Care Plan
First steps to consider
- Most everyday headaches can be treated at home.
- Try OTC pain relievers, rest, and drinking fluids.
When you may need a provider
- Your headache doesn’t improve in about 3 days
- You have chronic headaches (more than about 10 days per month) or your headaches are severe.
Emergency Care
Call 911 or go to the ER if you have any of the following symptoms:
- If your headache is the most painful that you’ve ever had
- If your headache is very severe and you also have a stiff neck, fever, confusion, changes in your vision, numbness, vomiting, or a recent head injury
A headache is usually not a serious problem and can be treated with over-the-counter pain relievers. But some types of headaches, like migraines, can be extremely painful and need to be treated by a doctor.
What is a headache?
Headaches are the most common type of pain. It can feel like a dull ache, sharp pain, or a throbbing sensation. It can be around your forehead, back of your head, behind your cheeks or eyes, or all over. Head pain may last for less than an hour or up to several days.
Many headaches aren’t serious and can be treated with OTC pain relievers. But others can be a symptom of another problem like high blood pressure. If you tend to get headaches, there may be ways of reducing how often you get them with medications, stress reduction, and changes to your diet.
Symptoms
A headache can develop slowly or suddenly. The pain may be on one or both sides of your head or affect one particular area. It may radiate (spread) to other parts of the head.
If you have a headache along with any of the symptoms below, it may be a sign that you have a serious condition, such as a concussion, stroke, or brain hemorrhage. Call 911.
- A stiff neck and fever
- Muscle or joint pain
- Nausea or vomiting
- A nosebleed
- Fainting, dizziness, or loss of balance
- Double vision or blurred vision
- Confusion
- Slurred speech
- Drooping on one side of your face
- Weakness on one side of your body
- Seizures
- A bump, swelling, or injury on your head
What are 3 types of headaches?
Tension headaches
Tension headaches are the most common type of headache. They occur when the muscles tighten in your neck, shoulders, scalp, and jaw. The pain often occurs on both sides of the head and develops slowly.
The pain is mild to moderate and feels like a steady ache (no throbbing). There aren’t usually other symptoms like nausea, vomiting, or sensitivity to light.
Migraine headaches
Migraines are moderate to severe headaches that are often accompanied by nausea and increased sensitivity to light and sound. They usually affect one side of the head with throbbing pain or a pulsing sensation. Migraines can last for a few hours or several days. You may have them once in a while or as often as several times a week.
Some people get an aura before or during a migraine. Symptoms of an aura include seeing shapes, bright spots, or flashes of light; pins and needles sensation in an arm or leg; difficulty speaking; or weakness or numbness in your face or in one side of the body.
Cluster headaches
Cluster headaches are less common, but cause severe pain and occur in groups (clusters) lasting about 1–3 hours. The pain starts suddenly (usually behind the eye) and you may have other symptoms like restlessness or agitation, red or watery eyes, nasal congestion, or eyelid drooping or swelling. Cluster headaches may occur every other day or as often as several times a day, for weeks or months at a time.
Dr. Rx
Many patients bounce in and out of the ER when their headaches are severe, but when they get better, they don’t follow up with a primary doctor. If this is you, make an appointment today so you can get your migraines under control! —Dr. Anne Jacobsen
Causes
The causes of headaches depend on the type you have and sometimes there are no known causes. Some common triggers for all headaches include alcohol and caffeine, smoking, stress, and fatigue.
Tension headaches don’t have a single cause. You may be more likely to get them if you have eyestrain (from looking at a computer for several hours, for example), insomnia, or are under stress.
Migraine headaches aren’t well understood. Many people who get migraines have a parent or sibling with the condition. Other risk factors include being female, under a lot of stress, and smoking. Common migraine triggers include hormone changes in women, bright or flashing lights or strong odors, weather changes, and certain foods.
Cluster headaches are also a mystery, though they may be related to a sudden surge of serotonin or histamine in the body.
