Thursday, June 4, 2015

Healthy Habits: Headache Types and Relief

I recently had a chance to interview Brian Loftus, MD of about headaches and treatments. As a migraine sufferer, I know it's important to find the right treatment plan!

What are some common types of headaches?
The most common headache type in the population is tension type headache. Once the headache becomes moderate or worse - then migraine is most common. Headaches during a menstrual cycle are almost always in women with underlying migraine.
What are some less common types?
In women - cluster headaches are very severe but very uncommon.  here are a large number of very uncommon headaches like hemicranial continua, paroxysmal hemicrania.
What are some signs that a headache needs medical attention?
New onset of a sudden headache that is the most severe in your life, new headaches after 50, new headaches with fever and stiff neck, new headaches in patients with cancer, HIV disease, or chemotherapy type medication. New headaches that just don’t stop.
What are some of the best treatments for headaches?
Headache therapy needs to be individualized to the headache type (migraine treatment is different from cluster treatment and is different from tension type headaches). Treatments then need to be individualized to the severity, frequency, pregnancy status, desire for pregnancy, patient’s weight, and other patient’s comorbid diseases. Virtually all patients with repetitive disabling headaches have migraines. Here is an something I have written to help women get better migraine care.

Step 1:  Get the Correct Headache Diagnosis.  More 90% of patients who have a 6-month history of intermittent disabling headaches have migraine headaches. While most people think of severe headaches accompanied with vomiting and sensitivity to light as being migraines, many migraines are also less severe. 

Determining your headache type is critical. Of the 36 million Americans who have migraines, only 50% have been properly diagnosed. Most of the remainder have been misdiagnosed as repeated sinus headaches and tension headaches. 
   Tension headaches are not typically severe and do not cause disability they way migraines do. Most people do not seek help from a physician for treatment and use common over the counter medications like Aleve® aspirin or Tylenol® to treat them.
   Migraines are commonly misdiagnosed as sinus headaches. if you are having fever during your headaches or have colored discharge or mucus from your nose then you may be having recurring sinus headaches but if you do not have these symptoms then the diagnosis of migraine should be considered.
With the correct diagnosis, you are much more likely to get a migraine headache therapy which is more effective than general pain treatment. 

If you want to try to figure out what type of headaches you are having on your own then using an active headache diary will help you classify your headaches (but remember a proper diagnosis needs to be made by a healthcare professional such as an internist, neurologist or headache specialist). iHeadache Online ( or the iHeadache® app on the Apple App store (both free) was developed by Neurologist and Headache Specialist Brian D. Loftus, MD. The app is the most popular headache diary on the Apple App Store with over 150,000 downloads to date.

Step 2:  Consider Lifestyle Changes. Consider making some life style changes to decrease your headache frequency. Eliminate caffeine, artificial sweeteners, chocolate, and alcohol from your diet.  Set a regular sleep/wake cycle. Do not skip meals. After getting a baseline of your headache frequency and pain intensity, begin tracking common triggers to see if any of them could be causing your headache. iHeadache Online has a function where you can enter triggers when you are having a headache and when you aren't. This makes it easy to see if your Godiva chocolate addiction is causing your headaches (and hopefully it isn't)! Trigger tracking without having a headache is only available on iHeadache Online but is being added to the iHeadache app soon.

Step 3: Consider Preventative Treatments.  If you have significant disability because of your headaches and they are frequent enough, consider headache prevention.  To determine your headache disability, use a headache diary like iHeadache online or the iHeadache App to track your headaches, medication taken, and disability you have with each headache. A couple of disabling headaches per month or frequent headaches (more than weekly) should be evaluated and your and your doctor should decide if preventative therapy would be helpful in your situation. If your doctor does not think you are having enough headaches to warrant taking a headache preventative then you owe it to yourself to see a different doctor. The key to determining headache frequency is to include all the days you have a headache - not just the days where your headaches were really bad.

Step 3: Find The Right Physician. 
While many primary care physicians and general neurologists can treat patients with headache and take care of simple cases, many are not equipped to take care of the more challenging cases and are not familiar with the newest treatments and procedures. 

At Bellaire Neurology, I depending on the patients circumstances and side effects I use about even (7) first-line generic oral migraine preventative medications/treatments and perform more than five (5) in-office medical procedures designed for long term migraine prevention for patients who have failed or do not desire to take ongoing oral medications for migraine prevention. Many headache specialists, including myself, have in-office headache rescue room services an infusion suite where you can get treatments in the office while having a severe headache. In-office treatments are typically much cheaper than going to an emergency room.  All headache specialists have various headache infusions and/or procedures available for patients who need a faster response than typically achieved by oral preventative medications or those that are not getting adequate benefit from oral migraine acute medications. 

Background information About the Author:
Brian Loftus, MD is in private practice in Bellaire, TX.  He is Board Certified in Neurology as well as Headache Medicine.  Because he developed migraines in residency, he has always had an interest in this disease.  He is the first headache physician in the Houston area with a Headache Rescue Room and the first to offer SPG block with Allevio® and Tx360® devices.  He is a co-developer of the iHeadache family of products the most widely recommended and utilized electronic headache diary system.  He maintains a patient oriented website at with a lot of information about migraines and other types of headaches.  He is the current Vice-President and one of the founding members of the Southern Headache Society (SHS). The mission of the SHS is to improve physician education in the treatment of headache.

·       ACHE (Education arm of the American Headache Society)
·       National Headache Foundation
·       Southern Headache Society 

Dr. Loftus list of the most common mistakes made by physicians when treating headaches:
1.     No prevention the physician has a poor understanding of the patients disability and the impact of their migraines on their life and does not feel preventative medications or procedures are necessary
2.     Continued use of ineffective agents it only takes a month or two to see if a preventative will work yet some physicians insist a patient continue trying a medication for at least three (3) months.
3.     Missed diagnosis of migraine few physicians use the formal criteria in their practice to diagnosis the type of headaches using the International Headache Societys International Classification of Headache DIsorders.
4.     Use of butalbital containing products these products are banned in Europe and commonly lead to more headaches (also known as rebound headaches). Despite the ban in Europe, many US physicians are still prescribing them to patients.
5.    Use of narcotics these medications do not restore a patient to function they just take away the pain for a while. Migraine specific medications are a much better long term option.

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