Frequent or recurrent headaches can come close to ruining your life.
The pain can interfere with your ability to work, keep social plans, get proper sleep, and has the ability to get in the way of you living your everyday "normal" life.
More than 45 million Americans regularly suffer from headaches.
The best way to relieve your pain is to pinpoint the source; but, that can be difficult if you're unsure of what's causing your headaches to reoccur.
What causes a person to suffer from debilitating headaches? What therapies are available to treat headaches? Can they be prevented?
Brian D. Loftus, MD, joins Melanie Cole, MS, to discuss how you can relieve your headache pain.
RadioMD Presents: Health Radio | Original Air Date: June 4, 2015
Host: Melanie Cole, MS
Guest: Brian D. Loftus, MD
It’s Health Radio. Here’s Melanie Cole.
MELANIE: Frequent or recurrent headaches can come close to ruining your life. If you’ve ever had a headache, they can hurt so much that all you want to do is lie down and close your eyes and even that doesn’t always take care of the situation. Sometimes they can be so pounding that you don’t even know what to do about it. More than 45 million Americans suffer from headaches regularly. My guest today is Dr. Brian Loftus. He’s a neurologist at Bellaire Neurology in Bellaire, Texas.
Welcome to the show, Dr. Loftus.
When you get a headache, we know that headaches can be a sign of impending stroke – and this is just me picking the worst possible outcomes – or God forbid, a brain something. So, when do we know that a headache is just a headache and seek treatment for it and when do we not freak out?
DR. LOFTUS: The time to get scared and head to the ER is a very rapid onset of a new type of headache that’s severe-- headache associated with fever and stiff neck; headache associated with weakness or numbness; and, of course, when you’re thinking about primary headaches – like tension headaches and migraines – they recur over and over again. But the first time you get your migraine, you may very well end up in an ER because you may have a very severe headache that you’ve never had anything like that before. So, getting checked out at an ER for the first time is always a good idea if your headache is really extreme. But usually people have a pattern and they know that they don’t have anything awful that is occurring.
MELANIE: Dr. Loftus, some people get headaches and some people don’t. They don’t get them when they’re sick. They don’t get them when they’re stressed. Some people just don’t get headaches. So is there a prevention? Is there a certain thing that you can pinpoint for the people that don’t typically get headaches and the people that do?
DR. LOFTUS: Presumably, it’s in the genes, so one more thing that you can blame your parents for. A tension headache which is the most common headache that we know much less about because it’s really disabling. Those are sort of the headaches that go away with Tylenol or Advil. The recurrent migraines are the ones that cause the disability for most people. There’s cluster headaches, also. But usually we’re talking about migraines, and there’s a whole host of migraine susceptibility genes that are being discovered. So far, they have not let to any specific treatment, but it’s pretty uncommon to have somebody with migraines with a decent sized family that doesn’t have a family history.
MELANIE: So, is there something you can do to prevent these headaches? Other than hangover headaches and just not overdrinking, what can you do to prevent some of these migraines or tension headaches? Is there anything?
DR. LOFTUS: For migraines in particular, the one thing you have under your control that’s a big trigger is sleep disturbance. Regular sleep habits is important for migraines. Not skipping meals is important for migraines. But, usually, if your headaches are frequent – twice a week or more, for sure, or even once a week--if your headaches have disability associated with them, you should get on a preventative regiment from your doctor, and they are usually pretty effective.
MELANIE: What is that kind of regimen?
DR. LOFTUS: In my practice, I sort of have 7 first-line drugs, and they all work about the same. So in order of my preference or use in practice is zonisamide, duloxetine, candesartan, propranolol, amitriptylene, topiramate, valproic acid. Needless to say, there’s lots of choices and the choice of medication is usually dictated upon patient’s weight because some of these cause weight gain and some cause weight loss; whether or not the patient wants to get pregnant or is pregnant, because that would limit the choices as well; if the patient has depression or anxiety. Some of these are antidepressants; if they have high blood pressure. Some of these are blood pressure agents. Usually, the choice is customized for the patient based upon their particular status in life. And then, for patients who are really miserable when they see me the first time, we also have a series of procedures that we can do to help get your migraines down. Most people have heard about Botox these days, but actually there’s a lot of cheaper options out that we do in the office at the first appointment like nerve blocks. There’s something called SPG blocks, or Sphenopalatine Ganglion blocks. It’s easier to just say SPG blocks. There’s multiple devices on the market for this now. The one I use is called an Allevio device, but there are others and those can be very effective in getting patients better before they even leave your office on the day that you see them.