Secondary headaches are caused by other medical issues, including:
- Allergies
- Sinus infection (sinus headaches)
- Hangover
- Overusing pain medication
- Depression or anxiety
- Insomnia
- Dehydration
- High blood pressure
- Bacterial or viral brain infection
- Stroke
- Neck or brain injury
Pro Tip
Always let your doctor know if the headache came on suddenly, like a thunderclap, or if it is the worst headache you’ve ever had. These unusual headaches can be a sign of a more serious medical problem. —Dr. Jacobsen
Treatment
Most everyday headaches can be treated with OTC pain relievers. Migraines and cluster headaches may need to be treated by your doctor with prescription medication and certain lifestyle changes and types of therapy (biofeedback, talk therapy).
If you think you have secondary headaches, or if you’re having headache symptoms that seem different than the ones you’ve had before, see your doctor.
At-home care
OTC medications
OTC pain relievers can help most headaches. These include ibuprofen (Advil, Motrin), acetaminophen (Tylenol), and aspirin. But if you need to take them more than twice a week, which can make headaches worse by causing rebound headaches, see a doctor.
OTC pain relievers can also treat mild to moderate migraines (no nausea or vomiting).
Supplies
- Hot and cold compresses. When placed on your head or neck, compresses can help relieve tension and migraine headaches.
Herbal supplements
Ask your doctor if any of these supplements may help your headaches.
- Magnesium. People who get migraines tend to be low on magnesium. Some studies have shown that taking magnesium may help prevent migraines.
- Riboflavin (vitamin B2), coenzyme Q10, and omega-3 fatty acids. These supplements may help prevent migraines or at least reduce symptoms.
- Essential oils. For some people, applying or inhaling certain oils—like peppermint, rosemary, and lavender—help them relax and relieve stress. But for other people these oils can trigger a migraine.
- Ginger. Ginger can help relieve migraine symptoms, especially nausea and vomiting. It comes in many forms, such as gels, capsules, tea, and lozenges.
Medical care
Medication
There are many types of prescription medication. Some treat the headache, while others help prevent them. Which one your doctor may recommend depends on the type of headaches you get.
Abortive treatments (to treat or stop a headache):
- Triptans, such as sumatriptan (Imitrex) or zolmitriptan (Zomig), treat migraines and cluster headaches.
- Ergot alkaloids (dihydroergotamine, ergotamine) treat migraines and cluster headaches.
- Supplemental oxygen (inhaling 100% oxygen) treats cluster headaches.
- Lasmiditan (Reyvow) treats migraines.
- Calcitonin gene-related peptide (CGRP) inhibitors prevent or treat migraines, including rimegepant (Nurtec), ubrogepant (Ubrelvy), and erenumab (Aimovig).
- Anti-nausea medications, such as prochlorperazine (Compazine) and promethazine (Phenergan), treat severe nausea.
Preventive treatments:
- Beta blockers (propranolol, timolol) prevent migraines.
- Hormone therapy can help women who get migraines without an aura that is related to their menstrual cycle.
- Antidepressants such as amitriptyline (Elavil) or venlafaxine (Effexor) prevent migraines and tension headaches.
- The CGRP inhibitors rimegepant (Nurtec) and erenumab (Aimovig) also prevent migraines.
- Lithium, verapamil, topiramate (Topamax), gabapentin, melatonin, or galcanezumab prevent cluster headaches. Topiramate and gabapentin may also be used to prevent tension headaches.
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Preventive tips
Headaches can’t always be prevented, but there are ways to reduce the chance you’ll get one. Good habits to follow include:
- Drink plenty of water.
- Avoid your triggers (odors, certain foods, etc.).
- Get 7–9 hours of sleep each night.
- Eat at regular times.
- Reduce stress.
- Exercise regularly.
- Quit smoking.
- Have good posture
- Reduce eyestrain by taking regular breaks when you have been looking at a screen for a long time.
Pro Tip
If kids come in with mild headaches, we often recommend an eye exam. This is a good idea for adults with headaches too. It’s easy to get your eyes checked—and treatment is available! —Dr. Jacobsen
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