Are Your Daily Headaches a Sign of Something More Serious?

Don’t fret just yet. The pounding pain in your head may be annoying, but it doesn’t necessarily indicate a bigger problem.

There it is again — the throbbing in your dome. If you’re bothered by frequent headaches, you may be concerned that you have a more serious condition, such as a brain tumor or an aneurysm. And while those and other dangerous conditions can be marked by headaches, it’s likely that your pain is primary. In other words: It’s probably not the result of another condition.

Unfortunately, doctors don’t know what causes most headaches. According to some estimates, only 10% of headaches have a known cause. But there are contributing factors that can trigger chronic headaches, such as:

• Alcohol
• Caffeine
• Dehydration
• Hunger
• Lack of sleep
• Sensory triggers such as bright lights, loud noises and pungent smells
• Stress

Chronic headaches can also be linked to other disorders, including depression, anxiety, sinus infections, allergies and temporomandibular joint dysfunction, also known as TMJ. In order to figure out your headache pattern and identify your triggers, you may want to keep a headache diary to share with your doctor. The National Headache Foundation provides a handy template.

Here are a few common types of chronic headaches:

Tension headache

This is the most common type of headache and it’s likely that you’ve had more than one of these in your life. But for some people, they occur almost every day. Tension headaches affect both sides of your head with a pressing, moderate pain. Over-the-counter medications like ibuprofen (Advil) or acetaminophen (Tylenol) often help, but taking them for long periods of time can lead to headaches called “medication overuse” or “rebound” headaches. Instead, you may want to try meditation, relaxation techniques or heat therapy.

Migraine

Migraines, although less common, are more severe. The pain is intense, may pulsate and can be accompanied by nausea, sensitivity to light or sound, vomiting or visual disturbances called “auras. ” Often, migraines only affect one side of the head, although they can affect both. They also affect women more often than men. Prescription medications are available to treat migraines, but you also may benefit from simply resting in a quiet, dark room and using hot or cold compresses. Progressive symptoms of more severe or frequent headaches, or any headache that is also associated with other neurological symptoms, should be evaluated by a physician

Cluster headache

Men are more likely to have these more sudden headaches, which are often marked by pain on one side of the head, behind the eye. They tend to happen in clustered periods of time, even multiple times a day, then disappear for a while. Eyes tend to water, and a restless feeling is common. These headaches usually require prescription medicines.

New daily persistent headache (NDPH)

If you suddenly get frequent headaches, you may have NDPH. The symptoms of NDPH can mimic tension headaches or migraines, but NDPH occurs in people who don’t have a history of headaches. Often, people with NDPH can remember exactly when the onset happened. Your doctor may need to run tests to make sure these headaches aren’t secondary — that is, a symptom of a serious underlying condition.

Although daily headaches might not be the result of a dangerous problem, they can affect your quality of life and shouldn’t be considered “normal.”

“Progressive symptoms of more severe or frequent headaches, or any headache that is also associated with other neurological symptoms, should be evaluated by a physician,” says Jonathan J. Russin, MD, a neurosurgeon at Keck Medicine of USC and assistant professor of clinical neurological surgery at the Keck School of Medicine of USC. “Even using these criteria, the majority of headaches will not represent an underlying problem. An exception is a ‘thunderclap’ headache, which refers to the sudden onset of the worst headache of your life. This type of headache should always be evaluated by a physician whether it is associated with other symptoms or not. ”

Topics

cluster headache

Dr. Jonathan J. Russin

headaches

migraine

tension headache

Tina Donvito

Tina Donvito is a freelance writer covering health, culture, travel and parenting.

Why Am I Getting Frequent Headaches?

To say, “I have a headache,” is one thing. To say, “I always have headaches,” is another. The latter is often more concerning.

Most people get headaches from time to time. They usually go away with or without any treatment. Frequent headaches are much less common and much more serious. They can disrupt your work or personal life. They can also be a sign of an illness or injury.

