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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
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