Written By Melissa Bean Sterzick
From the sinus headache that feels like nails in the nose to a stress headache
that binds up the neck and shoulders, the icy grip of brain freeze or
a migraine that is only bearable in a darkened room—headaches hit hard.
Common headaches include tension headaches, menstrual headaches and hangovers.
Sometimes people experience headaches from caffeine withdrawal or from
taking too many over-the-counter (OTC) medications. Others suffer from
cluster headaches, allergy headaches and hypertension headaches. For an
experience so common, diagnosis and relief can be difficult to find.
At Torrance Memorial, neurosurgeon Paula Eboli, MD, recently joined the
Cedars-Sinai team of the Lundquist Neurosciences Institute. Dr. Eboli
specializes in aneurysm clipping and endovascular coiling. She also specializes
in spine surgery for neck and back and all forms of brain tumors.
“Everybody gets headaches. You’re tired, you’re overworked,
you’re stressed, you ate something. You’re not going to get
out of headaches,” she says.
The key is knowing when to worry—or not worry—and how to proceed
either way. Dr. Eboli has a simple algorithm that can help anyone identify
which headaches are ordinary and which are cause for concern.
She says to first identify the severity of the headache. A headache that
falls lower on your pain scale can be treated with an OTC medication such
as acetaminophen or ibuprofen. If that works, no further action is needed.
“If there isn’t any nausea, vomiting or any other symptoms
like numbness or weakness, you can start with medication and see if that
works for you. If it’s a simple headache, it will usually respond
to over-the-counter medication,” Dr. Eboli says. “Most headaches
go away. If it doesn’t go away, you need to make an appointment
to see your doctor. That’s not an overreaction—that’s
a very normal thing to do.”
She says that migraines linger, so people who have been diagnosed with
migraines usually recognize their symptoms and know what to expect.
If the OTC medication doesn’t work or the headache recurs frequently
but is still at a moderate pain level, a call to the doctor’s office
and/or a doctor visit are the next steps. A primary care physician will
offer additional medications, tests and referrals to physical therapy,
or a headache specialist, depending on what the physician thinks is necessary.
“Headache specialists only do headaches. There are multiple lines
of treatment they can offer. Chronic headache is a common thing,”
Dr. Eboli says. “But when your headache doesn’t go away, you’re
going to get an MRI.”
While most headaches are not life threatening, they still require attention.
A thorough effort to reduce pain and testing to rule out more serious
issues are important. The headache sufferer might consider keeping a diary
with dates, times, possible triggers and durations of headaches.
Finally, a headache that should cause immediate concern is one with an
extreme level of pain, that strikes hard and fast and/or comes with intense symptoms.
“When it’s a really severe headache with sudden onset that
is the worst headache of your life, or if the headache has any nausea,
vomiting or vision changes, you should go to the emergency room,”
Dr. Eboli says.
If the headache includes neurological symptoms such as vision disturbance,
numbness, loss of consciousness, weakness or seizure, or follows a head
injury, go straight to the emergency room.
In addition, headache during pregnancy and headache with fever should also
be treated at the ER.
“You shouldn’t be having headaches for days nonstop. Any person
suffering a headache with neurological symptoms should go straight to
the emergency room. “If you’re not feeling well and you’re
sleepy or not acting normal, you should go to the ER,” says Dr. Eboli.
She continues, “Headaches related to a severe condition are less
common. Then you have the patients with chronic headaches, and then you
have the patients who every so often have a headache. If it affects your
daily living, you should address it with your doctor first. If it’s
a one-time thing that lasts an hour or so, that’s good.”
Whatever the cause, the discomfort of a headache can make addressing it
more challenging for the person suffering. Dangerous headaches are rare,
so for most headaches an OTC medication is often the right remedy. Beyond
that, as Dr. Eboli says, severity and duration are two important factors
for diagnosis and treatment. Everybody gets headaches, so knowing when
to worry and when not to worry is a comfort when they strike. •
Headaches that can be treated at home:
- Mild headaches that respond to OTC medications and do not include neurological
symptoms or fever.
Headaches that require medical attention:
- Headaches that don’t go away with OTC medication; recurring headaches.
Headaches that require emergency medical attention:
- Extreme headaches that come on very suddenly
- Recurring headaches in children
- Headaches after a significant blow to the head
- Headaches that come with confusion or disturbed vision, balance or speech
- Headaches associated with numbness or weakness
- Headaches with fever, seizures or unconsciousness
- Headaches accompanied by a stiff neck or rash
- Headaches with persistent vomiting
This is a list of physician recommendations and is not all inclusive. Please
consult your medical provider for any symptoms that are of concern.
Paula Eboli, MD, is part of the Cedars-Sinai team of the Lundquist Neurosciences
Institute. She practices at 23560 Crenshaw Blvd., Suite 101, in Torrance
and can be reached at 310-517-7022.