments for migraine, such as Botox. Click play to watch the video or read the transcript.

 

Botox is the only FDA-approved medicine for the treatment of chronic migraine. As defined by the FDA, chronic migraine is when you have a history of migraine with headaches 15 or more days a month, lasting four hours at a time. I do consider Botox to be the first line treatment for chronic migraine, but the limiting factor is insurance coverage for Botox. Insurance companies typically require a patient to try and fail two or three different classes of preventive medicines for migraine before they will approve Botox. Botox, in my opinion, has fewer side effects compared to oral preventive medications, and it is well tolerated.

Botox is given every 12 weeks in a series of 31 injections. The injection sites are across the upper and lower forehead, the sides of the head, the back of the head, the upper neck and in the shoulders.

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What are the pros and cons of using Botox?

Dr. Richard Kim discusses the pros and cons of using Botox to treat migraine. Click play to watch the video or read the transcript.

 

The benefits of using Botox to treat your chronic migraines are that you don’t need to take a daily oral medicine. Botox treatments are needed once every three months. Some downsides of Botox are that you have to get 31 injections every 12 weeks. Botox is effective. A common side effect is pain in the muscles at the injection sites, such as neck pain. Muscle weakness at the injection sites – such as a droopy eyelid, a peaked eyebrow, neck weakness or a heavy feeling in your head – occurs in 2 to 4 percent of people. The injections can also trigger headaches in about 9 percent of people who use Botox. The headache is easily treated with the medicines your doctor already prescribed for you. Overall, Botox is very well tolerated with very few medicine interactions.

How does Botox work?

Dr. Richard Kim discusses how Botox works to treat migraine. Click play to watch the video or read the transcript.

 

So no one really knows the exact answer. One thought is that Botox decreases muscle contraction or tightness, which reduces nerve irritation. Another theory – shown only in mice – is that Botox is able to travel into the brain through nerves that extend through the skull. Once in the brain the Botox may prevent the release of a chemical called CGRP, which is one of the main neurotransmitters involved in migraine pain.

    Are frequent migraines a risk factor for stroke? 

    Dr. Richard Kim discusses migraines as a risk factor for stroke. Click play to watch the video or read the transcript.

     

    Certain patients with migraine are at an increased risk for stroke, but not everyone. Studies show that women who experience migraine with aura are twice as likely to have a stroke. Other risk factors also come into play. If you use an estrogen-containing therapy, such as birth control, you are six times more likely to have a stroke. If you smoke, the risk for stroke increases even more.

    Talk with your primary care doctor to make sure you are doing what you can to lower your risk factors and control them, such as maintaining a stable blood pressure, keeping cholesterol in check and watching for diabetes.

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    A migraine with aura and a stroke have similar symptoms. When should you be concerned?

    Dr. Richard Kim discusses the similar symptoms of migraine with aura and stroke. Click play to watch the video or read the transcript.

     

    Migraine aura symptoms can be scary because they can mimic stroke symptoms. Patients with migraine can get visual symptoms, sensory symptoms like numbness and tingling, speech symptoms and even weakness. These can also be stroke symptoms. Telling the difference between the two can be difficult. Aura symptoms with migraine typically develop gradually over time (at least five minutes). Stroke symptoms usually are sudden in onset. If you have migraine with aura, you get the same symptoms multiple times, whereas with a stroke it is usually a first occurrence.

    If you have new neurologic symptoms that you've never had before, you should be evaluated for stroke.

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    What are cluster headaches?

    Dr. Richard Kim discusses cluster headaches. Click play to watch the video or read the transcript.

     

    Cluster headaches are a different type of primary headache disorder. They belong in the family of headaches called trigeminal autonomic cephalalgias. They can sometimes have symptoms similar to migraines, such as nausea, but they are a different kind of headache.

