You ask. Our headache experts answer.
reader mail
ARE THERE“ EXTREME” TENSION HEADACHES? I have been told by my doctor that I do not have migraines, but tension headaches. They can sometimes last up to 5 days. Does anyone have extreme tension headaches? I end up in urgent care a few times a year. – Lisa R.
There seems to be uncertainty about what type of headache that you have. In general, any disabling headache is migraine until you prove it as something else. It would reasonably be presumed that a headache requiring urgent care clinic treatment would be considered severe. By definition, tension-type headaches are mild to moderate in pain. Tension-type headaches are also known for what they are not. They are not severe. They are not throbbing. They are not worsened by movement. Nausea is rarely present. There are many in the Headache Medicine community who believe tension-type headaches and migraine exist on a continuum( the Convergence hypothesis). Under this paradigm, tension-type headaches are considered mild migraines.
But whether we are calling a rose a“ rose” or something else or tomato a“ to-ma-to”, you are not having your headache managed well. The Spectrum clinical trial( which supports the Convergence hypothesis) demonstrated that tension-type headaches respond well to the migraine medication, sumatriptan. So it would not be unreasonable to use a triptan to treat your“ extreme” headache. It would also be important to be sure that you are treating at the mild pain stage( when medications are most likely to be effective). It might be best to find a physician who has an interest in treating headaches as they would likely be more aggressive in bringing your acute headache under control. You might need an injectable therapy like, ketorolac, sumatriptan, or dihydroergotamine. I have many patients who self-administer these medications as a rescue treatment for their severe headaches so they do not need to visit a clinic, urgent care, or emergency department. Also, keep track of your headaches; when are they occurring, what was happening around that time, how were you sleeping? This information can provide valuable clues that will allow for better control when they do occur.
But if, at the end of the day, it turns out that you are wired to have 2 to 3“ extreme” attacks a year, then develop a treatment plan that will allow for aggressive early treatment to resolve the attacks.
Duren Michael Ready, MD FAHS Baylor Scott & White, Central Division Temple, TX
Want to Connect? Join us on social media and send in your questions for our team of experts.
Search for: National Headache Foundation
https:// twitter. com / nhf
Search for: nhf1970
Find us on the web: www. headaches. org
www. headaches. org | National Headache Foundation 11