When headaches won't go away

What to do when you have a headache that won't go away – and how to tell if it's a migraine.

When one of her bad migraines hits, Jacqueline G. (last name withheld) can't do anything but lie down in a dark room and wait for the waves of pain to recede. "It's completely debilitating," says the 73-yearold, who has been plagued by severe migraines since her 20s. "The nausea comes on right away, and then I can't keep anything down—even crackers or ice. And it can last from early morning to 12 at night."

Migraines are a particularly disabling form of headache because they launch a four-tiered attack:

• The first strike is the prodrome (or preheadache), a sick or moody feeling that may set in a day or two before the actual headache starts.
• Next, for about 20% of migraine sufferers, comes the aura—flashing lights, bright spots, or other visual phenomena that distort or even interrupt sight for a few minutes to an hour.
• Then the migraine hits, a crescendo of headache that can involve throbbing pain and nausea, as well as increased sensitivity to sound and light.
• And finally, the postdrome may occur—a "headache hangover" that leaves you feeling tired and drained from the whole ordeal. This feeling can last for a day or more.

Women are three times more likely to get migraine headaches than men, in part because the hormone estrogen "primes the pump." After menopause, migraine headaches in women usually become less frequent. Yet some women—like Jacqueline—continue to have migraines even after they've seen the last of their menstrual cycle.

People who get migraines often have "triggers" that instigate their headaches. Common migraine triggers include:

• strong odors
• stress
• lack of sleep
• loud noises or bright lights
• changes in weather
• low blood sugar from skipping meals
• foods such as red wine, chocolate, aged cheeses, dried fruits, nuts, beans, cured meats, soups and bouillons made with the preservative monosodium glutamate (MSG), yeasty beers and breads, and diet drinks containing artificial sweeteners such as aspartame.

How to get rid of migraine headaches

The first step to help reduce migraine attacks is to try to remove the triggers. Keeping a headache diary can help pinpoint your migraine triggers. For one month, write down

• what time each headache started and ended
• the intensity and location of the pain (for example, behind your eyes or in the back of your head)
• what warning signs heralded the headache
• what you ate that day
• what you were doing before the headache hit (for example, exercising)
• what treatment you used, and whether it helped.

Then, go over your diary with your primary care doctor, neurologist, or headache specialist to see where you can eliminate or modify triggers. If trigger avoidance isn't enough, your doctor might recommend migraine medications, which follow two therapeutic approaches:

Acute treatments (also known as abortive therapies) relieve pain and nausea, but you need to take them at the first twinge of a headache. Examples include:

Triptans—migraine-specific medicines that narrow blood vessels in the brain, such as frovatriptan (Frova), naratriptan (Amerge), zolmitriptan (Zomig), rizatriptan (Maxalt), and sumatriptan (Imitrex).

Pain relievers—NSAIDs, including aspirin and ibuprofen (Motrin, Advil), can help with less severe migraines. Acetaminophen (Tylenol, others) also helps some people with migraines. Some of these products are formulated specifically for migraines, combining one or more pain relievers with caffeine (such as Excedrin Migraine).

One note of caution: The overuse or misuse of some migraine medicines can trip off additional headaches—called rebound headaches—especially if you use these drugs more than three times a week. Talk to your doctor if you notice that you're getting more headaches than usual while on these medications.

Preventive treatments can reduce the frequency and severity of headaches. They are generally recommended for people who have frequent migraine attacks (more than two or three a week), or whose migraines haven't responded well to other treatments.

Other types of headaches

Migraines aren't the only type of headache that can cause misery. Others include:

Tension headaches—These common headaches feel like a pressure or tightness on both sides of the head. They can last from 30 minutes to several days. Tension headaches can occur from time to time, or on a daily basis. How to treat them: Address the health problem that's causing tension headaches, such as stress, sleep apnea, depression, or jaw clenching.

Cluster headaches—These sharp, severe headaches typically arrive in "clusters" at the same time of day or night. Cluster headaches are usually focused on one side of the head, often behind the eye. They can last anywhere from 5 minutes to a couple of hours. You may also have a runny nose, tearing in one eye, and a feeling of agitation. 

Sinus headaches—This type of headache occurs when the lining of the sinus passages becomes swollen and inflamed. The throbbing pain is often accompanied by pressure around the eyes, cheeks, and forehead; a stuffy nose; cough; and yellow-green mucus.

If you get regular headaches, you'll probably start to see a pattern to the symptoms. If you develop any unusual or particularly severe symptoms, call for medical help right away. Even if headaches have become part of your routine, talk to your doctor. Your doctor can get you started on a treatment to relieve your aching head and finally stop headaches from interfering with your life.