Most people get headaches from time to time. Occasional mild to moderate headaches usually don’t require medical attention. Stress, muscle tension, getting overheated, hunger, thirst, and illnesses like colds, sinusitis, and flu are frequent causes of headaches. Serious illnesses like tumors and meningitis are very rare causes of headaches.
Migraines are a specific type of headache that is characterized by moderate to severe pain with a pulsating quality, that is aggravated by physical activity. They’re frequently associated with nausea or vomiting, and sensitivity to light, noise, or touch. Migraines can be on one or both sides of the head and often run in families.
Whether you have headaches frequently or not, it’s important to know what types of headaches need medical attention. Headaches that are severe, worsening, or unusual for you need to be checked out by a doctor to determine if there is a medical condition causing them.
Signs that you need to see a doctor:
- You usually have two or more headaches a week
- You take a pain reliever for your headaches more than twice a week
- You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches
- Your headache pattern changes or your headaches worsen
- Your headaches are disabling or prevent you from going to school or work
- Your headaches wake you up
Seek urgent medical care if your headache:
- Is sudden and severe
- Accompanies a fever, stiff neck, confusion, seizure, double vision, weakness, numbness, or difficulty speaking
- Follows a head injury
- Gets worse despite rest and pain medication
If you plan to see your doctor for headaches be sure to keep a symptom diary like this for about 2 weeks prior to your visit. Include possible headache triggers, time of day, days per month, headache intensity, and response to treatment if any. This will help your doctor determine what kind of treatment will work best for you.
There are several common headache triggers that can have a significant impact on your life. Trying to avoid your triggers can prevent the majority of headaches.
The most common triggers for headaches in kids and adolescents are
- stress and anxiety
- lack of sleep
- and prolonged use of video games/screen time
Other triggers include
- squinting or eye strain
- high altitude
- hormone changes due to menstrual cycle
- medications, including rebound headaches from using pain medications too often
- lack of exercise (sitting still too long, especially with poor posture)
- sinus congestion
- certain foods including processed meat, chocolate, caffeine, artificial sweeteners, preservatives, alcohol, flavor enhancers like MSG, aged cheeses, and other less common food triggers.
If you want to treat your headache naturally:
- Rest in a quiet, dark room with your head slightly elevated on a pillow
- Place a warm or cold compress on your forehead or neck (whichever feels best)
- Massage your temples or neck with your fingers
- Take a warm bath or shower
- Add ¼ tsp dried ginger to a few bites of food or sip ginger tea (this helps with nausea as well as headache)
- Try relaxing deep breathing
If needed, headaches can be treated with over-the-counter pain relievers like Ibuprofen or Naproxen as directed on the label. Treat a headache as early as possible. Once a headache has been present for a long time, pain relievers are less effective. Keep in mind that headaches that require more than the recommended dose of pain reliever need to be checked out by a doctor.
Headaches that occur more than twice a week need more than just pain relievers. They require a prevention plan. Luckily, not all prevention plans require prescriptions. The most important steps in preventing headaches are:
- Reducing your personal triggers
- Getting help for sleep problems
- reducing stress, and treating anxiety Consider cognitive behavior therapy (CBT)
- eating meals at consistent times each day
- drinking plenty of water
Taking these measures is often all the prevention that is necessary. Even if these measures don’t help you completely avoid headaches, they will make most headaches significantly better.
“Nutraceuticals” including vitamins, minerals, herbal supplements, and dietary supplements can help prevent headaches for some people and usually have fewer side effects than prescription drugs. Magnesium, riboflavin (vitamin B2), coenzyme Q10, butterbur, and vitamin D3 have been shown to help decrease the frequency and severity of headaches. In general, Vitamin D and Riboflavin are more likely to help if you aren’t getting enough from your diet, but they are relatively safe to take even if your levels are adequate.
For my patients with frequent headaches, I often recommend:
- 2000 IU Vitamin D daily. If levels are below 40ng/ml, it can be taken twice daily the first few weeks
- 250mg Magnesium once or twice daily. (If you get loose stools, decrease the amount you’re taking.)
- Riboflavin (Vitamin B2) supplement up to 200mg twice a day for patients who might not get enough Riboflavin from their diet (vegans and picky eaters). I’m cautious about using megadoses of vitamins. If your urine turns bright yellow after each dose of Riboflavin you may be able to reduce your dose.
- Coenzyme Q10 50 to 100mg twice daily can be helpful.
- While it can be effective, I rarely recommend PA-free Butterbur 75mg once or twice daily because of possible side effects. (Don’t take butterbur if you might be allergic to ragweed or you’re taking medications for seizures or TB. Even PA-free Butterbur can contain pyrrolizidine alkaloids, or PA, which can cause liver damage. It’s a good idea for a doctor to monitor your liver function if you choose to take butterbur, or have taken it in the past).
- For some, a combination product like Migravent, (Riboflavin, Magnesium, PA-free Butterbur, and Co Q10) is a good choice.
- Ask your doctor if these supplements could help you.
Keep in mind that supplements are preventative medicines and you need to take the supplements for 3 to 4 months before you see a significant reduction in the frequency and severity of your headaches.
Supplements are not regulated by the FDA or approved for specific medical issues. If you take a supplement, check with Consumerlab to make sure your brand has been tested safe.
If lifestyle changes and natural remedies aren’t enough to keep your headaches at bay, you may need to add prescription preventative medication, like amitriptyline or topiramate, as well as a prescription rescue medication, like triptans. Keep in mind that following through on the recommended lifestyle changes is often more effective than prescription medications in the long run. Don’t discount them just because they don’t require a prescription!
Opioid prescriptions are never the right answer for headaches. If you are prescribed opioids (narcotics) for your headaches or your headaches are debilitating in spite of developing an action plan with your doctor, request a referral to a neurologist or get a second opinion. You deserve the best treatment possible.
This information is for educational purposes. Discuss it with your doctor to see if it’s appropriate for you.