Diagnosis and Treatment
for HEADACHES
by Dr. George Adam
Not all headaches are migraines and — believe it or not — not all migraines cause headaches. There are, in fact, several types of headaches: tension, cluster, sinus, analgesic rebound are just some of the diagnostic labels. The causes and types of headaches are legion. Migraine, cluster, sinus, TMJ, analgesic rebound, trigeminal neuralgia are just some of the diagnostic labels.
Many are susceptible to migraines because of genetic factors (having first degree family members with migraines is a clue); others develop head pain because of infections, trauma, medications or exposure to environmental triggers, dietary factors. Sometimes a headache is the first symptom of a serious medical condition such as rising blood pressure, sleep apnea, stroke, brain tumor or epilepsy.
As a neurologist, my first job is to rule out dangerous conditions requiring urgent treatment. My questions about the headaches’ onset, character, frequency, location, duration, triggers, exacerbating factors are aimed at establishing the type and cause of the headache. To rule out dangerous headaches, I look for “red flags” such as a recent change in the character of the headaches, progressive symptoms and certain abnormal findings on the examination. I may order tests such as brain MRIs as part of the initial assessment.
Once the cause of the headache is established, I need to find out about patients’ expectations and values. Some prefer to avoid taking medications and would rather try lifestyle modifications or natural treatments. Eliminating pain triggers and correcting underlying causes can often make all the difference: treating a stiff neck or an inflamed TMJ would be examples of this approach.
Preventive medications such as topiramate, propranolol and nortriptyline can be helpful when the headaches are frequent. Of course, a new prescription must not “clash” with the other medications and the titration schedule as well as the side effects deserves a thorough discussion. Over-the-counter and prescription pain medications can be helpful from time-to-time, but I see a lot of patients who take dangerous amounts of these drugs. Drugs that contain acetaminophen and non-steroidal anti-inflammatory agents can cause liver and kidney damage. Painkillers can also trigger rebound headaches (something like scratching and itch can cause more itching). Triptans such as sumatriptan can abort severe migraines if taken early enough.
Managing headaches requires focus and good patient-doctor communication. It may take several adjustments and fine-tuning before we find the best treatment for you.
To schedule an appointment with Dr. Adam,
call the St. Paul office at 651.291.2551
or visit our main website — nervedocs.org.
For more information on headaches: