While mild headaches can often be treated with an over-the-counter pain medication, relief of severe headaches is usually best achieved with the help of a physician.
A number of prescription medications can ease the pain, and the doctor can also help the individual learn techniques to ease stress—a major factor in headaches—helping prevent headaches from occurring.
Doctors Who Treat Headaches
Visiting a primary care physician first is advised. Ask the doctor about their experience treating headaches and find out what their overall approach to treatment of headaches can be helpful.
Blood tests, x-rays, and MRI (magnetic resonance imaging) or CT (computed tomography) scans are often performed. In some cases, the doctor may refer the individual to another specialist, depending on the type of headache and the person's other medical issues. Pain management physicians and neurologists often treat headaches. The primary care doctor may also refer the patient to one of these other specialists:
- An ophthalmologist if the headaches affect the eyes
- An allergist or ear, nose, and throat doctor for sinus headaches
- Headache specialists (not available in all states)
- Doctors of chiropractic or osteopathic medicine for the use of spinal manipulation.1-3
Keeping a headache journal and sharing it with the doctor can help the doctor diagnose the type of headache and determine the best treatment. The journal should include how severe and how long-lasting the headaches are. Tracking foods, sleep, weather, and menstrual cycle timing (for women) is also good to include.
A headache journal can help both doctor and patient pinpoint headache triggers. If headaches occur frequently with computer work, for example, making ergonomic adjustments, taking more breaks, or getting new glasses may be considered.
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Medications for Headaches
Some medications helpful in treating headaches were first used for other conditions. Antidepressants and anticonvulsant medications, originally designed for people with depression or epilepsy, respectively, are often helpful in treating severe headaches.
Drugs prescribed to prevent headaches may include:
- Tricyclic antidepressants
- Beta-blockers (typically used to treat high blood pressure)
- Anti-epileptic drugs
Medication taken on an as-needed, rather than preventive, basis is best taken as soon as possible after the headache begins. This allows the person to stay ahead of the pain.
Two types of medications used to stop severe headache pain when it starts are triptans and ergotamine derivatives. Triptans are a class of drugs that reduce pain, vomiting, and nausea. Some common triptans are sumatriptan (brand name Imitrex), Zolmitriptan (Zomig), and rizatriptan (Maxalt). Ergotamine derivatives, such as Ergotamine (brand name Ergomar), and dihydroergotamine mesylate (Migranal) relieve the throbbing headaches often associated with migraines.
Some headache medications are sold as nasal sprays or by injection, as well as in tablets or capsules. Alternatives to pills are helpful when nausea makes it impossible to swallow a pill. Other treatments, such as oxygen therapy for a cluster headache, are tailored to the symptoms of a specific type of headache.
Interventional techniques can be used as a treatment for headaches. Botulinum toxin (Botox) injections in specified areas as well as nerve blocks may be effective.
Medication-Free Pain Strategies
Medication is often just a part of successful treatment for severe headaches. Many people find that simply lying down or taking a nap is beneficial in treating headaches. Since stress and anxiety are often contributing factors, stress-reducing techniques are also frequently advised.
Relaxation training can give individuals a greater sense of control over their symptoms. Biofeedback, for instance, helps people learn to control stress-related body functions, such as blood pressure and muscle tension, to ease pain.
In some cases, approaches outside traditional Western medicine are helpful. Some widely used options include:
- Herbal therapies
Some pain relief strategies are easy to do at home. Applying heat or cold packs, or directing the flow of a hot shower to the back of the neck can ease the pain in some cases.
Practicing healthy habits overall—including regular exercise and adequate sleep—also helps reduce stress.