By Susan Elrich, MD
Many, many New Yorkers suffer from headaches at one point in their lives, and do not know how to approach managing them. There are different kinds of headaches and different causes for them, so treatments vary.
Headache types discussed here include migraine and tension-type headaches. Cluster and other headaches are beyond the scope of this article.
Migraines generally present as one sided, severe and pulsatile headaches, sometimes felt behind the eye, frontally or at the temple, and may radiate to the neck, back and shoulders. Patients with migraine with aura will experience visual phenomena, such as temporary, partial visual loss, or a fragmented rainbow-like effect. Other features that may occur include light and sound sensitivity, nausea, vomiting and dizziness. Pain worsens with head movement. Patients want to lie down and be left alone.
Acute treatments for migraines include the triptan class of medications, which include Imitrex, Maxalt, Zomig and others. These are not to be taken by patients with heart disease, not including well-managed high blood pressure.
There are other medications that either help provide migraine relief or reduce or prevent them from happening. Non-steroidal anti-inflammatories, such as ibuprofen or Naprosyn may help some patients. Medications for nausea and anxiety are sometimes given to patients in the emergency room, and help reduce symptoms.
Botox injections are used in patients who have a poor response to medications or have medication side effects. Most of my patients receiving Botox injections have positive outcomes. There is now immune-modulatory infusion therapy that has had encouraging results in reducing migraine frequency.
Tension headaches present as a pressure/squeezing sensation. Migraine features, such as light sensitivity, may also be seen in tension headaches. Very often tension headaches may occur after sitting at a computer for hours, or during a period of stress (emotional, or lack of food or sleep, as examples). Medical management includes non-steroidal medication, such as Naprosyn or ibuprofen, and muscle relaxants, if necessary. Reducing triggers to these headaches is important in their management.
I frequently send my patients to physical therapy for myofascial release, massage, traction, range of motion and strengthening exercises, along with heat therapy, which you can also do at home. Biofeedback has helped many patients with both migraine and tension type headaches. Acupuncture is an option. Psychotherapy and cognitive behavioral therapy may also be useful.
Start keeping a log, regarding frequency, intensity and duration of your headaches, as well as the medications and therapies you are using, so that the next time you see your neurologist you will be able to give him/her this information. You should see your neurologist for treatment if your headaches are impairing your ability to function. Seek immediate medical attention if you have a headache that has neurological features such as weakness, numbness, or loss of speech or vision.
To your health and well being.
