It’s All In Your Head
May 25, 2021
Hey everyone. I’m Dr. Jazz and I have a new topic to share with you guys. Headaches are a major reason for medical visits across the world, and can significantly affect the daily lives of those dealing with chronic headaches. But before we dive deeper into that let me give my disclaimer. This blog is NOT medical advice. This blog is for educational and informational purposes. If you have medical concerns or need medical advice, please consult your physician for appropriate evaluation and treatment. Now back to headaches. In this post I will reveal my own personal journey with headaches, and discuss various types of headaches and treatments.
My Headache Story
I’ve had headaches since the age of about 10 or 11 years old. At that time, I had some type of work up. I definitely remember having a cat scan of my brain. As I became a teenager and went to college, I used Imitrex for my acute headaches which at that time were diagnosed as classic migraine headaches. Throbbing pain to one side of my head, light sensitivity, and nausea. Everyone that knew me well was aware that if I had a headache, I would spend at least a day or so sleeping in a quiet room trying to “sleep off” the headache. For a short period of time, I took amitriptyline as a preventative measure for my headaches. I didn’t think that medication worked that well so I eventually just stopped taking it. Then I got busy with medical school and residency, but still had headaches. My last year of residency I was diagnosed with a pituitary tumor. It was concerning because the tumor was bleeding (hemorrhagic) and was close to my optic nerve (vision). The lead up to the surgery was extremely nerve wracking. All I could think of was that I’m finally finishing up all these years of training and did not want to have my vision affected. That whole experience is a whole other blog post. Whether it was related or just psychological, for a few years after the surgery, I felt that my headaches improved. Then while dealing with work, family, and just life, the headaches became almost daily again.
So, now I felt like I was dealing with multiple types of headaches- migraines, tension headaches, and medication over use headaches. I took over the counter medications all the time. I used menthol rub because my neck muscles and my temples would be extremely tight and sore. And I still had migraines too. These are the three type of headaches I want to breakdown in this post. There are so many other types of headaches but these three are very common.
Migraines are headaches that can have a hereditary component. My grandmother had migraines. Migraines can be with or without an aura. Aura is like a warning sign that the migraine is coming. Patients may have visual disturbances or some neurological symptoms. Then the headache begins. Classic migraine headaches are usually one sided and have severe throbbing, nausea, vomiting, light sensitivity, sound sensitivity, and possible neurological symptoms (complex migraines). There are several different categories of migraines and phases of a migraine headache (prodrome, aura, headache, postdrome). Patients can develop chronic migraines – migraines occurring at least 15 days out of the month. Unfortunately, for some, migraine headaches can last for days at a time. Treatment is geared toward preventive and acute treatment, and to improve quality of life. Medications used include Triptans, Calcium Channel blockers, Beta Blockers, Anti-depressants, CGRP (calcitonin gene-related peptide) monoclonal antibodies, and over the counter medications, such as Excedrin Migraine. Botox is also an option for headaches that are refractory to oral medications and other treatments.
Tension headaches are the most common type of headaches. They are dull like in nature, and patients describe tightness of the scalp and neck which feels almost vise like or like a tight band around the head. Tension headaches and migraine headaches can have overlapping symptoms like being one sided, light sensitivity, and nausea or vomiting. Tension headaches can be chronic as well and significantly affect daily activities. This can be confusing to differentiate. Treatment may be more geared towards relaxation (sleep, massage), decreasing stress, biofeedback techniques, using ice or heat to relax the muscles, and sometimes oral medications like anti-depressants or over the counter medications like ibuprofen or naproxen.
Lastly, there is a category called medication overuse headaches. This type of headache was previously known as rebound headaches. This is a difficult one because people with headaches take medication to relieve the pain. Sometimes we can get into a cycle of taking medication and then the headache comes right back in a few hours or the next day when the medication wears off. Then we take more medication. You may have this type of headache if you wake up with a headache or have headaches almost daily. If you are taking medication more than twice or three times a week, have to increase the dosage of medication you are taking (often over the counter), and have frequent headaches you might be in this headache pattern. To wean yourself from the medications, keep a headache diary, seek evaluation from a neurologist to get better control of your headaches, and make lifestyle changes (hydration, sleep, avoid headache triggers, exercise, stop smoking, etc.).
Now as I stated previously, this is a tiny segment of the types of headaches that can be diagnosed. There are over 150 types of headaches, which is why it is important to be evaluated for your headaches, especially if persistent. You can definitely see your primary care physician, but a neurologist is the specialist that evaluates and treats headaches. Please don’t suffer in silence or self- diagnose. I hope this post has shed some light on the world of headaches.
If you want to give some feedback to the blog or if you have suggestions for a new topic to discuss, drop me an email. You can email me at firstname.lastname@example.org, and follow my social media pages for my podcast on Instagram and Facebook, @thebreakdownwithdrdiagnosis. There you can find the link to my podcast website and subscribe to the podcast. I talk about this same topic with a board certified neurologist on my podcast. And remember, go check out my telemedicine company, Dr. Diagnosis. Follow Dr. Diagnosis on Instagram, Facebook, and Twitter, @diagnosemenow to stay updated on medical information and our events. And even if you don’t need to see a provider at Dr. Diagnosis, please check out the website at www.diagnosemenow.com. We have plenty of resources and links about COVID-19, influenza, mental health, and other topics. Until next time, stay safe and keep you and your loved ones healthy. See you soon!