Take two aspirin and call me in the…

If I ever find a genie bottle and I get three wishes, the first will be, “Genie, please send me a magic pill.”  The other two are private.  How I would love to have a magic pill so that I could be the most powerful doctor in the world (insert evil laugh.)  I know that a magic pill is what almost all of my patients want from me and since I really did go to medical school to make people feel better, I would love to give it to them.  Sadly, it does not exist and we are left with a lot of treatments that require a little work on both the part of the patient and the part of the doctor.  Headaches fall very strongly into this category.  Feeling better or avoiding a headache altogether takes a willingness to change habits and lifestyle and/or to participate in a trial and error experiment until the right combination of therapies is found.  Not easy but the alternative is, well, a real pain.

1.  Prevention – avoidance of headache triggers (see 10/25), healthy sleep habits, good posture, adequate hydration as in 8 glasses of water a day (does anyone out there actually drink 64 oz of water every day?) and stress reduction will all go a long way to prevent a headache from happening.  If you are a woman and your headaches coincide with your periods, consider increasing your zinc intake at that time of the month.

2. Over the counter – Ibuprofen (Motrin, Advil) can be very effective at relieving the pain of a mild to moderate headache, especially tension and hangover headaches.  Acetaminophen (tylenol) supposedly works too although not in my personal experience.  The difference being that Ibuprofen works as an anti-inflammatory in addition to pain relief.  Ibuprofen has more potential for side effects than tylenol.  If you find yourself needing meds for your headache everyday.  Stop.  Medication overuse can result in headaches as well.  A small amount of caffeine can be very useful.  Read the ingredients of headache meds — many, like Excedrin, contain caffeine.  Again, be careful because too much can ultimately worsen your pain.

3.  Prescription - in addition to simply stronger pain meds, which most responsible physicians will try to avoid giving you, there are drugs to combat the underlying causes of headaches, especially migraines.  Some are taken every day and some are taken before or at the onset of the headache.  They can come in pill form or in nasal sprays (nasal sprays sometimes being better for cluster headaches.)  In addition to meds formulated specifically for headaches, some blood pressure medications and anti-depressants are very effective.  This supports a vascular and/or chemical component as a causal factor in the headache.  Botox has recently been approved by the FDA in the treatment of migraines.  Funny, all of a sudden, I have a throbbing pain in my forehead, the corners of my eyes and in the deepening grooves from my nose to my outer upper lip — weird.

4.  Alternative – 27% of people who have headaches are using alternative treatments.  Anything from acupuncture and electrical stimulation to massage and meditation has been anecdotally successful.  While not scientifically proven, these methods are definitely worth a shot if you are suffering.

5.  Vacation

About 80% of people live with chronic or occasional headaches and yet, doesn’t it always seem like such a cop-out?  “I can’t make the meeting because I have a headache.”  ” We didn’t make the party because she had a headache.”  “Get off of me, I have a headache.”  It is a real problem and still so poorly understood.  Why don’t we get a foot-ache for no reason?
Most of the time, a headache is nothing but sometimes it can warn of something very serious.  Tune in tomorrow for signs and symptoms to watch out for in adults and children.

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