Expert tips for treating headaches and migraines

Headaches are among the most common health concerns and can significantly impact your daily life. Migraine headaches impact over 37 million men, women, and children in the U.S. Yet fewer than 5 percent have been seen by a healthcare provider, received an accurate diagnosis and obtained appropriate care.

“The first step in treating headaches is identifying which type of headache you are experiencing,” says Brenda Crum, a neurology nurse practitioner at Sentara Neurology Specialists in Woodbridge, Va.

There are many different headache types, including:

• Cluster headache: Causes pain on one side of the head that begins behind or around your eye but may spread to your face, head and neck.
• Occipital neuralgia: Causes burning, stabbing, electric, shocking, or shooting pain in the back of the head that can radiate to the top of the head.
• Rebound headache: Caused by the overuse of pain medicine such as over-the-counter medicines like aspirin, ibuprofen and acetaminophen.
• Sinus headache: Caused by sinuses becoming swollen or blocked. Symptoms include pain or pressure in the face, forehead, ears or upper teeth.
• Migraine headache: Causes strong throbbing pain on one or both sides of the head. May also cause other symptoms such as nausea, auras and vomiting/dizziness.
• Tension headache: Causes a feeling of pain, pressure or aching in the head, often over the front and side of the head.

Understanding the difference: headaches vs. migraines

The terms “migraine” and “headache” are sometimes used interchangeably. But migraines are a type of headache and are usually more severe. Migraines also cause additional symptoms such as:

• Visual disturbances (Aura): Seeing flashing lights, bright spots, etc.
• Throbbing head pain on one or both sides
• Sensitivity to light and noise
• Feeling nauseous and/or vomiting
• Dizziness

Diagnosing the cause

Crum takes a detailed history to understand the duration, triggers, and previous treatments when assessing a patient for headaches or migraines. She also looks for red flags in the neurological exam that might necessitate further investigation, such as a lumbar puncture, labs, CT scan or brain MRI. This thorough evaluation helps pinpoint the exact cause and rule out other potential issues.

Common triggers and lifestyle factors

When meeting with patients, Crum explores common headache triggers that many patients are unaware of, such as dehydration, excessive caffeine intake, prolonged screen time, irregular eating habits and poor sleep hygiene.

“Patients are surprised by how many things can contribute to headaches. Something as simple as getting an updated vision exam may help,” says Crum.

Addressing these lifestyle factors can significantly reduce the frequency and severity of headaches and migraines:

• Diet: Maintain a healthy diet, avoid too much sodium or sugar and avoid skipping meals, which can trigger headaches.
• Caffeine: Monitor your caffeine intake, as both too much caffeine and withdrawal from caffeine can cause headaches.
• Hydration: Aim to drink six to eight glasses of water a day. Dehydration is a common but often overlooked trigger. “I’ll ask patients about how much water they’re drinking daily, and they’ll tell me they carry water with them but aren’t drinking it,” laughs Crum.
• Screen time: Reduce screen time and ensure regular vision exams to avoid strain-induced headaches.

Sleep hygiene

Sleep hygiene is a term that refers to healthy habits, behaviors and environmental factors that can help you get a good night's sleep. Proper sleep hygiene is crucial in managing headaches and migraines. Crum often refers patients for sleep studies to check for conditions like sleep apnea, which can contribute to morning headaches. Good sleep practices include:

• Ensuring consistent sleep schedules
• Using a C-PAP machine if diagnosed with sleep apnea
• Creating a restful sleeping environment

Supplements to treat headaches and migraines

Crum prefers to start with vitamins and over-the-counter options before prescribing stronger medications. Crum often recommends her patients try the following options once they’ve cleared them with their healthcare team:

• Vitamin D
• Magnesium (in the form of magnesium citrate or magnesium glycinate taken at bedtime)
• Riboflavin
• Feverfew

Crum says these options may help prevent migraines, but she also emphasizes the importance of maintaining consistent levels of these supplements to prevent the recurrence of headaches.

Medication overuse and rebound headaches

Crum advises her patients to be cautious about over-the-counter pain medication overuse with medications such as aspirin and ibuprofen, which can cause rebound headaches. Crum works with patients to wean them off such medications and explore alternatives.

Newer medications and preventative vs. abortive treatments

Preventive migraine treatments can reduce migraine frequency and treat symptom severity. Abortive migraine treatments, which treat symptoms once a migraine occurs, can significantly reduce the intensity of the migraine. Crum assesses the frequency and severity of headaches to determine whether a patient needs preventative or abortive medication.

“Patients may come in and say they want to try a migraine treatment they saw advertised on TV,” Crum explains. “However, newer medications may be harder to get covered by insurance. Often, the insurance company requires proof of previous treatment attempts with more traditional treatments, such as triptans, beta-blockers, anti-convulsants and tricyclics, before they’ll cover one of the newer medications.”

She helps patients document their medication journey to make getting coverage for the newer medications easier when needed. She credits the newer medications with typically having fewer side effects than the older ones.

“I’ve been doing this almost 30 years and have seen medications evolve and improve over time,” adds Crum.

Comprehensive care and referrals

Managing headaches and migraines often requires a comprehensive approach that includes regular checkups and monitoring of other health conditions, such as blood pressure, diabetes and thyroid issues. Crum emphasizes the importance of routine blood work and, when necessary, referrals to specialists for further evaluation.

If you’re struggling with headaches that are interfering with your day-to-day activities, make an appointment to explore treatment options.

Sentara Neurology Specialists is a team of neurologists, neurosurgeons and neuropsychologists who treat headaches and other brain, spinal cord and nervous system disorders.