When a bad headache strikes, you just want it to end. The aching, throbbing pain can be debilitating and result in missed appointments, work, or time with family and friends.
Your headache symptoms can help your doctor determine its cause and the appropriate treatment. Most headaches aren’t the result of a serious illness, but some may result from a life-threatening condition requiring emergency care.
Headaches are generally classified by cause:
A primary headache is caused by overactivity of or problems with pain-sensitive structures in your head. A primary headache isn’t a symptom of an underlying disease.
Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck (or some combination of these factors) can play a role in primary headaches. Some people may also carry genes that make them more likely to develop such headaches.
The most common primary headaches are:
A few headache patterns also are generally considered types of primary headache, but are less common. These headaches have distinct features, such as an unusual duration or pain associated with a certain activity.
Although generally considered primary, each could be a symptom of an underlying disease. They include:
Some primary headaches can be triggered by lifestyle factors, including:
A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions — varying greatly in severity — may cause secondary headaches.
Possible causes of secondary headaches include:
Some types of secondary headaches include:
Regardless of whether you are prone to migraines, tension headaches, or cluster headaches (see “Is this your headache?”), you may be able to reduce their frequency by identifying what brings them on. Here’s a look at the most common triggers for each of these kinds of headaches.
1. Stress. Stress can cause tight muscles in the shoulders and neck, which often leads to tension headaches. “It’s believed to start in the muscles. When tension headaches become frequent, the pain in shoulder and neck muscles is felt by the brain as pain in the head,” says Dr. Sait Ashina, a neurologist who specializes in headache treatment at Harvard-affiliated Beth Israel Deaconess Medical Center. Stress is also a common trigger for migraines.
2. Diet. Hunger itself can trigger a migraine or tension headache. But eating certain foods may trigger migraines. It could be just one type of food — like beans or nuts — or many foods, such as avocados, bananas, cheese, chocolate, citrus, herring, dairy products, and onions. “Processed foods with nitrites, nitrates, yellow food dyes, or monosodium glutamate can be especially problematic,” Dr. Ashina notes.
3. Alcohol intake. Alcohol is a common cause of migraine and cluster headaches. For some people, a few ounces of red wine are all it takes to provoke a headache, although any kind of alcohol can be a trigger. It’s not clear if the alcohol itself is to blame or if another component in the drink causes the problem.
4. Environment. “Cluster headaches seem to be seasonal and often happen in the spring or fall,” Dr. Ashina says. “It’s something in the environment, but we can’t tell exactly what it is yet.” Environmental factors such as bright light, smoke, humidity, intense scents, or cold weather are associated with migraine headaches.
5. Hormones. Changes in estrogen levels are associated with migraines in women, and women suffer from migraines more often than men. Menstrual cycles may be tied to migraine in younger women. Varying estrogen levels during perimenopause can sometimes start migraines in women who never experienced them before. Estrogen therapy may also be a migraine trigger. Menopause does seem to end migraines in most women.
6. Caffeine withdrawal. If you normally consume caffeine in coffee or tea, stopping intake abruptly may trigger a migraine. This may be because caffeine causes blood vessels to constrict; without caffeine, the blood vessels widen and bulge out with each heartbeat — a chief reason for the pounding pain of migraines.
7. Lack of sleep. A lack of sleep is associated with migraines and tension headaches. “We don’t know why, but we do know there’s a correlation and that sleep can lead to pain relief. Sometimes people feel better after taking a nap,” Dr. Ashina says.
Your head hurts. Again. The first step in foiling your frequent headaches is determining what type of headache you have. Sometimes headaches are a symptom of another disease or condition; sometimes there’s no clear cause.
Take a close look at your headache signs and symptoms. Keeping a headache diary might help determine your headache type. Note when your headaches occur, your symptoms, and potential triggers, such as food, stress or changes in sleep.
There are many types and sub-types of headaches. Chronic daily headaches, which occur 15 days or more a month, are one sub-type. Tension-type headaches and migraines are also common sub-types of headaches. They can both be chronic, though they aren’t always. Other types of chronic daily headaches include:
Other headache types include:
Tension-type headaches, the most common variety of headaches:
Most occasional tension-type headaches are easily treated with over-the-counter medications, including:
Daily prescription medications, including tricyclic antidepressants, might manage chronic tension-type headaches. Alternative therapies aimed at stress reduction might help. They include:
Migraines are another common type of headache. They affect three times more women than men. Migraines typically:
Migraine treatment is aimed at relieving symptoms and preventing additional attacks. If you know what triggers your migraines, avoiding those triggers and learning how to manage them can help prevent migraines or lessen the pain. Treatment might include:
Seek emergency care if you have:
These symptoms suggest a more serious condition, so it’s important to get a prompt diagnosis and treatment.
Almost everyone gets headaches, and many are nothing to worry about. But if headaches are disrupting your activities, work or personal life, it’s time to see your doctor. Headaches can’t always be prevented, but your doctor can help you manage the symptoms.
Gabapentin is a drug that’s approved to help prevent seizures in people with epilepsy and treat nerve pain from shingles. It’s also sometimes used off-label for migraine prevention.
Gabapentin belongs to a class of drugs called anticonvulsants. A class of drugs is a group of medications that work in a similar way.
Anticonvulsants help calm nerve impulses. It’s believed that this action may help prevent migraine pain.
This drug comes as a capsule, tablet, or solution. You take it by mouth.
Gabapentin is available as the brand-name drugs Neurontin, Gralise, and Horizant. It’s also available as a generic drug.
Using a drug off-label means that a drug has been approved by the FDA for one purpose, and it’s being used for a different purpose that hasn’t been approved. A doctor can still prescribe it for this purpose because the FDA regulates the testing and approval of drugs, not how doctors use them to treat their patients. Your doctor can prescribe a drug off-label if they think it’s best for your care.
Gabapentin’s role in migraine prevention isn’t well known.
It’s believed that it may influence electrical activity in the brain through neurotransmitters and block calcium channels. It may also be a factor in reducing excitatory neurotransmitters like glutamate.
Still, more research needs to be done to determine why it works.
Generally, gabapentin isn’t used as a primary therapy for migraine prevention, but as an additional treatment to support other therapies.
The drugs used to prevent migraine attacks are different from drugs that treat an acute attack. Drugs that prevent migraine symptoms, such as gabapentin, must be taken on an ongoing basis to work properly.
The dosage for gabapentin for migraine ranges from 300 to 3,600 milligrams (mg) per day, depending on your age and other health factors.
Gabapentin for migraine prevention can be taken with or without food and comes in an extended release tablet, an immediate release tablet, or an oral solution.
Side effects of gabapentin include:
It’s important to follow your doctor’s recommendations on dosage and weaning off of the medication if needed. Never take more than is recommended by your doctor, even if you miss a dose.
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