…and How to Finally Get Relief

When you are in the throes of a headache, you do not care what is causing the pain. You just want relief. But not all headaches or migraines respond to the same treatment—and the wrong approach can keep you locked in your misery or even worsen the pain.

Should you take a migraine pill or a powerful pain reliever? Or would it be better to lie down in a cool, dark room or even go for a run? The answer depends on what is really causing your headache.

The problem is, there are more than 300 different causes of headaches, and just over half of people who have severe headaches are properly diagnosed.

What makes a difference: The more you know about symptoms associated with different types of headaches, the better equipped you’ll be to help your doctor pinpoint the underlying cause of your pain. Unusual symptoms, which often occur with headaches, are easily misinterpreted.

The Headache Mystery

Surprisingly, these common types of headaches can be difficult for some doctors to diagnose. For example…

    • Migraine with aura. The main symptom is throbbing or pounding head pain that occurs during or shortly after an aura (visual disturbances such as blurred vision…white, black or colored dots…flashing light…or blind spots). Nausea and, less frequently, vomiting may also occur. Severe migraines may develop without an aura, too.

Symptoms that can be misdiagnosed: Numbness or tingling or even weakness on one side of the face or body and/or speech difficulties—all of which may be misdiagnosed as stroke—and increased sensitivity to touch (called allodynia) can be symptoms of migraine with aura. So can dizziness, a runny nose or tearing eyes. Important: Most “sinus” headaches are really migraines.

Best treatment: Most individuals diagnosed with migraine are aware of lifestyle changes that can help—this includes avoiding triggers such as caffeine, certain odors and the artificial sweetener aspartame…eating a healthful diet…and exercising regularly. Most important, do not miss or delay meals—this commonly triggers migraines.

Medication also may be needed but should be taken promptly for the best results. For example, if a triptan migraine drug, such as sumatriptan (Imitrex), or similar medication is prescribed, be sure to take it within the first 60 minutes of the migraine (the sooner, the better).

Supplements, including vitamin B-2, magnesium and coenzyme Q10, may be taken daily as a preventive. They may help by increasing energy in the nerve cells.

    • Episodic cluster headache. Unlike most headaches, cluster headaches strike more men than women, with excruciating and sudden daily headaches one to three times per day, always on one side of the head, in or around an eye. The headaches can last from 15 minutes to three hours and often persist for one to three months, about once a year.

While a migraine sufferer’s pain may improve when relaxing in a cool, dark room, a cluster headache patient may get some relief from walking or even running.

Symptoms that can be misdiagnosed: Doctors may misdiagnose cluster headaches as sinusitis or a tooth problem because the pain extends to the sinuses, upper teeth, back of the head or even the neck.

Best treatment: To treat cluster headaches, steroid pills may be taken daily for a week or two. An injection of sumatriptan may be given for each headache. Nasal spray triptans such as zolmitriptan (Zomig) also may be tried, and breathing pure oxygen via a mask may help. If cluster headaches persist, the calcium channel blocker verapamil (Verelan) is usually prescribed. If these therapies fail, patients may need a nerve block—an injection of anesthetics and steroids in the occipital nerve, which immediately numbs the pain. A tiny electrical device also can be implanted to stimulate the nerve.

    • Episodic tension-type headache. Most adults get these headaches occasionally. They cause squeezing or pressing (nonthrobbing) pain, often on both sides of the head. Stress is the usual trigger. Muscles in the back of the neck and scalp tighten, which may cause headache pain.

Symptoms that can be misdiagnosed: Some tension-type headaches are so severe that they are misdiagnosed as migraines, and patients are prescribed migraine medication that is not always helpful.

Best treatment: Most people with tension-type headaches get some relief from over-the-counter drugs, such as aspirin, naproxen (Aleve) or acetaminophen (Tylenol). There are two other effective but underused treatments—removing yourself from the stressful situation and getting any kind of aerobic exercise.

Getting The Help You Need

To properly diagnose your headaches, your physician should review your medical history and your family’s medical history, conduct a physical examination and rule out other possible causes of head pain, such as an aneurysm or a congenital malformation. Be sure that you thoroughly describe your symptoms to your doctor.

What helps most: Keeping a headache diary, either in a notebook or on a computer or tablet, is crucial to getting the right diagnosis. This diary should include such information as the time of day your headaches occur…the specific location and type of pain (for example, throbbing, pressing or piercing)…other symptoms (such as nausea, light sensitivity or dizziness)…food you ate before the headache…and activities before the headache developed. For a free chart you can use as a headache diary, go to AmericanHeadacheSociety.org.

If you don’t get relief after working with your physician for a few months, consider consulting a headache specialist or neurologist. Board-certified headache specialists are the best qualified to treat headaches. To find one near you, consult ProMyHealth.org.