Headache

Alternative names:

cephalalgia; pain in the head

Home care:

Headaches may be relieved by resting with the eyes closed and head supported, or by relaxation techniques such as meditation. A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches.

Over-the-counter pain medications are often effective headache relievers. For tension headaches, acetaminophen (Tylenol), aspirin, or ibuprofen (Advil or Motrin) are often effective. Migraine headaches will often respond to aspirin or naproxen (Aleve); studies have also shown Migraine Strength Excedrine to be quite effective. Avoid giving aspirin or other salicylates to children, because of the risk of Reye's syndrome and other disorders.

Prescription medications used for migraine headaches include mixtures of ergotamine and caffeine (Cafergot), Midrin, sumatriptan, and others. Sometimes medications for nausea and vomiting are helpful.

Medications may be given prophylactically to prevent headaches before they occur. Examples of these include nortriptyline, atenolol, and verapamil.

If you are using pain medications more than 2 days a week you may be suffering from rebound headaches. Rebound headaches are caused by a cycle of using pain medications for short-term relief, which is then followed by the headache pain returning for increasingly longer periods of time despite taking more pain medications. All types of pain pills (including over-the-counter pain pills such as acetaminophen, aspirin, ibuprofen, and naproxen), muscle relaxants, some decongestants, and caffeine can cause this pattern. If you think this may be a problem for you, talk to your health care provider. To treat rebound headaches, stop taking all pain medications and other possible triggers for several weeks. Ask your health care provider what treatments can be used during the withdrawal period.

Call your health care provider if:

The following symptoms are serious; see the health care provider promptly:

• the headache comes on suddenly and is explosive or violent.
• the headache gets worse over time or is associated with visual difficulties, slurring of speech, problems in moving arms or legs, or similar problems.
• the headache is associated with fever and a very stiff neck.
• the headache is associated with head injury.
• the headache is the worst you have ever had and comes on suddenly.

For the following, see the health care provider soon, but not as an emergency:

• the headache has persisted more than a few days.
• the headaches are worse in the morning, no other symptoms are present.
• you have headaches frequently and there is no known cause such as allergies or chronic sinusitis.

What to expect at your health care provider's office:

A history will be obtained and an examination of head, eyes, ears, nose, throat, neck, and nervous system will be performed.

The diagnosis is usually based on the history given by the patient. A "headache diary" may be helpful for recording information about headaches over a period of time. Medical history questions documenting headache in detail may include:

• location
  • Is the headache located in the forehead or around the eyes (frontal or periorbital)?
  • Is the headache located in the back of the head (occipital)?
  • Is the headache located near the temples (temporal)?
  • Is the headache behind the eyeball (retrobulbar)?
  • Is the headache all over (generalized)?
  • Is the headache on one side only (unilateral)?
    • Is the headache always on same side?
• quality/type
  • Is this the worst headache in the patient's experience?
  • Is this a new type of headache for the patient?
  • Would the headache be described as pulsating (throbbing)?
  • Is it severe?
  • Is it moderately severe?
  • Is there a pressure or band-like sensation?
• time pattern
  • Does the headache occur upon awakening in the morning?
  • Did the headaches begin with this episode of illness?
  • How long have you had headaches?
  • How long does each headache last?
  • Does the headache awaken you from sleep?
  • Did other symptoms begin shortly after the headaches began?
  • Did the headaches begin suddenly?
  • Do headaches occur repeatedly (recurrent)?
    • Do they occur multiple times daily?
    • Do they occur over a period of weeks?
  • Are the headaches worse during the day and better at night?
  • Does the headache reach maximum intensity over 1 to 2 hours?
  • Did they develop rapidly?
  • At what age did headaches begin?
• aggravating factors
  • Are the headaches worse when lying down or in a reclining position?
  • Are the headaches worse when standing up?
  • Are the headaches worse when coughing, sneezing, straining, lifting (Valsalva maneuver)?
  • Are headaches triggered by reminders of a traumatic event?
  • Do they occur at a specific time related to your menstrual period (women)?
• relieving factors
  • What home treatment have you tried?
  • How effective was it?
  • Is the headache relieved by medication that contains ergotamine (such as Cafregot and Midrin) or "triptans" (such as sumatriptan)?
• associated complaints
  • Does nausea or vomiting accompany the headache?
  • Is the headache preceded by a pop/snap in the skull?
  • Do neurological symptoms (weakness, loss of speech, etc.) occur when you have a headache?
  • Is the headache preceded by temporary loss of half of the visual field?
  • Does the headache cause the eye to tear on the same side as where the headache is?
  • Is there nasal discharge or stuffiness on the same side?
  • What other symptoms are present?

Diagnostic tests that may be performed include:

• head CT scan
• head MRI
• sinuses X-rays
• temporal artery biopsy
• lumbar puncture

Intervention:
If migraine is diagnosed, medications that contain ergot may be indicated. Temporal arteritis must be treated with steroids to help prevent blindness. Other disorders are treated as appropriate.

Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director, Utah Health Informatics and adam.com editorial