Headaches are common causes of pain. Worldwide over 70% of adults have at least one headache per year. The three most common types are tension, migraine, and cluster headaches.

Tension headaches are usually felt on both sides of the head and typically respond to over-the-counter medications. They are thought to be caused by contractions of muscles in the scalp and neck. These contractions can be in response to stress, anxiety, lack of rest, poor posture, depression, or head injury. They can run in families and are slightly more common in women than in men. NSAIDs like ibuprofen, acetaminophen (Tylenol), stress reduction, ice or heat on neck muscles, and improving posture can also help.

Migraine headaches are often confined to one side of the head and are much more severe than tension headaches, often described as pulsating or throbbing. They can be accompanied by nausea and vomiting, light flashes, and sensitivity to light and sound. They can be triggered by stress, certain foods, or hormonal changes. Patients can be warned by an aura such as a visual disturbance just before the migraine. The pain can last for several hours to days. The cause is thought to involve abnormal firing of brain cells, along with abnormal widening of blood vessels in the brain. Sometimes sleep alone can end a migraine attack. The following medications are effective treatments which should be taken at the first sign of a migraine headache.

  • Wigraine (ergotamine and caffeine) works by constricting blood vessels in the head that expand during migraine attacks.
  • Imitrex (sumatriptan) and Maxalt (rizatriptan) block pain pathways in the brain.
  • Reyvow (lasmiditan) is thought to inhibit pain signaling through the trigeminal nerve, a nerve that carries messages from the face to the brain.
  • Ubrelvy (ubrogepant) blocks pain transmission, inflammation, and blood vessel dilation.
  • Dihydroergotamine is an ergot derivative that constricts bleed vessels in the brain

When migraine attacks become too frequent, topiramine (Topamax) can be taken daily to help prevent them.

Cluster headaches are described as sudden pain behind the eye with agitation, red, watery eyes, nasal congestion, sweating, and drooping or swelling eyelid. They reach maximum pain in about 10 minutes and occur in clusters and is often seasonal. They are thought to be caused by disturbances in the body’s biological clock. Cluster headaches can be treated by inhalation of oxygen through a mask, with Imitrex (sumatriptan), or with injections of local anesthetic.

Did you know? QuickMD can refill your chronic headache medications remotely via telemedicine and prescribe Imitrex or other anti-headache medications online?