Headaches are a very common reason people go see the doctor.


Headaches are very common and can be debilitating. Especially migraines.


We used to think that migraine headaches were just caused by dilation of cerebral blood vessels in the brain. Now we know that there are many other factors involved, like chemical messengers and things.


That’s why there are more than a couple of new drugs that very adequately treat migraine headaches, which have been very difficult to treat through the years.


I remember when I first started practicing medicine 35 years ago, this certainly wasn’t the case. Someone would come in with a migraine, and we would have to give them a shot of Demerol and Phenergan, knock them out and send them home with someone. They’d have to sleep it off over a day or two.


Then the Triptans came to play. The first one was Imitrex and it was a remarkable treatment at the time.


How Triptans work is they constrict the vessels. In certain people with cardiac disease and hypertension this could be an issue though. In some people they simply don’t work.


These would reverse it, and the patient would leave with no headache.


Now there’s medications out there that are even better, and certainly safer than the Triptans with less side effects.


Types of Headaches
  • Tension headache (Most Common)
  • Migraine
  • Sinus headache
  • Rebound headache
  • Cluster headache


Cluster headaches are a severe type of headache. It’s not as common. It feels like a hot poking iron sticking in your eye. It’s one sided around the eye. The eye will turn red and your nose will start running. It’s short duration, but they tend to come back daily for up to 15 days.


A rebound headache happens when you are used to taking Tylenol or ibuprofen, you don’t take them, and the headache “rebounds” and comes back.


In East Tennessee, because of the allergies, we blame a lot of headaches as sinus headaches.


In fact, they’re more likely to be migraines.


Because of this migraines are very under diagnosed and are being put off as sinus headaches or even tension headaches.


Migraines are what we call “sick headaches”. They are usually one sided. Throbbing. They’re associated with nausea, vomiting, and visual disturbances.


They are the type of headache that you go to bed with, because they are that severe.


There are two types of migraine headaches.


Migraines with an aura: This migraine is going to come on. You can feel it or sense it. Some people see flashing lights, different smells, sensations, numbness and tingling.
It’s usually a visual aura.
Migraines without an aura: With this type you have no cognition that it’s coming.
Either way, both of these are treatable.


Treating an acute migraine is different than prevention of migraines
For prevention you may qualify to go in for monthly shots to a neurologist. The problem with this is that it’s expensive and it’s difficult to qualify for. You need to have 4-15 migraines per month, and have already tried other medications in order to get approved. What these monthly shots can do is decrease the amount of headaches you get.


Other medications for prevention are calcium channel blockers and beta blockers. Both of these are blood pressure medications.


And more commonly used is Topamax, which is a medication for seizures.


Triggers for Migraines
You need to figure out what triggers your migraine.


Triggers can be hormonal. Migraines are more common in women because of their monthly cycles.


You can treat it with hormones like progesterone.


Sometimes birth control can cause migraines.


In women, you first want to try and figure out their hormones.


Other Triggers for Migraines
  • Alcohol
  • Caffeine
  • Cheese
  • Stress
  • Perfumes
  • Smells
  • Cigarette smoke


As you can see, there are lots of triggers.


What can you do to naturally prevent migraines? 
Like so many things, it goes back to lifestyle. Get enough sleep. Drink enough water. Keep your stress down. Exercise and eat the right foods.


Lack of sleep and dehydration are huge triggers for migraines.


One thing I always suggest is to make a headache diary to figure out your own headaches.


Vitamins and supplements for migraines 
  • Magnesium – This is my number one vitamin for this.
  • CoQ10
  • B12
  • Feverfew herb


Migraine Cocktail
Something new we’re doing in office for acute migraines is an IV that has magnesium in it. It tends to get rid of severe migraines.


We’re also using an Oxygen Concentrator. This is where you put a mask on and breathe in 8-10 liters of pure oxygen. It takes around 10 minutes, and often it will abort the migraine.


We’re starting to have patients do both the IV and Oxygen mask at the same time, and having great results with it. This works well with cluster headaches as well as migraines.


Action step from this week’s Doctor’s Note: Do a headache diary!


And remember, there’s several new options for you now.