“Unfortunately, many people don’t seek help because they think they can cope on their own,” says Christy Jackson, MD, a neurologist and director of the Donald J. Dalessio Headache Center at Scripps Clinic. “They may rely on over-the-counter pain relievers instead of getting medical help. In some cases, headaches are not properly diagnosed. ”

Consult with your primary care doctor if your headache symptoms get worse or occur more often despite treatment at home. Your doctor may refer you to a headache specialist.

“No one should go through life suffering from chronic headaches,” Dr. Jackson says. “Not when they are treatable.”

Headache specialists at Scripps help people who suffer from recurring, chronic headaches through a combination of traditional and complementary care with a focus on prevention and lifestyle changes.

“We evaluate your symptoms and design a treatment plan that targets the underlying physical, psychological and environmental causes of your headaches,” Dr. Jackson says.

“There are many effective treatments to relieve symptoms and prevent future attacks,” adds Robert Bonakdar, MD, a pain specialist at the Scripps Center for Integrative Medicine. Treatments may include medication, biofeedback and other therapies.

Dr. Bonakdar stresses the importance of clear and open communication between doctor and patient. “Correct diagnosis depends largely on the information you share with your health care provider.”

It’s important to understand your diagnosis as much as possible, including what type of headache you have and what is causing it. There are many types of headaches, levels of frequency and severity.

Headache pain can range from mild to disabling. Headaches can be episodic or chronic. Episodic headaches occur occasionally. Chronic headaches are more consistent. They can strike for 15 days or more in a month.

Headaches are divided into two main types: primary and secondary. Primary headaches are those not caused by another medical condition. Migraine and tension headaches are the most common.

Secondary headaches are symptoms of another health problem, such as a fever, infection, stress or a head injury.

Tension headaches, which are the most common type of headache, cause mild to moderate pain. They often present as a dull, constant pain felt on both sides of the head, and have no other symptoms.

These type of headaches are caused by tightening or tension in the muscles in the head, neck and scalp. They can be brought on by stress, noise, fumes and even long periods of watching TV or computer screens. They’re easier to handle than other types of headaches because they usually just come and go. Chronic tension headaches are much less common.

Migraine is the most disruptive type of primary headache. It is often marked by a throbbing pain that is moderate to severe. It can last four to 72 hours and happen one to four times a month.

Migraines often include other symptoms. Someone with a migraine may be sensitive to light and sound. They may prefer to be in a dark, quiet space. They may also experience nausea and vomiting and visual disturbances (aura).

Women are more likely than men to get migraines. Migraine attacks may also run in a family and begin at an early age.

Certain environmental factors are common triggers, such as sleep disruption, dehydration, skipped meals, some foods, hormone fluctuations and exposure to chemicals.

“The goal is to treat migraine symptoms right away and to prevent symptoms by avoiding or changing triggers,” Dr. Jackson says.

Cluster headaches are more severe but less common. They often begin on one side of the head and recur for days or weeks. Attacks can last between 15 minutes to three hours and occur every day.

They tend to affect men between the ages of 20 and 50, and smokers. People who experience these types of headaches are often restless, agitated and sweat profusely. Alcohol can trigger an attack.

Also known as rebound headaches, they are caused by an overuse of pain medications, such as aspirin, acetaminophen and ibuprofen. Women are affected more often than men.

When over-the-counter medicine fails to work and headaches become more frequent, medication and other therapies may be prescribed.

Medications to prevent frequent migraines include antidepressants and Botox injections and newer medications.

In 2018, the Food and Drug Administration (FDA) approved a new class of medications that modulate a neuropeptide known as calcitonin gene-related peptide (CGRP) that is believed to play a key role in migraine. Neuropeptides are small protein-like molecules used by neurons to communicate with each other.

For treatment of migraines as they occur, your doctor may prescribe triptans for relief.