MELANIE: So, do you right away go to a neurologist? What kind of doctor? Would you see your internist first, and then they will refer you to a neurologist? Or if you start to suffer these headaches, should you just make an appointment with a neurologist right off the bat?
DR. LOFTUS: Well, I think there are three levels of doctors that you should think about. There’s your primary care doctor, there’s the neurologist, and then there’s a headache specialist like me. What I would generally tell patients is to think about how often are your headaches, and if they’re once a week or less, then I’d start with your primary care. If they’re sort of in the one to three times a week, probably start with your general neurologist. If they’re more than half the days, you probably should start with a headache specialist. Then, I generally recommend the rule of three. So, if you go to a doctor three times for your headaches and they have not made you significantly better, then I recommend you consider going to the next level up of specialist.
MELANIE: That’s a great answer. Now, what about keeping a diary? Because with so many of our various ills, you forget. When you don’t have that headache, you forget what it was like to have one. You know, pain is sometimes like that. So, do you keep a diary of how intense the pain is, when you got it, and maybe what you were thinking of or what was going on in your life, what you ate or drank before you got that headache?
DR. LOFTUS: I think keeping a diary is very important, and I have developed something called “iHeadache.” There’s an app on the Apple system. There’s also iHeadache online on a computer for those who don’t have Apple products. The key things that I like my patients to track who have frequent headaches is how often they have it, the medications that they’re taking, and the disability that they’re having with their headaches. It’s hard to look for triggers when your headaches are frequent. When your headaches are infrequent, that’s when you can really try to find the trigger and the trigger that you’re thinking about is sleep disturbance, things you ate. So, when headaches are infrequent, I ask patients for five headaches in a row, write down everything about the 24 hours beforehand that they can think of and don’t do anything about it until they have sort of a series of them. Now, having said that I recommend all my patients to sleep well, not to skip meals, I usually have them stop all caffeine if they’re having more than one or two cups of coffee a day, just because that’s such a frequent trigger that’s out there. But as far as finding which food bothers you, if your headaches are even twice a week then there’s a random chance of 25% or so that that food had nothing to do with that headache that day. So, triggers is what we focus on when the counts are down. Getting the counts down is usually with procedures and with medication.
MELANIE: You’ve mentioned caffeine. Are there other foods that you’d like to warn people about? Sodium, can that contribute? Are there certain foods you want us to stay away from if there’s someone who suffers from these headaches?
DR. LOFTUS: The classic foods are the aged cheeses and wine, and there are certainly a lot of folks who are sensitive to that.
DR. LOFTUS: Yeah, unfortunately.
MELANIE: Is that the fermenting? So, maybe also sauerkraut, tempeh, miso, kimchi, any of those things too?
DR. LOFTUS: Probably. And then the vasoactive things, like MSG, is sort of a food additive. But to be perfectly honest, again, those are things that I focus on when your headaches are infrequent. And a lot of times people will find that, “Oh, it’s after I go out to this restaurant that we go to every other week or so that I always seem to have a headache the next day.” But, initially, when your headaches are just about every day or half the days, it’s really hard to figure those things out.
MELANIE: So, you have about 30 seconds. Wrap it up with your best advice for those suffering from whether it’s migraines or more infrequent tension and stress headaches.
DR. LOFTUS: I think the key is you don’t have to suffer as much as you used to. We have lots of great medications if your headaches are infrequent – those are called triptans. If your headaches are frequent, then you need to work hard on prevention and find a doctor to work with you.
MELANIE: Thank you so much. That is great information. You’re listening to Health Radio right here on RadioMD, and if you missed any of the great information that we’re giving, you can listen any time on demand. Go to my show page at Health Radio. Check them out. Share them with your friends. Scroll around and learn something with us.
This is Melanie Cole. Thanks so much for listening, and stay well.