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.
Headaches
Headaches affect almost everyone. Migraines and tension headaches are the most common varieties of headache, although there are many different types. While most headaches can be treated at home, some types need immediate medical care.
Cluster Headaches [Read/Print full article]
Overview
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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.
Women can experience headache-type symptoms early on in pregnancy. 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.
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.
Symptoms
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Common symptoms of cluster headaches can include:
- Burning or sharp, piercing pain on one side of your head.
- Pain that affects the forehead and eye on one side.
- Watery, red eye on the same side as the pain.
- Droopy eyelid, and you may have a runny or stuffy nose on the same side.
- Pain gets worse quickly and may last from 30 minutes to several hours.
- Headaches often begin at night, within two to three hours of falling asleep.
- Can continue for days, weeks or months.
Once the cluster stops, you may not have another one for months or years. Cluster headaches usually recur at the same time of day and even the same season. Sometimes, cluster headaches become chronic and continuous.
Causes and Risk Factors
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Although the cause of cluster headaches is largely unknown, the latest research suggests that they emanate from activity in the hypothalamus, a structure deep inside the brain. Other possible triggers include:
- Genetics. People with a family history of cluster headaches are more likely to get them.
- Trigeminal nerve. The trigeminal nerve, a large nerve that controls sensation in the face, forehead, chin and jaw, seems to be more active in people who have cluster headaches.
- Tobacco/alcohol use. Most people with these headaches are heavy smokers and/or regularly consume alcohol.
- Biological clock disturbance. These headaches often occur at the same time of day, suggesting that the body's natural clock may play a role in causing these headaches.
Diagnosis
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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.
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Treatments
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Although there is no cure for cluster headaches, treatment can reduce their frequency, lessen the amount of pain, and shorten the length of each headache cycle.
Medications
We may prescribe medications that can prevent a cluster of headaches from starting. These medications are taken every day. Other medications and treatments aim to stop, or shorten, the cluster headache once it has started.
In addition, certain medicines can be used to treat the individual headaches. These can include anti-seizure medicines and triptans.
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 may also recommend oxygen therapy, which can be effective for treating a cluster headache once it is underway. We usually recommend 6 liters per minute for 15 minutes.
Additional References:
- External Link to Headache Diary
Prevention
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To reduce the frequency and severity of cluster headaches, many people find that it helps to:
- Decrease alcohol use.
- Cut caffeine intake to no more than 2 cups of coffee, tea, or soda a day.
- Stop smoking - we have programs that can help you quit permanently.
Additional References:
- External Link to Quit Smoking, We Can Help
Lifestyle Changes and Management
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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.
Your Care with Me
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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.
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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.
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Coordinating Your Care
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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.
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Convenient Resources for You
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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.
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Related Health Tools:
Interactive Programs
- Online Health Coach Online Health Coach
- Managing Your Headaches Managing Your Headaches
- Quit Tobacco Medications Quit Tobacco Medications
Personal Logs and Diaries
- Headache Diary Headache Diary
Podcasts
- Quitting Smoking Quitting Smoking
- Relieve Stress Relieve Stress
- Stress Management Stress Management
- Tension Headaches Tension Headaches
Videos
- Understanding Depression Understanding Depression
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.