your headache triggers. When you get a headache, write down the day and time the pain began. The diary should include notes about what you ate and drank in the last 24 hours, how much you slept and when, and what was going on in your life immediately before the pain started.
Over-the-counter painkillers such as aspirin, ibuprofen, or acetaminophen may relieve pain if relaxation techniques do not work. If you are planning to take part in an activity that you know will trigger a headache, taking one of these painkillers beforehand may be helpful.
Narcotic pain relievers are sometimes prescribed. Remember that pain medications only relieve headache symptoms for a short period of time. After a while, they do not work as well or the help they provide does not last as long. Regular, overuse of pain medications can lead to rebound headaches.
Other prescription treatments may include:
- Muscle relaxants such as tizanidine
- Selective serotonin-reuptake inhibitors (SSRIs) such as paroxetine (Paxil) or citalopram (Celexa) taken daily to help prevent or decrease the number of headaches
- Tricyclic antidepressants such as amitriptyline, nortriptyline, or doxepin taken daily to help prevent or decrease the number of headaches
Combining drug treatment with relaxation or stress-management training, biofeedback, cognitive behavioral therapy, or acupuncture may provide better relief for chronic headaches.
Botox (botulinum toxin) is also becoming popular as a treatment for chronic daily headaches, including tension headaches. However, it is currently not approved for such use.
Your doctor can diagnose this type of headache by asking questions about your symptoms and family history of migraines. A complete physical exam will be done to determine if your headaches are due to muscle tension, sinus problems, or a serious brain disorder.
There is no specific test to prove that your headache is actually a migraine. However, your doctor may order a brain MRI or CT scan if you have never had one before or if you have unusual symptoms with your migraine, including weakness, memory problems, or loss of alertness.
An EEG may be needed to rule out seizures. A lumbar puncture (spinal tap) might be done.
Possible Complications
Rebound headaches — headaches that keep coming back — may occur from overuse of painkillers.
It’s important to see a doctor if you have chronic headaches. In some cases, the headache may be a symptom of a more serious disorder.
When to Contact a Medical Professional
Call 911 if:
- You are experiencing “the worst headache of your life”
- You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before
- Your headaches are more severe when lying down
- The headache starts very suddenly
Also, call your doctor if:
- Your headache patterns or pain change
- Treatments that once worked are no longer helpful
- You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst
- You are pregnant or could become pregnant — some medications should not be taken when pregnant
Preventions
Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may improve relaxation exercises and may be helpful for chronic tension headaches.
Tips to prevent tension headaches:
- Keep warm if the headache is associated with cold.
- Use a different pillow or change sleeping positions.
- Practice good posture when reading, working, or doing other activities.
- Exercise the neck and shoulders frequently when typing, working on computers, or doing other close work.
- Get plenty of sleep and rest.
Understanding your headache triggers can help you avoid foods and situations that cause your migraines. Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches.