By Franki Hanke

“Ah, it’s just a little one. It’s fine…” Migraine havers often undertreat and ignore their headaches. After all, if it happens all the time, you can’t take it seriously every time, right? But headache pain will actually worsen over time if undertreated. 

How bad can headaches be? 

Fifteen percent of Americans suffer from severe headaches, or migraines, that are often painful and disruptive. Anyone who experiences headaches knows their severity. 

While everyone has a headache once in a while, it’s considered a headache disorder with symptoms within the past year. The more often and more intense the headaches are the worse the impact on quality of life yet they continue to be underdiagnosed. 

There are four types of headache disorders. 

Tension-Type Headaches

Tension-type headaches can be episodic or chronic. Episodic headaches occur on less than 15 days a month while chronic headaches occur more often. Head pain is often described as pressure or tightness like a band around the head. 

Migraine Headache

Migraines are recurring headache attacks with a frequency between once a year and once a week. They range from moderate to severe intensity and pulsate on one side of the head. Head pain can last from a few hours to a few days. 

The most common associated symptom is nausea. 

Cluster Headache

Cluster headaches are less prevalent but frequently recur usually with a focus around one eye. 

Medication-Overuse Headache 

If you suffer from another primary headache disorder,  you may be at risk for this secondary disorder. Medication overuse, also called analgesic-rebound, headaches occur from chronic and excessive use of medication to treat headaches. 

What to do about headaches? 

If you see yourself in any of those descriptions but haven’t spoken to your primary care physician about it, it’s time for an appointment. Headaches, even when they feel manageable, can worsen over time. 

Relying on over-the-counter medication may not be your only solution, either. You need to reach out to a physician to explore all of your available options. 

The important thing is to do something about your headache. “We teach that a migraine is like a fire. If they come home and there’s a pot sparking on the stove, not treating their migraine is essentially like saying, oh, well, the pot’s only sparking. I’ll go pay some bills. When they come back, the whole kitchen is on fire,” said Dr. Ligament-Bartolome as quoted by the American Headache Society. 

How to Get a Diagnosis 

Ahead of your appointment, pay attention to your headaches. If you’re forgetful, take notes of when you experience headaches, how long they last, and what the pain felt like. 

When thinking about your pain level, you may try re-framing your pain from the 1-10 pain scale typically used to a traffic light scale. 

Green – You have a headache but are able to go (to work, to cook dinner, etc.) 

Yellow – You need to slow down to avoid a headache worsening or to keep going.

Red – You need to stop your normal action for the headache.

When tracking your headaches, note the scale of each headache for their frequency. 

At your appointment, consider asking the following questions: 

How should I treat a headache that’s green-level, early onset, or low-intensity?

How should I treat a headache that’s yellow-level or increasing in intensity?

How should I treat a headache that’s red-level or severe? 

What preventative methods are an option for my headaches? 

What other test or specialist should I pursue to better treat my headaches? 

To understand some of the language associated with headache and migraine attacks better, read the American Migraine Foundation’s symptom page. 

If you have a bit of white coat syndrome, bring your notes on paper so you don’t forget to bring it up. At the top of the appointment, tell your physician that you’d like to talk about your headaches. 

Your doctor can help with adjusting a treatment plan to ensure you prevent and treat headaches while avoiding an overuse disorder associated with over-the-counter and prescription medications. Depending on the severity of your headaches, your primary care physician may recommend seeing a neurologist. 

Typical Medications for Headache

It’s essential to develop a treatment plan with your primary care or neurology physician. Your doctor can recommend or prescribe a combination of medications to combat your headaches. 

Some medications treat the pain or symptoms of a headache. 

Triptans

Triptans are used specifically in migraine treatment as they selectively bind with serotonin receptors that dilate during migraines. 

NSAID – Nonsteroidal Anti-Inflammatory Drugs

Including aspirin, ibuprofen, and naproxen, NSAIDS are a broader pain medication than triptans, but are often the over-the-counter approach or are used in combination with triptans. The best NSAIDs for acute migraines are ibuprofen (like Advil or Motrin) and naproxen sodium (like Aleve or Anaprox), according to the American Migraine Foundation. 

Acetaminophen

Better known by the brand name Tylenol, acetaminophen appears to be less effective for headaches but is occasionally used by itself or in combination. 

Anti-Emetic

If you experience nausea with your headaches, you may benefit from an antiemetic (anti-nausea) medication. Your healthcare provider can recommend the best fit for you and prescribe as necessary. 

Preventative Medications – Antidepressants & CGRP Inhibitors

Other medications aid in migraine prevention. These are less frequently used despite being effective for many people. Between 34% and 43% of people are candidates for tricyclic antidepressants for headache treatment and aren’t receiving it. 

Newer options act on the CGRP inhibitors to prevent or treat migraines. Clinical trials have found this newer medication to be effective. Some treatment options may have side effects that you navigate with a healthcare professional to minimize. 

An antidepressant or a CGRP inhibitor may be an option for your treatment. Speak with your doctor to explore these options. 

Non-Medication Treatments for Headaches

While treating migraines or headaches with no medication is rare (and not recommended) lifestyle habits may help in addition to a medication plan. 

Exercise

Routine physical activity three or more times a week, when paired with medication, decreased headache days per month. 

Reduce Stress

I know, easier said than done, but you can try to combat the stress in your life with a few ten-minute habits. 

Limit Triggers

If there are specific triggers to your headaches, whether they are environmental or food, you can limit them to decrease headache frequency. You can try to identify triggers with this worksheet. 

Headaches can feel mundane, but they are a serious neurological disorder. The prevalence of people suffering without seeking further help is much much too high. If you do have headaches with any recurring frequency, make an appointment. You could be living with less pain and discomfort. 

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