My Doctor Online The Permanente Medical Group

Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Headache Overview

Overview

Almost everyone has headache pain from time to time. Headaches are classified as either primary or secondary:

  • Primary headaches, such as migraines and cluster headaches have no clear organic cause.  These headaches are due to disturbances in the brain's pain system and often seem to involve increased sensitivity to factors either inside or outside the body.
  • Secondary headaches are a symptom of some other disorder. There are at least 300 of these types of headaches. They include metabolic problems, vascular problems like high blood pressure, and infections.

The most common primary headache disorders are migraine and tension type headaches. Your headache symptoms can range from mild discomfort to the severe disabling pain caused by cluster headaches.

Good self-care and stress management are essential to help in the management of your headaches. Nutritious meals at regular times, enough sleep, and regular exercise can also help manage your condition. Though the vast majority of headaches are treated at home with self-care, sometimes it is important to seek medical care to make sure your headaches are not a sign of a more serious condition.

If any of the following occur, call our 24-hour Appointment and Advice line immediately: 

  • Your first headache occurs after age 50.
  • You have new, severe symptoms unlike your usual headache symptoms.
  • You have the worst headache you have ever experienced.
  • Your headaches are getting worse over time.
  • Your headache gets worse with exertion, or with coughing, sneezing, or sexual activity.
  • You feel drowsy, feverish, or suddenly weak.

Types

Migraine

A migraine is defined as a headache lasting between 4 and 72 hours, accompanied by nausea and/or vomiting, and light and sound sensitivity. You may experience pulsating pain on one side of the head. The pain may get worse with exertion, such as walking up a flight of stairs. Migraines can be an inherited condition.

Tension headaches

Most headaches are tension headaches, and they can affect men, women, and children of all ages. Tension headaches have the following features:

  • Aching pain and tightness around the forehead, temples, or back of the head and neck.
  • Sensation of a pressing, tightening band around the head.
  • Sensitivity to lights or sound, but not both.
  • Headache lasts from 30 minutes to 7 days.
  • Can develop into chronic headaches.   
Cluster headaches

Cluster headaches are far less common than either migraine or tension headaches. Their symptoms include:

  • Intense, disabling pain on one side of the head, accompanied by a watery eye and stuffy nose on the same side.
  • Pain that starts suddenly.
  • They occur in groups, or clusters, over a few weeks to months.
Chronic daily headaches

Chronic daily headaches are headaches that occur 15 or more days a month. Most people who develop chronic daily headaches are also migraine sufferers (also called migraineurs). The migraines may become more frequent until the headaches occur almost daily. Migraineurs who suffer from chronic daily headaches usually describe two types of headaches: 

  • The first type is a milder tension-type headache.
  • The second type is a more disabling headache, like a severe migraine, on top of their regular tension headache.

People who do not have migraines also suffer from chronic daily headaches. These headaches are usually chronic tension-type headaches, characterized by tight, pressing pain on both sides of the head. The pain can range from mild to moderate and is usually located in the back of the head and neck but may extend forward. 

If you experience chronic daily headaches, it may be because you are taking over-the-counter pain medications such as acetaminophen and ibuprofen, or combination migraine medicines that include caffeine, and/or triptans frequently. 

Recent research indicates that headaches occur when the nervous system becomes overly sensitive. Frequent use of pain medications seems to promote this. When overuse of medication causes headaches we call them rebound headaches. However, not all chronic daily headaches are rebound headaches.

Headaches and pregnancy

Frequently, women can experience headache-type symptoms early on in pregnancy. In the majority of cases, there is no specific cause for this condition. Treatment is based upon symptoms and specified by what is safest for you and the pregnancy. By midpregnancy, most of these symptoms will decrease in severity or disappear entirely. Later in pregnancy, a new-onset headache may be a sign of a different condition or pregnancy complications. Any persistent or severe headache should be evaluated.

Diagnosis

Accurately diagnosing the cause of your headaches is important so that we can choose the most effective treatment. 

We diagnose your condition by asking you questions about your symptoms and past medical history, and performing a physical examination. This enables us to verify that your symptoms are not caused by a more serious underlying illness or condition.  

When we suspect another condition we may order a brain scan, such as a CT scan or MRI. We may refer you for additional tests if:

  • Headaches are a new problem.
  • You have a change in your symptoms.
  • Your exam indicates you may have another condition.

Some kinds of headaches, particularly chronic daily headaches, can be caused by depression. We will also evaluate you for depression during your examination.

Treatments

  • Most headaches are treated at home with over-the-counter medications. We can recommend additional treatment depending on the frequency, severity and type of headaches you are experiencing.
  • Most types of headaches can be controlled by following a healthy routine that includes regular, healthy meals, plenty of sleep and exercise.
  • We also recommend that you monitor your headaches to identify triggers or activities that precede your headaches. Keeping a Headache Diary is a good way to do this.
  • Although over-the-counter pain medications are effective at treating the occasional headache, overdependence on these and other medications can actually cause more headaches. We can help you develop a plan to gradually reduce your dependence on these drugs.
  • Some headache medications are not recommended during pregnancy. If you are considering getting pregnant, or are currently pregnant and taking medications to control your headaches, please notify me so we can review these medications together.

Lifestyle Changes and Management

Commit to a healthy lifestyle

Many headaches can be prevented by committing to a healthy lifestyle that includes:

  • A healthy diet.
  • Plenty of exercise.
  • Getting 8 hours of regular sleep.
  • Minimizing stress.
Use an online program

Our online health coach has programs that can help you lose weight, eat healthy foods, quit smoking and manage stress. Please refer to our Managing Your Headaches program for detailed information about everyday changes you can make to help reduce and control your headaches.

Manage anxiety and depression

Anxiety and depression can be underlying causes of headaches. Our online video, Understanding Depression, can help you evaluate your own symptoms to see if depression may be a factor. Contact us if you think you need to be evaluated or treated for depression.

Find a support group

Find, or create, your own headache support group. We have headache management classes at many of our medical centers in Northern California. A number of community headache organizations also have online or in-person support groups for headache sufferers. 

Additional References:

Related Health Tools:

Interactive Programs
Personal Logs and Diaries
Podcasts
Videos

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.



Copyright © 2009-2010 The Permanente Medical Group, Inc. All rights reserved.