Medication for frequent headaches may be combined with non-medication options, such as biofeedback, relaxation, bio stimulation and diet therapy.

Biofeedback uses electronic monitoring to help teach individuals how to control certain physical responses, such as muscle tension.

Many different relaxation therapies are available and can be individualized.

“Manual and massage therapy can be especially helpful for those with significant muscle tension or neck stiffness related to headache,” Dr. Bonakdar says.

For those who may have significant stress and sleep issues, one of the most powerful techniques is mindfulness. “This technique helps individuals increase awareness to manage triggers and automatic responses that often lead to the next headache.”

Mindfulness is typically offered at Scripps as an 8-week stress reduction course.

Biostimulation is a broad term that encompasses therapies such as acupuncture, which involves the use of needles to stimulate specific points of the body to alleviate pain.

“With a treatment course, acupuncture has been found to be as helpful as medication in the prevention of migraines,” Dr. Bonakdar says.

Electrical stimulation and other techniques can also be used. The most recent is the Nerivio wearable device, which was one of Time magazine’s Best Inventions of 2019.

Many headache sufferers often report a diet-related trigger. “When this is the case, the solution may be as simple as identifying and avoiding these triggers or finding a diet or supplement regimen that can fill gaps created by long-term headaches,” Dr. Bonakdar says.

While many foods can cause headaches, some are more common than others. Dr. Bonakdar works closely with the center’s dietician to help patients identify and avoid individualized triggers, which typically fall into a few categories:

• Allergenic foods which may take testing to confirm, such as peanuts and foods made with gluten
• Additives, such as those found in pre-packaged and processed foods
• Artificial sweeteners, such as those found in diet foods to reduce calorie content
• Aged foods, including wine, cheese, sauerkraut and cured meats.

“Diet is just one component of headache management,” he adds. “It’s important to look at the whole person to develop a treatment plan that includes a healthy lifestyle, integrative therapies — and when appropriate — medication.”

HEADACHE – Hadassah Medical Moscow

Traditional migraine therapy consists of behavioral therapy, relief of an already developed attack and preventive treatment aimed at preventing attacks. Behavioral therapy, a necessary step in effective patient management, is carried out during a conversation with the patient and includes: explaining the benign nature of migraine, dissuading the presence of an organic disease, discussing the role of attack triggers and the need to avoid them, risk factors for migraine chronicity (taking a large number of painkillers, stress , psycho-emotional states), as well as the rationale for treatment tactics (mechanisms of action of prescribed drugs).

Treatment of a migraine attack is prescribed depending on its intensity and the degree of maladaptation of the patient. With infrequent attacks of mild or moderate intensity, simple or combined analgesics are indicated; with severe nausea and vomiting – antiemetics. With a high intensity of pain and significant maladaptation, triptans are prescribed.

New drug groups have been approved worldwide for the treatment of migraine attacks. This, in turn, enables doctors to treat their patients more effectively, and for patients to reduce the number of days with a headache, improve quality of life, sleep, mood and performance.

Lasmiditan is a selective serotonin 1F receptor agonist that does not have vasoconstrictive activity. The role of lasmiditan in clinical practice has not yet been determined, but it is probably best suited for patients with relative contraindications to triptans due to cardiovascular risk factors.

In October 2019, the US Food and Drug Administration (FDA) approved lasmiditan oral tablets for the treatment of acute migraine in adults. The drug is currently not registered in the Russian Federation.

CGRP antagonists (Rimegepant and Ubrogepant) Monoclonal antibodies directed against the CGRP receptor or ligand. These are oral options available for the acute treatment of migraine in patients with insufficient response or contraindications (eg coronary artery disease) to triptan treatment.

Ubrogepant received US Food and Drug Administration (FDA) approval for the treatment of acute migraine in adults in December 2019year, and rimegepant received a similar FDA approval in February 2020. This group of drugs is not registered in the territory of the Russian Federation.

