My Doctor Online The Permanente Medical Group

Symptoms

.

If allowed to continue, these headaches seem to get progressively worse. Symptoms can include:

• A permanent tension-type headache with tight, pressing pain (mild to moderate) on both sides of the head.
• Pain that is usually located in the back of the head and neck but may extend forward.
• A disabling headache, like a severe migraine, on top of the permanent tension-type headache. Migraineurs are most likely to experience this.
• Sleep disturbance.
• Anxiety and/or depression.
• Gastrointestinal symptoms.
• Sensitivity to light, sounds, and smell.
• Sensitivity that may spread to your skin and make just being touched painful – this is known as "allodynia."

Causes and Risk Factors

.

• Too much caffeine.
• Frequent use of decongestants and muscle relaxants.
• Taking prescription medications that contain opiates.
• Chronic tension or stress.
• Underlying anxiety and depression.
• Sleep problems such as chronic insomnia.
• Obesity. A loss of only 10 pounds can reduce the number and severity of headaches.
• Poor diet. Diets with excessive sugar, salt, fat and processed foods contribute to headaches.
• Chemical sensitivity. Exposure to perfumes, smoke, or other fumes including indoor air pollution can cause or exacerbate headaches.

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 recommend 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.

In addition, women can experience headache-type symptoms early on in preganancy. In the majority of cases, there is no apparent 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.

.

Treatments

.

If you think you have chronic or rebound headaches, tell us about them. We need to know which over-the-counter medications or supplements you use and how often you take them. Remember to take medications only as directed, and don't take more than the recommended dose.

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.

We can help you develop a rebound headache action plan to gradually wean yourself off medications that may be causing your symptoms. 

• Chronic daily headaches can be controlled through daily lifestyle changes.
• Eat regular, healthy meals including breakfast.
• Avoid beverages, foods and medications containing caffeine.
• Exercise for at least 30 minutes a day.
• Go to bed and wake up at the same time every day.

Prevention

.

Effective ways to prevent chronic daily/rebound headaches include:

• Avoid pain or analgesic medications that contain caffeine (e.g. Excedrin). These substances constrict the vessels in the brain, which relieves pain in the short-term. However when the effect wears off, the vessels dilate again and the pain comes back, forcing you to take another dose. This turns into a vicious cycle.
• Take a step back. The only way to stop rebound headaches is to avoid taking medication on a frequent basis. Look at your lifestyle and how you can prevent headaches in other ways such as diet, exercise, and reducing stress.
• Be your own detective. Keep a Headache Diary to see if your headaches follow a pattern or follow obvious triggers that are avoidable.
• Evaluate your diet. Try and limit overly processed foods with high levels of sugar, salt, and artificial ingredients. You may find that avoiding foods containing monosodium glutamate will improve your symptoms.

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 program 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. 

Your Care with Me

.

Most headaches can be treated at home with over-the-counter pain relievers. If you have regular headaches that do not respond to these medications, or if you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

.

.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

.

Coordinating Your Care

.

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

.

Convenient Resources for You

.

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

.