    Cluster headaches are strictly one-sided headaches, typically around the eye. These are very severe, excruciating headaches lasting anywhere from 15 minutes to three hours. Patients with cluster headaches usually have what we call unilateral, cranial autonomic symptoms such as tearing of the eye, redness of the eye, swelling of the eyelid and a runny nose or stuffy nose, on the same side of the head as the headache.

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    How are cluster headaches treated?

    Dr. Richard Kim discusses treatments for cluster headaches. Click play to watch the video or read the transcript.

     

    Cluster headaches are treated in a multi-pronged approach. We give medicines to try to stop the cluster headaches when the patient has them. These include triptans, which are also used for migraine. Then we do a mini-preventive, or short-term treatment, usually lasting several days or a few weeks. This can give quick, short-term relief. We use different medicines to provide long-term prevention of the headaches.

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    What other conditions have a side effect of headaches? 

    Dr. Richard Kim discusses conditions where headache is a side effect. Click play to watch the video or read the transcript.

     

    That's a hard question. There are more than 300 different types of causes of headache. Most headaches are what we call secondary headaches, meaning some other illness or disorder causes the headache. Examples of secondary headaches are those caused by fever, an infectious cause or illness or brain tumor. Headaches can also be a side effect of blood vessel disorders, especially with the arteries and veins of the head. Metabolic disorders and thyroid disorders are linked to headaches. Anemia and kidney disease can cause headaches, too.

      When should you see a physician or specialist for your headaches?

      Dr. Richard Kim discusses when to see a doctor for your headache. Click play to watch the video or read the transcript.

       

      You should see a physician for your headaches in a couple of different scenarios. If you already have an established diagnosis and you're taking medicine for your headaches and the medicine is not working, you should seek help. 

      You should also see your doctor if you experience any “red flags” with a headache. These are symptoms to look out for that may indicate something more serious going on.

      There's a mnemonic called "SNOOP" for red flags. 

      S = Systemic symptoms or illnesses, such as fevers, weight loss or any history of HIV or cancer. 
      N = Neurological signs such as an altered mental state or seizures.
      O = Onset of headache that is sudden. This is what we call a "thunder clap headache" or a very severe headache that peaks within seconds. 
      O = Older age of headache onset, especially after 40. 
      P = There are four Ps: A Previous headache history that doesn’t match the current headache. A headache with a Postural component: you feel worse when you stand up or lay down. You are Pregnant with a new or worsening headache. A headache that is Precipitated by Valsalva maneuvers (exhaling with mouth and nose closed), such as bearing down on the toilet. 

      Most people experience tension-type headaches and treat themselves with Tylenol or ibuprofen and the headache goes away. Someone with chronic tension-type headache should seek help from a doctor. If you have chronic migraine or cluster headaches, a specialist can help.

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      Are imaging tests used to diagnose headaches?

      Dr. Richard Kim discusses how imaging tests are used to diagnose your headache. Click play to watch the video or read the transcript.

       

      To diagnose your headache, your physician will evaluate your symptoms, take a thorough history and complete a physical exam. The most important thing is to rule out other conditions that could be causing the headaches. This can include conditions like aneurysms and tumors. Imaging of the brain and head can help figure out what’s going on. An MRI of the brain or CT scan of the head may be ordered to evaluate you for other causes. Lab tests may be completed to check for thyroid disease and other disorders that may be contributing to the headaches.

      How can patients manage their headaches and migraines?

      Dr. Richard Kim discusses how patients can manage their headaches or migraines. Click play to watch the video or read the transcript.

       

      To manage your migraines, I recommend keeping a headache diary or calendar. You want to know how often you are getting headaches, how long they last and how severe they are. You can also note any potential triggers or associations between certain foods, stress, weather and your headaches. If there is a trigger that's avoidable, avoid it.

      To manage tension, cluster and migraine headaches, treat the headaches early on. The longer you wait, the harder the headache can be to treat – and medicines may be less effective. Talk with your doctor and come up with a treatment plan for medicines you take when you do get a headache and – if needed – medications to prevent the headaches from starting.

