headache improves or goes away with the medica-
tion but then returns when the medication wears
off or the person does not take the medication.
Eventually the medication can no longer relieve
the headache and often the headaches become
more frequent and more severe.
Treatment for rebound headache requires a
shift to other methods for relieving pain, such as
ACUPUNCTUREor BIOFEEDBACK. The doctor may also
prescribe medications to prevent headaches, such
as propanolol or isometheptene, and a triptan
medication to thwart a migraine at its early warn-
ing signs (such as an aura). It may take several
weeks to two months for the headaches to fully
recede. Stress management methods such as MEDI-
TATIONand YOGAhelp shift focus to controlling and
healing the pain rather than on the pain itself.
KEEP A HEADACHE JOURNAL
Doctors recommend people who have frequent
headaches keep a journal that describes their
symptoms in detail. This helps identify patterns
for how the headaches develop and what effects
various pain relief measures have to relieve the
pain.Symptoms and Diagnostic PathThe symptoms of headache provide important
clues about the cause and potential treatment
options. The doctor will want to know the follow-
ing:
- How does the pain feel? Common descriptions
of headache pain include sharp, dull, throb-
bing, stabbing, viselike. - How does the pain start? Some headaches start
as minor discomfort and increase to a level of
pain that interferes with activities. Some
headaches start suddenly with moderate to
severe pain. - Where is the pain? Headache pain may be pri-
marily on one side of the head or face, involve
the entire head and face, or involve only the
face or only the head. The pain may feel like it
encircles the head, is deep or along the surface
of the scalp, or comes from a specific location. - How long does each headache last and how
often do headaches occur?- To what extent does the headache interfere with
regular activities? - Are there any disturbances of vision (such as
flashing lights or double vision), awareness,
alertness, sensory perception, ability to speak,
ability to move? - Do there seem to be any particular triggers for
the headache, such as stressful situations, spe-
cific foods, certain locations or activities? - Are there other symptoms such as fever, sinus
congestion, stiff neck, nausea, vomiting? - What methods and medications have been tried
to relieve the headache? Are they unsuccessful,
sometimes successful, or partially successful?
- To what extent does the headache interfere with
The doctor will also ask questions about any
other health conditions and whether other family
members have chronic headache, migraine
headache, seasonal allergies, and AUTOIMMUNE DIS-
ORDERS. The doctor typically performs a general
medical examination including a basic NEUROLOGIC
EXAMINATIONand a basicOPHTHALMIC EXAMINATION.
Imaging procedures such as COMPUTED TOMOGRAPHY
(CT) SCANand MAGNETIC RESONANCE IMAGING(MRI)
may rule out rare causes for headache such as
stroke or tumor. However, the doctor often can
make the diagnosis based on the symptoms and
headache history.Treatment Options and Outlook
Most treatment approaches for chronic headache
combine medications and other methods to relieve
symptoms when the headache occurs and prevent
headaches from recurring. Relaxation techniques
such as meditation and yoga can help lessen the
effect of stress. Other methods in which the per-
son learns to recognize indications that a
headache is coming on are often effective in stop-
ping the headache from unfolding. Biofeedback
and HYPNOSISmay help a person halt a headache.
Numerous prescription medications are available
to prevent headaches.
Heat to the back of the neck and resting in a
dark, quiet room are measures that often soothe
headaches that do occur. Medication is the main-
stay of treatment for headache once it develops.
Aspirin, acetaminophen, and NONSTEROIDAL ANTI-
INFLAMMATORY DRUGS(NSAIDS) such as ibuprofen areheadache 375