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Oh My Aching Head!

Anyone with a bad headache is likely mumbling the same mantra: “Make it stop!”

Unlike pain elsewhere in your body a bad headache really can't be ignored. Headaches come in many varieties but each fits under the umbrella of either primary – like the most common tension headache migraine and cluster – or secondary headaches which have an obvious cause such as hangover head trauma brain tumor or infection. While some primary headaches are brought on by stress or dehydration others are hereditary. Because June is National Migraine Awareness Month Dr. Dennis Lipton internal medicine specialist at Vail Valley Medical Center outlines causes cures and complexities of several types of headache.

For starters if you've had a lasting pounding headache and it is accompanied with other symptoms like fever nausea vomiting blurred vision or numbness and tingling don't simply pop some painkillers and wait it out. Seek medical attention right away. People who suffer from migraines – which are generally hereditary – take migraine-specific medication (triptans) and can usually tell immediately when the pain begins that it is a migraine rather than a tension headache because the symptoms often do include nausea and visual changes.

“My job as a physician is to make this important differentiation and ensure that a headache does not represent something more worrisome” Dr. Lipton says. “That's why if someone has a new changed or otherwise unexplained headache it's important to get it evaluated. Many people with disruptive headaches that don't respond well to over-the-counter medications have diagnosed themselves with chronic sinus problems eyestrain or tension headache. They may actually meet criteria for migraine and are missing out on effective treatment.

Doctors also prescribe triptans for cluster headaches which are a rare but extremely painful and characterized by acute pain on one side of the head that occurs in clusters – sporadically throughout the day or over several weeks. People suffering from cluster headaches tend to pace around and act very agitated in contrast to the migraine sufferer who usually just wants to lie down in a dark quiet place. Other medications prescribed to prevent migraine or cluster headaches include propranolol verapamil or topiramate.

Medicine isn't always the answer however. For tension headaches a cold compress to the forehead massage meditation or light exercise such as a brisk walk can help tremendously. The best over-the-counter medications are acetaminophen or ibuprofen. Here in the high country a very common cure for headaches of all varieties is oxygen.

“Headache is one of the cardinal symptoms of full blown altitude sickness or Acute Mountain Sickness (AMS)” Dr. Lipton says. “Often a mild nagging headache is the only symptom people have when they first come to altitude. As long as the headache is mild and is not associated with any other worrisome symptoms it can be treated symptomatically and should resolve within 48 to 72 hours. For someone who gets migraines altitude can certainly be a trigger for an episode so they should come prepared. Also interestingly people who get migraines seem to be more prone to getting AMS to begin with.”

Even individuals not prone to migraines or regular headaches should drink plenty of hydrating fluids when visiting the high country especially if you're hiking biking and partaking in vigorous high-altitude activities. This can certainly help prevent headaches since dehydration is a common cause (also the culprit behind hangovers). While drinking water helps tremendously drinking fluids rich in electrolytes – such as Gatorade – can be even better.

“Drinking electrolytes in fluid [sports drinks] as you rehydrate can provide your body the tools it needs to adjust to altitude optimally as many long-time Vail Valley residents and physicians have discovered. I often recommend it for people struggling with altitude-related headache and hydration problems” Dr. Lipton says.

It's not always easy to isolate the cause of a headache. Tension headaches can be caused by everything from recurring stress poor nutrition exposure to chemicals or fumes dehydration lack of exercise too much exercise or overuse of medication. For individuals who get headaches frequently and don't know why Lipton recommends documenting details until a pattern emerges.

“Write down everything you do everywhere you go your sleep and wake time and everything you eat and wait for a headache to happen” he says. “Alternatively you can wait until you get a headache then write down everything from the last 24 hours as noted. Once you find a trigger do your best to avoid it. Some good general advice assuming secondary causes have been ruled out is to maintain a regular schedule of sleeping eating and exercise.”

More Facts & Stats

• According to The World Health Organization half to three quarters of 18 to 65-year-old adults have at least one headache per year and about 10 percent have migraines.
• High Stress and sleep deprivation are two of the most common triggers of primary headaches.
• At-home remedies include sleep Ibprofen or acetaminophen cold compress to the forehead water electrolyte-rich fluids a brisk walk
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About Dr. Dennis Lipton - Internal Medicine  | (970) 926-6340
Dennis Lipton MD is a board-certified internist trained in the essentials of primary care and disease prevention and can help ensure patients receive the proper medical screening tests and immunizations.