Health and Psychology

Headaches are a common phenomena.  It's one of the most common problem I treat in clinical practice with exceptionally good outcomes.  The first step in treatment involves identifying the type of headache somone has.

There are multiple types of headaches.

• Muscle tension headaches-These headaches are caused by muscle strain and general muscle tension.  If they occur on an occasional basis they can be relieved by stretching, massage, accupuncture/accupressure, changing position/ergonomics, or simple over the counter pain medications like aspirin, Tylenol, or Aleve.
• Medication over use headaches--also known as rebound headaches.  If someone is taking over the counter pain medications like aspirin, Tylenol or Aleve more than twice a week, or a triptan (migraine medications like Zomig or Imitrex) more than 10 days a month, then they are likely to need assistance in detoxing from these medications.
• Dental pain headaches--bruxism (the grinding of teeth) or temporomandibilar joint pain (TMJ) can cause headache.  A visit to the dentist can help with a fitting for a bite guard to lessen the stress on the teeth jaw and the joint of the jaw.  Popping or clicking of the jaw helps with diagnosis.
• Cluster headaches--these are allergy related headaches.  They usually occur on one side of the head, the affected eye on that side gets red, the pain is excruciating, the nose may run.  They typically occur at the same time of day and the same time of year.  Oxygen helps relieve pain as does antiallergy medication like a histamine blocker, or a triptan.  Alcohol, cigarettes, high altitude, and pollen levels can be triggers.
• Migraines--migraine headaches are vascular headaches in which the hands and feet get cold and the blood vessels constrict.  There may be a distinctive aura or prodrome of flashing lights, visual patterns, or neurological symptoms, that occur with the headache.  There are YouTube videos of people with complex migraine and neurological symptoms that start to resemble symptoms of stroke with loss of speech.  Migraines often have identified triggers and can be treated with triptans to lessen the intensity or severity of the headache.  Keeping a log and knowing the triggers can help.
• Caffeine withdrawal headaches--caffeine is a stimulant that people can be dependent upon.  When attempting to cut back on heavy caffeine substitute half decaffeinated with half caffeinated products and decrease the amount by one drink per day until you reach a reasonable level.  If you are drinking more than 10 cups of coffee or are treating excess fatigue with high doses of caffeine, you need to be seen by a physician to evaluate the reason for the fatigue.
• Orgasm headaches are pain that follows having an orgasm.  These headaches need to be evaluated by a physician with an MRI due to a rare neurological problem involving the arteries in the brain not functioning properly.  Simple orgasm headaches with no neurological symptoms may be prevented by taking medication prior to having sex.
• Early morning headaches--these may indicate low blood sugar, changes in oxygen level due to sleep apnea, hormonal fluctuations, neck or back pain, dental pain, or caffeine withdrawal.  
• Sinus headaches are caused by sinus pressure and sinus pain.  There may be an underlying sinus infection.  Dental infections can spread to the sinuses as well.  Often these are mistaken for migraines, but the hands and feet don't get cold, and there may be a nasal discharge.
• Ice cream headache-also known as brain freeze headaches occur when eating something cold like ice cream.  These headaches go away when the roof of the mouth warms back up.
• Chronic daily headaches-these are often medication overuse headaches.  They occur more than 15 days a month for at least three months.  In cases where triggers and detoxing off meddications is not effective Botox injections have been helpful.
• Hormonal headaches--these can occur with changes in hormone levels due to menstruation or pregnancy.  They occur during the first few months of pregnancy or for a few days before or after a menstral cycle.  Changes in food to include B vitamins and magnesium may be helpful.  Evaluation of hormone levels may help reduce or eliminate these headaches.
• Post-concussive headaches--these headaches are of migraine like severity and occur for a period of around five years following a head injury.  They frequently are accompanied by slight neurological symptoms and rarely respond to medications.  They lessen in intensity and severity over the course of five years.  Headaches following concussion that are increasing in severity over that time frame need to be evaluated by a physician with neuroimaging.  
• Headaches with hypertension--severely high blood pressure can cause headaches.  
• Severe headache with neck pain/stiffness and fever requires a trip to an emergency room.
• Headache with nausea, vomiting, and difficulty with speaking or walking requires a trip to an emergency room.
• Headaches described as the worst pain ever-requires a trip to the emergency room.