Steamboat Pilot & Today

Nearly everyone has a headache from time to time, and we've all heard the phrase "take two aspirin and call me in the morning." However, about 45 million Americans have headaches that are severe or persistent enough that pain medication and a good night's sleep are not the solutions.

Most headaches fall into one of five categories: secondary, tension, migraine, chronic or cluster. A secondary headache results from another illness such as a cold, the flu or a sinus infection and is effectively treated with over-the-counter pain medications.

The tension headache also rarely requires a doctor's attention. Get away from the source of the tension, and the headache goes away. A tension headache typically involves tightness, pressure or a dull ache that may feel as if you're wearing a headband that's too tight.

Tension headaches may be associated with a missed meal, dehydration, a hangover, sleep loss, caffeine withdrawal, stress or anger. A tension headache usually can be relieved with over-the-counter medication, sleep, a hot bath, massage or an enjoyable activity that directs attention away from the pain.

Migraine headaches are far more serious and debilitating. The pain may start on one side or be generalized. Some patients experience a visual warning or aura consisting of flashing lights or bright spots before the eyes. When the pain comes, it is intense, throbbing and often accompanied by nausea, vomiting and/or extreme fatigue.

Patients typically become virtually disabled by migraine attacks. Without treatment, migraines may last from a few hours to several days. Women are two to three times more likely than males to get migraines, probably because of the influence of hormones. Genetics also may increase a person's risk. Like any chronic illness, migraines require a physician's care.

It is important to identify and avoid triggers and act quickly when a migraine attack occurs. Medications are available for treatment and prevention; these are more effective when taken early. Primary care physicians can help many patients who suffer from migraines. More extreme cases may be referred to a pain-management center.

Linda Corkadel, a registered nurse and coordinator of the Pain Management program at Yampa Valley Medical Center in Steamboat Springs, said Botox has been used with success for patients who have frequent migraines.

A chronic daily headache occurs for an average of more than four hours on more than 15 days a month. This condition usually develops gradually in individuals suffering from either tension or migraine headaches.

In at least half of adult cases, a CDH is a rebound headache resulting from overuse or misuse of headache medications. Treatment involves withdrawal from the medication, even though this may increase the pain temporarily.

Cluster headaches strike suddenly, even during sleep. They quickly escalate to sharp, stabbing pain on one side of the head, such as around an eye. These headaches are relatively short but occur in clusters of as many as eight a day. This pattern may persist for several weeks, and then the headaches suddenly disappear, only to return months later.

Triggers may include an allergy, alcoholic beverages or changes in the season. The key to treatment is to find whatever causes cluster headaches and avoid it.

Of course, headaches do not always fit into neat categories. You can help your doctor make a diagnosis by keeping a diary. Take detailed notes about when headaches occur, how long they last, what you had to eat and drink before the headache and what you were doing at the time. With careful detective work, patient and doctor often can track the causes of headaches and come up with a satisfactory solution.