Heads Up! Q&A About Common Headache Disorders

Has a headache limited you in the past few months? 

I’ll tell you right now, I think a LOT of us have experienced some form of a headache in the past few months while working through this pandemic’s new reality. Change in routines, sleep habits, foods, and maybe a little more red wine than usual. Or that headache that signals you have forgotten one of your usual medications (medication withdrawal headache).

They can be these nagging, annoying interfering bothers that definitely need a medical visit to get to the bottom of what’s up. Here’s a quick tour around some common headache disorders we see in primary care. It’s not inclusive, and as always, in NO WAY replaces a visit or phone call to your primary care practitioner for an individual review.

Migraines are often pulsatile, lasting 4 to 72 hours, on one side of the head, associated with nausea or vomiting and are disabling in their intensity. Typically someone else in your family also has one, and you are diagnosed long before your fifties.

Other headaches we often label are tension-type headaches, cervicogenic headaches, and medication over-use headaches.

If you are taking over the counter pain medication for headaches or otherwise, and use these medications regularly for more than 15 days per month, they may actually be making your headaches WORSE! Honestly, right? In this case, chat with your medical team about a plan to decrease your use of these meds (like ibuprofen or acetaminophen) and start something called prophylaxis, a medication you take daily to reduce how often and how strong your headaches are.

What are triggering my headaches?

If you have been diagnosed with migraine, or tension-type headache, then here are some common triggers to have a look out for:

• Stress
• Missed meals
• Changing weather
• Missing sleep
• Hormonal changes (menstrual cycle related)
• Higher doses of caffeine
• Some food additives (think aspartame, MSG, etc)

If you were thinking of monitoring your headaches, a headache diary can be kept in your phone or downloaded from headachenetwork.ca  (click the “publications” tab). This gives me a sense of how often you get headaches, what triggers you have (menstrual cycles, stress, foods).

Will you require imaging like a CT or a brain MRI?

If a patient has stable headaches that meet the criteria for migraine, which is diagnosed based on history and physical alone, and there are no “red flag findings”, there is no indication for brain imaging.

What are those “Red Flag” findings?

Assuming I don’t have any of those above symptoms, how can I treat my headache while I’m waiting for my appointment with primary care?

Treatments for the acute migraine include at combinations of medications. Most patients should start with treatments like ibuprofen or acetaminophen. You need to take this early in your headache. Medication choice/combination and dosage is a discussion between you and your healthcare provider.  Let me repeat this again for the seats in the back! Medication is most effective if it is taken early in the attack. 

If your migraines are so severe and often, often more than once or twice per week, you may benefit from a medication that you take on a daily basis to prophylactically prevent the severity and number of migraines.

👉If your headaches are cyclic and related to your menstrual cycle, chat with primary care to see if using hormonal regulation of your cycle is an option for you.

💊Over the counter treatments with limited evidence but low side effects (talk to your pharmacist before selecting herbal supplements):

• Magnesium citrate 300 mg twice daily 
• Riboflavin 400mg/day
• Butterbur 75 mg twice daily 
• Coenzyme q10 100mg three times daily

That’s it! 

Remember, 

headaches are a symptom, not a diagnosis. 

It is so important to talk to your own medical team and get yourself the correct diagnosis for the headache disorder that you are experiencing. Then you can start exploring the many treatments combinations in order to reduce how often and how severe your attacks are (as this is not meant as specific medical advice, see the disclaimer). 

Want more?

 Click 👉 The Headache Network

References

Migraine Headache Practice Based Small Group Learning Program Vol.22 (13), November 2014

Headache Disorders: Approach to Non-Migraine Types. Vol. 18(10), August 2010

Guideline for Primary Care Management of Headache in Adult. Canadian Family Physician Vol. 61, August 2015