Headaches: Causes, Types, Treatment & When to See a Doctor

Headaches are one of the world’s most common health issues, affecting some 40 million Americans. But they’re often misunderstood or not taken seriously.

Headaches can be severe and relentless, affecting mood and preventing people from work, sleep, and daily activities. Migraine headaches can be particularly debilitating: research shows that they’re the third highest cause of disability worldwide.

Headache specialists, such as Columbia internist Chantel Strachan, MD, are part of initiatives to educate more primary care physicians on headache and migraine. Dr. Strachan, who completed a fellowship in headache and facial pain, shares the basics of headaches and migraines, how to treat them, and when to see a doctor.

What is a headache?

Headaches happen when something activates nerves in your body that send pain signals to the brain. Nerves can be activated by a variety of factors, including stress, sleep deprivation, hunger, alcohol, computer screens, and teeth grinding, to name a few.

A headache can be its own medical condition or a symptom of something else, such as:

• Dehydration
• Concussion or other traumatic brain injury
• Medication side effect
• High blood pressure
• Sinus congestion
• Tumor
• Migraine

How do I get rid of a headache?

The most common type of head pain is a tension headache, which can be caused by physical and emotional stress, anxiety, or head injury. Tension headaches are usually treatable with acetaminophen (Tylenol) or ibuprofen (Advil). Some people need stronger medication, such as Excedrin Migraine or other over-the-counter drugs with added caffeine, and sometimes prescription medication.

Pay attention to how often you take over-the-counter and prescription pain medications, because overusing them can lead to more frequent headaches. These are known as medication overuse headaches or rebound headaches.

Many people get relief from massage, acupuncture, and eating fresh, healthier foods.

If a headache doesn’t go away within three days with any of these methods, contact your doctor. It may be a sign that something more than a headache is going on.

What kind of doctor should I see if I have headaches?

If your headache doesn’t warrant a trip straight to the emergency room, go to a primary care physician first, ideally someone who specializes in headache. Primary care physicians are trained to look at the big picture and can determine if something else is going on, such as high blood pressure, anemia, or depression. They can also refer you to a specialist, such as a neurologist, if needed.

It can be easy to overlook headaches, but they can be serious. If you’re not getting the help you need, don’t give up. More and more doctors are receiving training to provide treatment and support.

Chantel Strachan, MD, is an assistant professor of medicine at Columbia University Vagelos College of Physicians and Surgeons and a headache specialist at Columbia Primary Care.