      It's also a good idea to have medicines for mild to moderate migraines as well as medicine for a severe migraine, plus a rescue medicine, if those first and second line prescriptions aren't working.

      If you have light and sound sensitivity, go into a dark and quiet room, lie down, try to take a nap and get some rest. Some people find relief using ice packs on their temples, the forehead, back of the head or on the neck. Other people find that taking a cold shower can also provide some relief.

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      Why do people who work at a computer frequently get headaches?

      Dr. Richard Kim discusses why people who work at a computer often get headaches. Click play to watch the video or read the transcript.

       

      If you find yourself frequently getting headaches while working at a computer, there are steps you can take to prevent them. One is your posture. Poor posture can cause neck pain, and that can trigger headaches. Bright screens and fluorescent lighting can also be triggers for headaches. 

      Think about what you do while at your desk. Ask yourself these questions: Did I have caffeine? Did I have too much caffeine? Are my shoulders too tight? People at work often habitually drink coffee and that can be a trigger for headaches as well. 

      How can weather patterns trigger a headache?

      Dr. Aaron Block discusses how weather patterns can trigger a headache. Click play to watch the video or read the transcript.

       

      Different weather patterns can trigger different types of headaches.

      For some of us, changes in barometric pressure can change our sinuses and cause a headache, Premier Physician Network (PPN) physicians say. For others, a dry and dusty day can trigger allergies that can bring on a headache.

      The National Headache FoundationOff Site Icon (NHF) also says that in some cases headaches can be caused by humidity and temperature changes.

      Talk with your doctor for more information about how weather patterns can trigger headaches.

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      Can headaches triggered by weather changes also be related to allergies?

      Dr. Aaron Block discusses whether headaches triggered by weather changes can also be related to allergies. Click play to watch the video or read the transcript.

         

      Headaches triggered by weather changes can be related to allergies.

      Especially with each change of season – as new plants produce different types of pollen – headaches can be common, Premier Physician Network (PPN) physicians say.

      Allergy-related headaches aren’t the most common kind of headache. Allergy headaches are either sinus headaches or migraines, according to the American College of Allergy, Asthma, and ImmunologyOff Site Icon (ACAAI).

      Talk to your doctor for more information about headaches triggered by weather changes also being related to allergies.

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      What can you do to reduce your risk of developing a headache from weather patterns?

      Dr. Aaron Block discusses how you can reduce your risk of developing a headache from weather patterns. Click play to watch the video or read the transcript.

          

      Frustrated by having to fight a headache when the weather changes? You can start reducing your risk of weather-related headaches by talking to your doctor. 

      Premier Physician Network (PPN) physicians say to keep a headache diary that includes:

      • Anything you ate that was not typical
      • Barometric pressure changes
      • If you were around anyone who was sick
      • Kind of headache
      • Temperature changes
      • Type of headache
      • Where the headache is located in your head
      • Weather pattern changes

      By checking your diary, your doctor can help figure out what is causing your headache and make a plan to help you avoid headaches in the future.

      For more information, talk with your doctor about how to reduce your risk of weather-related headaches.

      Is there maintenance medicine that can help prevent a weather-related headache?

      Dr. Aaron Block discusses whether there is medicine that can help prevent a weather-related headache. Click play to watch the video or read the transcript.

           

      If your weather-related headaches are caused by allergies, there is medicine that can help prevent some of your headaches.

      Allergies that cause you sinus problems, for example, can be fought with a nasal spray to prevent nasal inflammation that can lead to a headache, Premier Physician Network (PPN) physicians say.

      If you have a pollen allergy, you might be able to take a long-term allergy medication to help reduce your sensitivity and curb your headaches.

      Talk to your doctor for more information about maintenance medicine that can help prevent weather-related headaches.


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      Source: Richard Kim, MD, The Clinical Neuroscience Institute; Aaron Block, MD, Franklin Family Practice

      Content Updated: May 1, 2018

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