Neurologist Explains Headaches + Latest Options for Diagnosing, Prevention & Treatment

Content derived from DocTalk video (watch below) with Alexey Shikuev, MD – Neuroscience Institute

0:22 | Let’s start with our first question: What are the main types of headaches, and what are their differences?
Headaches can often be divided into two large categories:

1. Primary headache disorders | These are headaches we cannot connect to an underlying cause or medical condition.
2. Secondary headache disorders | These are headaches that are caused by some form of injury to the head, including things like trauma, infection, or a tumor.

In general, headaches can be a symptom of many medical conditions. It is not uncommon to see headaches occur with the flu, COVID, as a medication side effect, as well as with certain toxins.

1:16 | How often do people have headaches, and who suffers from them more?
The two most common primary headache disorders are tension headaches and migraine headaches. Tension headaches make up about 25% of headaches, whereas migraines make up about 12 to 14% worldwide; that’s about 40 million people in the U.S. alone. Additionally, women are two to three times more likely to suffer from migraines than men.

1:56 | What are the newer options for prevention and treatment, particularly for migraines?
Treatment for migraines has come a long way in the last five years. In the past, we borrowed medications from a lot of different fields to treat migraines, including anti-seizure medications, blood pressure medications, and some antidepressants. Today, we know to use medications that target a peptide known as CGRP. Peptides are amino acids, and amino acids make protein. When a medication targets this specific peptide, it interrupts the pathway of a migraine and effectively treats it.

Currently, these medications are available in several options:

• Injectable: There are three injectable options for this medication, all of which are given once a month. They’re known for having minimal side effects and are commonly well-tolerated.
  
• Intravenous (IV): There is one IV option for this type of medication; this is usually done in an infusion center every three months. This is used to prevent migraines, rather than treat them.
  
• Oral: There are also three new oral medications that target the same peptide, but they work a bit differently than the others. These can be used for migraine prevention, as well as to treat acute migraine attacks.
  

3:33 | What are rebound or medication overuse headaches? How can you prevent them?
Medication overuse headaches, previously called rebound headaches, are something we see in patients who have frequent headaches and are taking a lot of pain medication to help with their symptoms. Commonly, we will see this in patients that have headaches for more than 10 to 15 days per month. When this happens, we often see the headaches getting worse instead of better.

Common medications that can include medication overuse headaches include:

• Non-steroidal anti-inflammatories (NSAIDS)
  • Ibuprofen
  • Naproxen
  • Aspirin
    
• Combination drugs, like Excedrin
  
• Tylenol (aka: acetaminophen or paracetamol)
  
• Opioid medications used to treat patients with chronic pain
  

4:47 | If you’re having more frequent headaches, should you keep a diary?
Yes, we encourage our patients to maintain a headache diary that tracks the frequency of headaches, how long they last, any potential causes of the headache, and any medication reactions that may occur. With today’s technology, there are many phone apps one can find to track this.

5:14 | When should you see a provider about your headaches?
Any time you’re having symptoms, it’s always a good idea to start by seeing your primary care provider. They’re great at diagnosing basic headaches, as well as doing a basic workup and determining whether a patient needs to see a specialist.

Reasons patients may need to see a specialist include:

• Being unable to determine the cause of a headache
• A headache that has unusual or abnormal features
• If a headache is not improving with medication or treatment
• If a headache is actively worsening, rather than getting better with treatment

A headache can be a sign of a medical emergency, so it’s important to know when to seek immediate medical attention. If any of the following scenarios occur, call 9-1-1 or have one of your friends or family take you to the closest emergency room:

1. An excruciating headache that comes on very quickly. People often describe it as the worst headache of their life, and it commonly reaches its peak intensity in less than a minute. We refer to it as a Thunderclap Headache, and it can be a sign of a serious medical condition, like a brain bleed, ruptured aneurysm, blood clot, or an arterial dissection.
   
2. A headache with focal symptoms. A focal symptom is something that affects movement, like when a patient has a new weakness or numbness in one part of their body, or the entire half of their body. It can also include sudden and unexpected vision loss, slurred speech, difficulty with speech, or an inability to understand; all of which can be a sign of a stroke.
   
3. A headache with a fever. If a headache occurs with a fever, as well as with stiffness, muscle tightening, or uncontrolled spasms in the muscles of the neck, this can be a sign of a brain infection called meningitis.