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Headache
HEALTH INSIGHTS

Headache

By David A. Thompson, M.D. 
 | 
March 22, 2017

911 warning

Headache

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Does this describe your symptoms?

Definition

  • Pain or discomfort of the scalp or forehead areas

  • The face and ears are excluded

Common Causes

  • During the course of a year, the majority of adults suffer headaches.

  • Muscle Tension Headaches: The majority of headaches are caused by muscle tension. The discomfort is usually diffuse and may radiate down into the neck and shoulders. The discomfort is aggravated by emotional stress.

  • Migraine Headaches: Also referred to as vascular headaches. The headache is moderate to severe in intensity, described as throbbing or pulsing in nature, and usually unilateral. Associated symptoms include nausea and vomiting. Some individuals will have visual warning symptoms (aura) that a migraine is coming.

  • Sinusitis: Headaches occur with sinusitis. The headache is usually located in the forehead area and the individual has associated sinus symptoms (nasal discharge, congestion).

  • Fever: A mild to moderate headache frequently accompanies the fever that occurs with common viral infections such as the flu and the common cold. A severe headache that persists after the fever has come down to normal is a red flag that something more serious may be causing the headache.

  • Caffeine Withdrawal: This occurs in individuals who drink large amounts of caffeine (e.g., coffee, tea, colas) and suddenly stop. Some caffeine drinkers will note a headache upon arising that goes away after their first cup of coffee.

Some Serious Causes of Headache

  • Stroke ("Brain Attack")

  • Meningitis, encephalitis

  • Temporal arteritis

  • Brain tumor

  • Carbon monoxide exposure

If not, see these topics

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When to Call Your Doctor

call 911

Call 911 Now (you may need an ambulance) If

  • Difficult to awaken or acting confused

  • New onset of weakness of the face, arm or leg on one side of the body

  • New onset of numbness of the face, arm or leg on one side of the body

  • New onset of slurred speech, garbled speech, or inability to speak

call now

Call Your Doctor Now (night or day) If

  • You feel weak or very sick

  • Pain is severe and its the worst headache of your life

  • Pain is severe and you have not had severe headaches before

  • Stiff neck (can't touch chin to chest)

  • Blurred or double vision

  • Unsteady walking

  • Fever of 103° F (39.4° C) or higher

  • Fever of 100.5° F (38.1° C) or higher and you:

    • Are over 60 years of age OR

    • Have diabetes mellitus or a weakened immune system (e.g., HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy) OR

    • Are bedridden (e.g., nursing home patient, stroke, chronic illness, recovering from surgery)

  • Possible exposure to carbon monoxide

call within 24 hours

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think you need to be seen

  • Sinus pain of forehead with nasal symptoms (discharge, congestion)

  • Age greater than 50 years

  • Weakened immune system (e.g., HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy)

  • Fever present for more than 3 days

call within 24 hours

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

  • Headache present longer than 24 hours

  • Headaches are a recurrent problem

home care

Self Care at Home If

  • Mild-moderate headache and you don't think you need to be seen

  • Similar to previously diagnosed migraine headaches and you don't think you need to be seen

  • Similar to previously diagnosed muscle-tension headaches and you don't think you need to be seen

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HOME CARE ADVICE FOR HEADACHE

  1. Migraine Headache:

    • Migraine headaches are also called vascular headaches. A migraine can be anywhere from mild to severely painful. Sufferers often describe it as throbbing or pulsing. It is often just on one side.

    • Associated symptoms include nausea and vomiting. Some individuals will have visual or other neurological warning symptoms (aura) that a migraine is coming.

  2. Muscle Tension Headache:

    • The majority of headaches are caused by muscle tension.

    • The discomfort is usually diffuse and may be described as a "tight band" around the head. It may radiate down into the neck and shoulders. The discomfort can be aggravated by emotional stress.

    • This sounds like a painful headache that you are having, but there are pain medications you can take and other instructions I can give you to reduce the pain.

  3. Pain Medicines:

    • For pain relief, take acetaminophen, ibuprofen, or naproxen.

    Acetaminophen (e.g., Tylenol):

    • Take 650 mg by mouth every 4-6 hours. Each Regular Strength Tylenol pill has 325 mg of acetaminophen.

    • Another choice is to take 1,000 mg every 8 hours. Each Extra Strength Tylenol pill has 500 mg of acetaminophen.

    • The most you should take each day is 3,000 mg.

    Ibuprofen (e.g., Motrin, Advil):

    • Take 400 mg by mouth every 6 hours.

    • Another choice is to take 600 mg by mouth every 8 hours.

    • Use the lowest amount that makes your pain feel better.

    Naproxen (e.g., Aleve):

    • Take 250-500 mg by mouth every 12 hours.

    • Use the lowest amount that makes your pain feel better.

    Extra Notes:

    • Acetaminophen is thought to be safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription medicines. It might be in more than one medicine that you are taking. You need to be careful and not take an overdose. An acetaminophen overdose can hurt the liver.

    • Caution: Do not take acetaminophen if you have liver disease.

    • Caution: Do not take ibuprofen or naproxen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of medicine. Do not take ibuprofen or naproxen for more than 7 days without consulting your doctor.

    • Before taking any medicine, read all the instructions on the package

  4. Migraine Medication: If your doctor has prescribed specific medication for your migraine, take it as directed as soon as the migraine starts.

  5. Rest: Lie down in a dark, quiet place and try to relax. Close your eyes and imagine your entire body relaxing.

  6. Local Cold: Apply a cold wet washcloth or cold pack to the forehead for 20 minutes.

  7. Stretching: Stretch and massage any tight neck muscles.

  8. Call Your Doctor If:

    • Headache lasts longer than 24 hours

    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Updated:  

March 22, 2017