Preventive therapy is aimed at reducing the frequency, duration, intensity of attacks, the number of doses of painkillers and improving the quality of life of patients.

The main indications for course treatment: the frequency of days with GB > 4 per month, the lack of effectiveness of drugs for the relief of migraine attacks, the presence of risk factors for migraine chronicity (abuses, depression), prolonged aura (> 60 min). The duration of the course of treatment is from 3 to 12 months (an average of 4-6 months for episodic, 8-12 months for chronic migraine), then an attempt is made to gradually withdraw the drug (s) or reduce their dosage.

CGRP antagonists is a human monoclonal antibody that binds to and inhibits the calcitonin gene-related CGRP receptor (CGRP) and is a therapeutic target in migraine due to its putative role in mediating the transmission of trigeminovascular pain and the vasodilator component of neurogenic inflammation

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Large molecules in the form of monoclonal antibodies directed against the CGRP receptor or ligand are injected to prevent migraine. The US Food and Drug Administration (FDA) approved the CGRP antagonist monoclonal antibodies erenumab, fremanezumab, and galcanezumab in 2018 and eptinezumab in 2020 for the preventive treatment of migraine. In 2020, two drugs (erenumab, fremanezumab) were registered in the Russian Federation.

All about headaches – causes, diagnosis and treatment

It is extremely rare to meet people who have not experienced a headache at least once in their lives. A complaint of headache or cephalalgia is one of the most common complaints at a neurologist’s appointment. More than 13% of the population suffers from chronic headaches.

Types of headaches

Headache forms are various: migraine; tension headache; post-traumatic headache; headache caused by an increase or decrease in intracranial pressure; headache with prolonged use of drugs; headache caused by infections, etc.

• Vascular headache occurs due to spasm of arteries or vein dilation, insufficiency of their tone, slowing of blood flow.
• Muscle tension headache caused by muscle tension during prolonged non-physiological position (e.g. non-compliance with the principles of physiological seating by schoolchildren, drivers, programmers, etc.)
• Neuralgic headache is caused by nerve involvement.
• Psychic headache is associated with disturbances in the exchange of mediators of the central nervous system.
• Mixed headache is characterized by a combination of the above factors that develop sequentially or almost simultaneously.

It is necessary to mention extremely rare cephalalgias: cluster headache, chronic paroxysmal hemicrania, temporal arteritis, etc.

What is a headache?

Any headache should be a reason to contact a neurologist, so as not to miss the pathology of the nervous system or internal organs, signaling itself with a headache. This can be hypertension, diseases of the upper respiratory tract, kidneys, gastrointestinal tract, infectious, dental diseases, etc.

Headache diagnostics

The causes of the headache are established after undergoing a comprehensive neurological examination: Echo-encephalography, electroencephalography, ultrasound dopplerography of the vessels of the head and neck, rheoencephalography, P-graphy of the skull, magnetic resonance and computed tomography of the brain, examination of the fundus, consultations of the necessary specialists, laboratory research methods.

Treatment recommendations

Self-medication, prolonged uncontrolled use of painkillers to relieve headache symptoms should not be dealt with. In such a case, by drowning out the pain, the patient does not in any way affect its cause, which can be very serious. Moreover, the daily abuse of analgesics leads to the opposite effect – an overuse headache occurs. Daily uncontrolled intake of analgesics leads to drug disease, which is observed in 20% of the population of developed countries.

An integrated approach to treatment is needed, depending on the pathogenetic mechanisms of headache development identified during the examination. In each case, the treatment is selected individually and includes both relief of headache attacks and treatment in the period between attacks. The doctor’s arsenal includes medication methods, acupuncture, psychotherapy, autogenic training, post-isometric relaxation, manual therapy (especially for relieving muscle tension with tension headaches), biofeedback, massage, physiotherapy, physiotherapy, millimeter resonance therapy, laser therapy, homeopathic approaches .