Neurology

Conditions We Treat

Headache

Headache—in all its varieties—is common and can seriously affect your quality of life. When headaches don’t respond to the usual treatments, neurology consultants with Highland Neurology at Highland Hospital can help. Our specialists have extensive experience in diagnosing and treating a wide variety of headache disorders. 

When people think of headaches and neurologists, they think of migraine. Certainly migraine is a common neurological problem, but at Highland Neurology, we treat the full spectrum of headache disorders, including tension type headache, cluster headache, chronic daily headache, medication overuse headache, cervicogenic ("neck-related") headache, and post-traumatic headache. These are just a few of the types of headaches neurologists treat. There are many others. For further information, see the website for the International Headache Society or the National Headache Foundation.

A Brief Survey of Headache Types

Migraine

According to the National Headache Foundation, migraine probably affects around 30 million Americans. How can such a common affliction be so often under-diagnosed? This is partly because there are two kinds of migraine and most people know only about one:

  • Migraine with aura is the "classic" migraine that most people know: warning symptoms (an "aura"—often of zig-zag lights in the vision) precede a severe headache, usually one-sided, that is accompanied by nausea, vomiting, and sensitivity to bright lights and loud noises.
  • Migraine without aura is the "other kind of migraine" and is much more common. In fact, until a recent change in terminology, migraine without aura was also known as "common migraine" because it is so widespread. In this form of migraine, most people have no warning symptoms or aura. The headache is severe, can be one-sided or on all over the head, may be accompanied by nausea or vomiting, and severely impairs the patient's ability to go about their daily activities.
  • Read more about the diagnosis of migraine on the World Headache Alliance website.

The good news is that treatment is available. Our comprehensive approach includes treatment of acute migraine, prevention of future migraine, and patient education about the causes and triggers for migraines.

Chronic Daily Headache

Specific diagnostic criteria exist for chronic daily headache. You can find them on the International Headache Society website. The name pretty much says it all: these headaches are chronic and occur every day. Many types of headache can evolve into a chronic daily form, including migraine and tension-type headaches. Treatment focuses on identifying the underlying headache disorder, breaking the cycle of daily headaches, and preventing future recurrence of headaches.

Medication Overuse Headache

Suffering from chronic headaches usually means chronic medication use. While medications may provide some relief, many patients find that ever increasing doses of pain relievers are needed to keep the headache at bay. Relief is often short lived and the headache returns, requiring a still higher dose of medication. This vicious cycle can lead to medication overuse headaches. As in chronic daily headache, your neurologist will focus on how to break the current cycle, begin effective preventative treatments, and prevent the cycle from starting again.

Cluster Headache 

Cluster headache is relatively less common than migraine, but is not rare by any means. These headaches come in attacks that "cluster" together, with a flurry of attacks followed by a pain free period followed again by a cluster of attacks. In the typical cluster headache, attacks occur mostly at night with severe pain that is usually centered behind one eye. The attack is accompanied by redness of the eye and a runny nose, often just on the affected side. Cluster headaches tend to be more common in men.

Evaluation of Headache Disorders

What can you expect from a neurological evaluation of your headaches? A patient's history is often the key to diagnosis in neurology, and this is especially true in the evaluation of headache. So, as the first step in your evaluation, your neurologist will spend a great deal of time talking with you, taking a careful history, and doing a brief neurological examination. You can make the most of your visit by thinking about your headache history and making some notes to bring with you to the appointment.  Helpful information in the history includes:

  • How often your headaches occur (you can even mark this on a calendar)
  • Things that seem to trigger your headaches (such as stress, certain foods, alcoholic beverages, weather changes, or [in women] relationship to the menstrual cycle)
  • Medications you have used in the past (including those that did not help), along with dosages and how long you took them, if known

It is also helpful to bring the actual pill bottles for all the medications you are taking, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements.

Blood testing may or may not be needed in selected patients to exclude the presence of other medical conditions. Brain scans (magnetic resonance imaging [MRI]) or computed tomography (CT) scans may also be ordered, depending on your history and examination.

Treatment of Headache Disorders

Treatment of headaches is a team effort, and the team consists of the doctor and the patient. Of the two, what the patient does is more important! Patients with headaches must learn about their headache disorder, and must be willing to take steps to treat it.  This includes not just taking medication, but also monitoring the effectiveness of treatments and making lifestyle modifications to optimize headache control. Your doctor will provide medication and education, but more than perhaps any other disorder, actual treatment is up to the patient.

Using headache medications takes into account not only the type of headache, but also the age of the patient and his or her other medical problems. A partial list of medications and associated information is available from the National Headache Foundation

Most headache medications are either abortive (used to treat or "abort" an acute headache) or prophylactic (used to prevent headache recurrence). For example, a person who suffers from sinus headaches brought on by pollen allergies might take an antihistamine every day to try and prevent a headache (prophylaxis), but use over-the-counter ibuprofen (abortive) on days when a headache occurs anyway. 

Abortive headache medications include many different drugs, ranging from over-the-counter aspirin or ibuprofen to very specific prescription medications. One well known class of medications used for migraines are the triptans . There are many different drugs in this family and all work in similar ways, but differences between the triptans allows the patient and the neurologist to choose the medication that may work best in a specific situation. 

Prophylactic headache medications are almost all drugs that were originally designed for another purpose but which have been found also to reduce or prevent headaches. For example, in migraine sufferers, a low dose of an antidepressant or a blood pressure medicine often results in a dramatic reduction in headaches. The mechanism by which these drugs act in headache is not well understood, but it appears they alter chemical transmitters in the brain’s pain centers and makes them less sensitive.

As mentioned above, lifestyle modifications can also be important in treating headaches. Identifying and avoiding headache triggers is an important first step. A partial list of triggers and tips on headache hygiene is available from the American Headache Society.

Helpful Resources

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Face

Ask the person to smile. Is the face lopsided?

Arm

Ask the person to raise arms. Does one arm drift down?

Speech

Ask the person to repeat a phrase. Does their speech sound strange? Can they do it without slurring words?

Time

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