When headaches need medical attention

Headaches are common, and in some cases cannot be avoided. However, there are ways to reduce their likelihood. Ironically, for frequent sufferers, your go-to treatment could be playing a role. And sometimes a headache is more than just that and needs medical attention.

Headaches are typically classified into three main categories: migraine, tension type, and cluster. The theories behind why these types of headaches occur are complicated and there is not a defined consensus. There are lifestyle choices that are thought to play a role, like extremes or irregularities in sleeping, eating, stress, and exercise. Where possible, these triggers should be avoided. 

Most mild, infrequent, headaches can be managed with self-treatment. However, there are some red flags that signal medical attention is required:

• Sudden onset (within seconds/minutes) of a severe headache
• Severity getting worse, as frequency increases
• Presence of fever, stiff neck, and/or altered consciousness 
• Weakness, body aches, and/or weight loss 

Medication over-use headaches occur when treatment is taken in a manner that exceeds typical dosing frequency. If you have a headache that rears its ugly head first thing every morning, the culprit may be medication over-use.  The same treatment that caused the headache may provide transient relief, but the headache returns. 

Each type of medication has a different threshold for triggering an over-use headache, but over-the-counter pain killers (acetaminophen, ibuprofen, naproxen, and aspirin) typically cause headaches if they are taken on 15 days or more per month. 

Other types of treatment that require a prescription or a discussion with the pharmacist, (narcotics, combination drugs, etc.) can provoke headaches when used for just 10 days or more per month. 

Indulging in caffeinated beverages (200mg or more of caffeine per day) may also increase the risk of over-use headaches. The best course of action is to discontinue the offending agent under the guidance of your health care provider and have the root cause of the original headache investigated.  

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Author Heather Cross a certified geriatric pharmacist, working as a licensed pharmacist since 2009. She is a regular contributor to Optimyz Magazine for our “Ask a pharmacist” column.