My Doctor Online The Permanente Medical Group

Types

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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

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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 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

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• 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

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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.

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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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