Headaches and How to Treat Them

Most people have likely suffered from a headache at one point or another. In fact, says Summit Health Neurologist Dr. Steven Goins, “headaches are fairly common and affect three quarters of adults.” It’s important to understand the type of headache you have— and what the cause might be—to properly treat your pain and determine if there is another underlying problem.

Primary Versus Secondary Headaches

Not all headaches are the same. In fact, the medical community divides them into two overarching categories—primary and secondary. Primary means there is no serious underlying etiology or set of causes. These types of headaches include:

  • Migraine
  • Tension headaches
  • Cluster headaches (rare)

In contrast, secondary headaches have an underlying cause. These include:

  • Sinus infection
  • Arterial inflammation
  • Intracranial hypertension
  • Meningitis
  • Cerebral hemorrhage
  • Cerebral venous thrombosis
  • Brain tumor
  • Neck-related causes (common in seniors)

Can I Prevent Headaches?

When it comes to preventing secondary headaches, the key is identifying the underlying cause and treating that. For primary headaches, lifestyle changes can have an impact on prevention. Diet affects headaches, especially migraines, notes Dr. Goins, pointing to the following as potential causes:

  • Caffeine
  • Chocolate
  • Aged cheese
  • Alcohol (in particular red wine)

Other important contributing factors are:

  • Lack of sleep
  • Not staying well-hydrated
  • Skipping meals

You can learn more about diet and other headache triggers on the National Headache Foundation website.

If lifestyle changes don’t help, Dr. Goins advises to work with your doctor to discuss other options for ongoing treatment or preventative steps. “Individual migraine attacks can be treated with over-the-counter medications such as acetaminophen or naproxen. Sometimes a caffeinated beverage can help too.  But prescription medications such as triptan drugs are commonly used with success for the individual attacks,” he says. Occasionally, a patient with migraines will not respond to triptans but will respond to dihydroergotamine nasal spray.

For a patient who is having frequent migraines, it is often better to try to reduce the migraine frequency by using a preventative medication. There are several medications that can gradually reduce migraine frequency such as beta-blockers and topiramate. For individuals who have frequent severe migraines not responding to oral preventative medications, treatment with Botox® injections could be an option. Some migraine sufferers can qualify for treatment with CGRP receptor antagonist medications. Both options are costly and may require insurance preauthorization.

Are Headaches Hereditary?

Migraine headaches are strongly inherited. Up to 80 percent of patients with migraines may have an affected parent or sibling and this is often a clue to making the diagnosis.

Should I Go to the ER for a Headache?

If headaches have been occurring for longer than 6 months, it is improbable that there is a dangerous cause for the headaches that might be found on a brain imaging study. And although new onset headaches are usually migraines, there may be other serious causes. You should seek medical attention immediately for severe and sudden-onset headaches. What is usually referred to as, ‘the worst headache of my life’ could indicate a subarachnoid hemorrhage from an aneurysm rupture.

Other notable symptoms to look out for:

  • Headache with stiff neck and fever, which could indicate meningitis
  • Headache that is worse lying down, which could indicate a tumor or intracranial hypertension

If you don’t need emergency medical treatment, you should still discuss your headaches with your doctor to review and address any potential health problems.